Conditions · Perimenopause & Menopause
Hot flashes, broken sleep, weight that won’t move, mood swings, brain fog, low libido — and a system that shrugs and calls it “normal.” In Fredericksburg, VA, we test thoroughly and optimize with bioidentical hormones. Start with an initial appointment.
True You evaluates and treats perimenopause and menopause at 904 Princess Anne St, Suite 207 in downtown Fredericksburg. Brian C. Hoff, MD begins with a 60-minute appointment and lab work. Women’s hormone therapy, including bioidentical estradiol and progesterone, is one option among several and is offered when your history and results support it.
We are cash-based and do not bill insurance. Costs are explained at your consultation.
Perimenopause can begin years before your last period, as shifting estrogen and progesterone quietly drive sleep, mood, metabolism, and libido changes. Too many women are told it’s just age and sent on their way.
At True You, Dr. Hoff takes a root-cause approach: comprehensive hormone testing and a personalized, physician-guided plan — often bioidentical hormone therapy — to help you feel steady, clear, and like yourself again.
Why “it’s just age” isn’t an answer
The difference is what gets tested — and whether your symptoms are taken seriously.
The conventional menopause visit
The True You approach
Hormones that read “normal for your age” can still leave you feeling awful — an age-based range isn’t the same as optimal.
Temperature swings that wreck your sleep and your day.
Waking at 3am, unrefreshed even after a full night.
Irritability, low mood, and cloudy thinking that isn’t you.
Midsection weight that resists effort, and lost desire.
Perimenopause is the transition leading up to menopause. It often begins in your 40s, sometimes earlier, and can last several years. Estrogen and progesterone don’t simply decline — they fluctuate, sometimes sharply, which is why symptoms can come and go and periods can become irregular, heavier, or lighter.
Menopause is the point when you’ve gone 12 months without a period. After that, hormone levels stay lower, and some symptoms — hot flashes, sleep disruption, vaginal dryness, changes in body composition — may continue. Both stages are normal. Feeling miserable through them isn’t something you have to accept.
The transition affects more than temperature — and many women don’t connect these to hormones.
Periods that are irregular, heavier, lighter, or closer together.
New anxiety, forgetfulness, and trouble finding words.
Joint aches and slower recovery from exercise.
Vaginal dryness, discomfort, and lower desire.
Drier skin and thinning or shedding hair.
Weight moving to the midsection and changes in blood sugar.
For many women, broken sleep is the symptom that makes everything else harder. Night sweats wake you, falling progesterone can make sleep lighter, and blood-sugar swings and stress add 3am wake-ups. Poor sleep then worsens mood, cravings, focus, and patience.
We treat sleep as a priority, not an afterthought — looking at hormones, blood sugar, stress, and habits together. The same goes for mood. New anxiety or low mood in your 40s deserves a real work-up, not an automatic prescription, and when hormones are a driver, treating them can make a meaningful difference.
Treatment starts with understanding your hormones, symptoms, and health history. For many women, bioidentical hormone therapy — estrogen, progesterone, and sometimes testosterone, dosed to your labs — can ease hot flashes and night sweats, improve sleep, steady mood, and support libido. Dr. Hoff explains the benefits and risks for you specifically and monitors closely once you start.
Hormones are only part of the plan. We also check the thyroid, address sleep and stress, and give nutrition and strength guidance to protect metabolism, muscle, and bone. If hormone therapy isn’t right for you — or you’d rather not use it — we’ll work on the other drivers and talk through non-hormonal approaches.
How it works
A clear plan, built around you.
Step 1
An in-person visit at our Fredericksburg office to talk through symptoms, cycles, sleep, mood, and goals.
Step 2
Estradiol, progesterone, testosterone, thyroid, and metabolic markers.
Step 3
Dr. Hoff reviews your results and recommends options, including whether BHRT is a good fit.
Step 4
Check-ins and repeat labs to fine-tune — many of them virtual.
For many women, hormone therapy is the most effective treatment for hot flashes and night sweats, and it also helps vaginal dryness. Medical societies generally describe the best balance of benefit and risk for women who start within about ten years of menopause and are under sixty. The picture is less favorable for women who start much later or who have certain medical histories.
Estrogen products carry FDA warnings about endometrial cancer when taken without a progestogen in women who have a uterus, and about cardiovascular disease, breast cancer and dementia. Those risks differ from person to person and depend on the type of hormone, the dose and the route. Dr. Hoff reviews your own history with you before anything is prescribed.
