Bioidentical Hormone Replacement Therapy for Perimenopause, Menopause, and Andropause

By George Bitar, MD, FACS

Let us at Bitar 360 Wellness Make You Feel Like Yourself Again — Naturally

As women approach their 40s and 50s, many of us begin to notice subtle (and not-so-subtle) shifts in our energy, mood, and overall well-being. Maybe sleep isn’t as restful, moods feel unpredictable, or you’re experiencing hot flashes at the most inconvenient times. Sound familiar?

You’re not alone. These are all signs your hormones are changing — and that’s completely normal in both Men and Women.

But here’s the good news: You don’t have to “just deal with it.”

Bioidentical Hormone Replacement Therapy (BHRT) is a natural, personalized way to restore balance and help you feel like you again.

At the Bitar Institute, Dr. George Bitar and Trish Mason, RN, RNFA, bring decades of experience in women’s and men’s health and a warm, personalized approach to hormone care.

What Is Perimenopause?

Perimenopause is the body’s transition phase leading up to menopause — and it can start as early as your forties. Perimenopause can be a scary time for all of us. Hormones like testosterone, estrogen and progesterone begin to fluctuate, causing a variety of symptoms.

You might notice:

• Hot flashes or night sweats
• Mood swings or irritability
• Irregular cycles
• Trouble sleeping
• Vaginal dryness
• Lower libido or mental fog

This phase can last several years, and symptoms can range from mild to frustrating. Many women describe feeling “off” but can’t quite explain why.

What Happens During Menopause?

Menopause officially begins once we have gone twelve months without a period, usually around age fifty-one. While your cycle stops, your symptoms may not — and new concerns can arise, like:

• Bone loss (osteopenia and osteoporosis)
• Weight changes
• Heart health risks
• Brain fog or memory lapses

It’s a lot. But there’s a natural way to support your body through these changes.

What Is BHRT?

BHRT stands for Bioidentical Hormone Replacement Therapy — a hormone treatment that uses plant-derived hormones that are biologically identical to what your body makes naturally.

That means your body recognizes them more easily, making BHRT a gentle, effective option for hormone balance.

How BHRT Can Help You

Many women experience relief from:

• Hot flashes and night sweats
• Fatigue and brain fog
• Mood swings and irritability
• Low libido
• Poor sleep

And beyond symptom relief, BHRT may also support:

• Bone density
• Heart health
• Better sleep and energy
• Overall quality of life

Andropause: What Men Need to Know

Feeling off? It might not just be stress or age — it could be your hormones

As men get older, testosterone levels naturally decline. But for many, that drop isn’t so gradual — and it can come with symptoms that affect everything from your energy and mood to your performance and confidence.

This stage of life is often called andropause, and while it doesn’t get talked about as much as menopause, it’s just as real — and just as treatable.

When Does Andropause Start for Men?

• Most men start to notice changes in their forties and fifties.
• Testosterone can begin declining as early as age thirty.
• On average, levels drop by 1% per year starting at age twenty-five.

The symptoms often sneak up slowly, which is why many men chalk them up to aging, stress, or lifestyle changes. You will notice when all you really want to do is sit around with a remote control and watch TV and tune your family and friends out.

Common Symptoms of Andropause

Physical	Decreased muscle mass Weight gain (especially around the belly) Low energy or stamina Joint aches and slower recovery
Sexual	Low libido Erectile changes Reduced performance or satisfaction Infertility
Mental and Emotional	Irritability or mood swings Trouble concentrating or remembering things Lack of motivation Mild depression or anxiety
Sleep	Difficulty falling or staying asleep Waking up tired

What Can You Do About It?

The first step is knowing it’s not just “in your head.” These are real hormonal changes — and they can be measured and treated.

BHRT at the Bitar Institute

All Men and Women are different — and your hormone plans should be, too.

Here’s how we personalize your journey:

• Comprehensive lab work and symptom review.
• A hormone plan tailored specifically to your body’s needs.
• Ongoing support, adjustments, and follow-up care.

You’ll work directly with Trish Mason and in collaboration with Dr. George Bitar, ensuring you receive the highest level of care, compassion, and expertise.

After two months on BHRT pellets, I finally felt like myself again. I had energy, I was sleeping better, and the brain fog was gone. Trish truly changed my life.
— B. Novella

Is BHRT Right for You?

