Services · Sexual Health
Low desire, changes in arousal or function, discomfort that wasn’t there before — these are health concerns, not something to quietly put up with. We evaluate them privately and thoroughly, for men and women. Start with an initial appointment.
Sexual health is connected to almost everything else: hormones, sleep, stress, metabolism, circulation, mood, and the medications you take. When desire or function changes, it is often a signal that something in that larger system has shifted — and it deserves the same careful attention as any other symptom.
Many people wait years to mention it, or are told it’s just stress or age. At True You, Dr. Hoff takes a root-cause approach: a private, unhurried conversation, comprehensive lab testing, and a personalized, physician-guided plan that is monitored over time.
Visits take place at our downtown Fredericksburg office at 904 Princess Anne St, Suite 207, and many follow-ups can be handled virtually.
Less interest in intimacy than you’re used to, for men and women.
Shifts in testosterone, estrogen, or progesterone that affect desire and comfort.
Fatigue that leaves little room for connection.
Anxiety, low mood, or stress that dampens desire.
Short or broken sleep that lowers drive and mood.
Dryness or discomfort that can come with lower estrogen.
Hormones play a central role in desire and sexual comfort. In both men and women, testosterone contributes to libido and energy. In women, estrogen and progesterone shape comfort, mood, and sleep. Thyroid hormones affect energy and mood, and stress hormones can push all of these off balance.
Because the symptoms overlap, a single number rarely explains what is going on. We test the hormones that matter for your situation, look at them alongside thyroid and metabolic markers, and interpret the results against how you actually feel. When hormone therapy is appropriate, it is physician-supervised and monitored with follow-up labs. Learn more about bioidentical hormone replacement therapy.
For many women, the first changes in libido arrive during perimenopause, often years before the final period. Falling estrogen can lead to vaginal dryness and discomfort, while shifting progesterone and testosterone can affect desire, sleep, and mood. Hot flashes, night sweats, and fatigue make intimacy harder still.
These changes are common, but they are not something you simply have to accept. A careful evaluation can show which hormones have shifted and whether treatment makes sense for you. See our perimenopause and menopause page for how we approach the transition as a whole.
In men, lower desire is often connected to declining or poorly balanced testosterone, along with sleep, stress, weight, and blood sugar. Erectile changes deserve a proper evaluation, because they can be related to circulation, metabolic health, hormones, or medications — and can sometimes be an early sign of a broader health issue.
We look at the whole picture rather than a single symptom. Read more about low testosterone and our broader approach to men’s health.
Yes. Desire, arousal, and comfort can all change over time, for men and women. Hormone levels shift with age, and conditions that become more common later in life — such as diabetes, heart disease, and joint pain — can affect sexual health, as can many of the medications used to treat them. Emotional factors like stress, anxiety, and low mood matter at every age.
Change with age is common, but it isn’t a reason to stop asking questions. Understanding what has shifted is the first step toward deciding what, if anything, to do about it.
Not every sexual health concern starts with hormones. Long-term stress raises cortisol, which can dampen desire and disrupt sleep. Short or broken sleep lowers energy and mood and, in men, can affect testosterone. Anxiety and low mood can reduce interest in intimacy on their own, and some medications used for mood, blood pressure, or sleep can affect sexual function as a side effect.
That is why we ask about your whole life, not just the symptom. Often several smaller factors add up, and addressing them together works better than chasing any one in isolation. If you take a medication you think may be involved, bring it up at your appointment rather than stopping it on your own.
Why it deserves a real work-up
The difference is whether anyone looks for the reason behind the change.
The quick answer
The True You approach
A hormone level can read “normal for your age” and still not match how you feel — which is why results are interpreted with you.
Every plan starts from your results and your goals. Depending on what testing shows, it may include bioidentical hormone therapy when it is clinically appropriate, attention to thyroid and metabolic health, and practical changes to sleep, stress, nutrition, and activity. Dr. Hoff explains the options, what each involves, and what to expect, so you can decide together.
Follow-up is part of the plan. We re-test, review how you feel, and adjust over time.
How it works
Private, clinical, and unhurried — from the first conversation to follow-up.
Step 1
In person at our Fredericksburg office: your history, symptoms, medications, and goals.
Step 2
Hormone, thyroid, and metabolic lab work chosen for your situation.
Step 3
Dr. Hoff explains every finding and builds a personalized plan with you.
Step 4
Re-testing and adjustments over time, with many visits handled virtually.
When to talk to a physician
Explore related care
Bioidentical hormone therapy for men and women, dosed to your labs.
Learn more
Care for the hormone shifts behind sleep, mood, and libido changes.
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A common, testable driver of low drive and energy.
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The whole picture: hormones, weight, sleep, and energy.
Learn moreBook a private appointment with Dr. Hoff’s team in Fredericksburg, VA, or call (540) 701-0407.
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Read articlePatient reviews
Rated 4.7 from 45 Google reviews
“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.”
“Outstanding experience from start to finish. Dr. Hoff is extremely professional and well-organized, with a friendly and welcoming staff. Dr. Hoff is knowledgeable, thorough, and truly took the time to listen and explain everything clearly. I felt genuinely cared for and confident in the treatment plan. Highly recommend!”
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