Testing usually includes estradiol, progesterone, total and free testosterone, SHBG, a thyroid panel, and metabolic markers such as A1c and fasting insulin. In perimenopause, hormone levels can swing from week to week, so a single result is read alongside your symptoms and your cycle, not on its own.
Treatment may involve estradiol, progesterone, and in some cases testosterone. Hormones can be given by patch, cream or gel, capsule, injection or pellet, and the right form depends on you. Dr. Hoff explains the choices and tells you whether each product is FDA-approved or compounded.
Safety first
Not every woman wants hormones, and not every woman should take them. Sleep, strength training, nutrition, alcohol, stress and thyroid disease all affect how you feel through the transition. Dr. Hoff reviews these with you and will discuss non-hormone treatments when they are a better fit. Weight change in this stage is common and is addressed through our medical weight loss program when appropriate.
How it works
Thorough first, then adjusted over time.
Step 1
Symptoms, cycle history, medical and family history, medications, and what you want to feel better.
Step 2
Hormone, thyroid and metabolic testing.
Step 3
Dr. Hoff explains what the results mean and lays out your options with risks and benefits.
Step 4
If you choose treatment, we start conservatively and agree on what to watch.
Step 5
After the first several weeks, to see what has changed and whether any adjustment is needed.
Step 6
Regular reviews, many of them virtual, with labs as your plan needs them.
It depends on your plan. A woman who needs a thyroid correction and a sleep plan has a different set of costs from one starting hormone therapy. We are cash-based and do not bill insurance, and we explain what your plan will cost at the consultation, before you start.
Look for a clinician who takes a full history, orders appropriate labs, explains the risks that apply to you, and has a plan for follow-up. Ask what forms of hormone they use and whether they are FDA-approved or compounded. Ask how often you will be seen, and who you will see. True You answers each of these directly at your consultation.
Menopause care is a series of visits, not a single appointment. Women come to us from across the region.
Our office is at 904 Princess Anne St, Suite 207, in downtown Fredericksburg, open Monday through Friday, 9:00 am to 5:00 pm. We serve patients in Fredericksburg, Falmouth and Stafford, Spotsylvania Courthouse and the rest of Spotsylvania County, Locust Grove, Lake of the Woods and Orange, and King George. The first visit and lab work are in person; many follow-ups can be done by video. Book an appointment or call (540) 701-0407.
Explore related care
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A slow thyroid mimics and worsens menopause symptoms — we look deeper.
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The connected picture behind energy, sleep, mood, weight, and libido.
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Physician-guided, metabolic weight loss for the midsection weight that won’t move.
Learn moreBook an appointment with Dr. Hoff’s team in Fredericksburg, VA.
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Rated 4.7 from 46 Google reviews
“The people at True You helped save my life . They have been so supportive from the very first call. Dr. Hoff found the underlying issue that was affecting my health. I had bounced from one primary care office to another and from specialist to specialist, wasting money on copays along the way! I walked into their office with genuine concern about where my health was headed and what the rest of my life would look like. I now feel better than I have in over 20 years! I take any health concern to Dr. Hoff first. My biggest concern used to be whether I would be able to live well enough to remain an active part of my family. Now, my only concern is whether they can keep up with me! Thank you, Dr. Hoff and Tina Hoff! Not only will I get to enjoy watching my grandkids grow up, but I'll also be able to get around and chase them down, too! God bless you both!”
“Dr Hoff goes above and beyond to listen to you and respond with a program that can truly change your life. He’s very down to earth, easy to talk to, a wealth of knowledge, and genuinely cares about improving your life experience. I wish I would’ve found him and his staff sooner. I would give six stars if it were possible, thank you!”
“Dr. Hoff has truly changed my life in less than six months. I went from waking up every morning feeling miserable and constantly bloated to now feeling healthy, energized, and excited to take on each new day and experience life again. More importantly, I genuinely believe he is helping save my life in the long run by focusing not only on treating symptoms, but on improving my overall health and quality of life. Dr. Hoff is exceptionally knowledgeable and highly skilled in his field, but what truly sets him apart is the genuine care and compassion he shows his patients — something that has become far too rare in healthcare today. I’m also incredibly grateful for the entire staff and everyone there for creating an environment where patients feel heard, supported, cared for, and truly valued.”
Reviews shown as published on our Google Business Profile.