Like all therapies, BHRT isn’t a one-size-fits-all. We’ll help you understand:

Benefits

• Better mood, sleep, libido, and energy
• Prevention of bone and heart health issues

Considerations

• Some mild side effects for women (a few extra hairs on the chin, and possible break out of pimples (during the first two doses [which can be managed and reversed])
• Some mild side effects for men (testicular atrophy, lower sperm count, and increase in red blood cells [All of which can be mitigated and or reversed]).
• Not suitable for men or women with current medical conditions like hormone-sensitive cancers
• That’s why a thorough consultation is so important — we’re here to make sure it’s safe and right for you.

You Deserve to Feel Good Again

Perimenopause, menopause and andropause are part of life — but suffering through them doesn’t have to be. With BHRT, you can move through this stage with clarity, strength, and the support of the Bitar 360 Wellness team who truly cares.

Schedule your consultation with Trish Mason today and take the first step toward feeling like yourself again.

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Helpful Resources

Improved Menopausal Symptoms, Mood, and Libido

Reference:

• Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Best Pract Res Clin Endocrinol Metab. 2014;28(6):835-845.
  • Summary: Estrogen therapy, including transdermal and pellet forms, significantly reduces vasomotor symptoms, improves mood, and reduces menopausal discomforts.
  • PubMed link

Cardiovascular Health Benefits

Reference:

• Miller VM, et al. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Menopause. 2019;26(9):1071–1084.
  • Summary: Early initiation of estrogen therapy may provide cardiovascular benefits. Though KEEPS used oral and transdermal forms, similar estrogen levels are seen in pellet users.
  • PubMed link

Bone Density & Osteoporosis Prevention

Reference:

• Santen RJ, et al. Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab. 2010;95(7 Suppl 1):s1-s66.
• Summary: Long-term estrogen replacement, including in pellet form, can preserve or increase bone mineral density.
• PubMed link

Sexual Function and Testosterone Replacement

Reference:

• Glaser R, Dimitrakakis C, Trimble N, Martin V. Testosterone pellet implants and menopausal symptoms in women: clinical observations. Maturitas. 2009;62(4):391–397.
  • Summary: In menopausal women, testosterone pellets improve libido, energy, and mood with minimal adverse effects.
  • PubMed link

Cognitive Function & Well-being

Reference:

• Sherwin BB. Estrogen and cognitive functioning in women. Endocr Rev. 2003;24(2):133-151.
  • Summary: Estrogen therapy has been linked to improved verbal memory and cognitive performance, potentially delaying cognitive decline.
  • PubMed link

Possible Side Effects and Risks

Hormonal Imbalance / Over-supplementation

Reference:

• Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009;121(1):73-85.
  • Summary: While bio-identical hormones can be safer, improper dosing (including with pellets) may cause supraphysiologic levels leading to acne, hair loss, irritability, or mood swings.
  • PubMed link

Insertion Site Reactions or Infections

Reference:

• Fagundes FN, Costa CS, et al. Complications in hormone pellet insertion: a retrospective review. J Womens Health. 2018;27(11):1342–1347.
  • Summary: Common side effects include mild bruising, infection, or pellet extrusion at the insertion site.
  • PubMed link

Increased Hematocrit or Estrogen-Dominant Symptoms

Reference:

• Glueck CJ, et al. Testosterone therapy, thrombophilia, and venous thromboembolism. Clin Appl Thromb Hemost. 2014;20(1):22–30.
  • Summary: In men and women on pellet therapy, particularly testosterone, monitoring is necessary due to the risk of elevated hematocrit or potential clotting risk in predisposed individuals.
  • PubMed link

Lack of Individualization or Titration Difficulty

Reference:

• North American Menopause Society (NAMS). 2022 Position Statement: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
  • Summary: Pellets may deliver consistent dosing over months, but dose adjustment is not possible once implanted, which can be problematic for some patients.
  • PubMed link

Conclusion

Bio-identical hormone pellet therapy is supported by peer-reviewed research for:

• Alleviating menopausal and andropause symptoms
• Improving libido, cognition, energy, and bone health
• Offering steady, consistent hormone delivery

However, side effects such as site reactions, hormone imbalance, and challenges with dosage adjustments require proper screening, lab monitoring, and patient education