Services · Sexual Health

Sexual health care in Fredericksburg, VA

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.

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Sexual health is part of your overall health

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.

Common sexual health concerns

Low libido

Less interest in intimacy than you’re used to, for men and women.

Hormone-related changes

Shifts in testosterone, estrogen, or progesterone that affect desire and comfort.

Low energy

Fatigue that leaves little room for connection.

Stress & mood

Anxiety, low mood, or stress that dampens desire.

Poor sleep

Short or broken sleep that lowers drive and mood.

Menopause changes

Dryness or discomfort that can come with lower estrogen.

Hormones and libido

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.

Sexual health in women: perimenopause, menopause, and beyond

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.

Sexual health in men: testosterone and beyond

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.

Can sexual health change with age?

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.

Stress, sleep, and mood

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

A quick answer vs. a proper evaluation

The difference is whether anyone looks for the reason behind the change.

The quick answer

“It’s probably just stress”
Hormones rarely checked
One symptom, one prescription
A rushed, awkward visit
No follow-up

The True You approach

Your symptoms are taken seriously and fully worked up
Hormone, thyroid, and metabolic testing for your situation
Sleep, stress, medications, and health history in context
An unhurried, private conversation with a physician
A plan that is monitored and adjusted over time

Book an appointment

A hormone level can read “normal for your age” and still not match how you feel — which is why results are interpreted with you.

What a sexual health plan can include

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

How we evaluate sexual health concerns

Private, clinical, and unhurried — from the first conversation to follow-up.

01

Step 1

A private conversation

In person at our Fredericksburg office: your history, symptoms, medications, and goals.
02

Step 2

Comprehensive testing

Hormone, thyroid, and metabolic lab work chosen for your situation.
03

Step 3

Results & plan

Dr. Hoff explains every finding and builds a personalized plan with you.
04

Step 4

Monitored follow-up

Re-testing and adjustments over time, with many visits handled virtually.

When to talk to a physician

It’s worth an evaluation if

Your desire has changed noticeably and it bothers you
Intimacy has become uncomfortable or painful
You’ve noticed changes in erections or sexual function
Sexual changes arrived alongside fatigue, weight gain, or poor sleep
You’re in perimenopause or menopause and your symptoms affect your relationship
You started a new medication and noticed changes afterward

Sexual health — common questions

Do you see both men and women for sexual health?

Yes. Low libido and hormone-related sexual concerns affect men and women, and we evaluate each person individually.

What causes low libido?

Often more than one thing. Hormone changes, poor sleep, stress, low mood, thyroid issues, blood sugar, and certain medications can all play a role. Testing helps sort out which factors apply to you.

Can hormones really affect desire?

They can. Testosterone contributes to libido in both men and women, and estrogen and progesterone affect comfort, mood, and sleep in women. We test before recommending anything.

Is hormone therapy right for me?

It depends on your labs, symptoms, and health history. We evaluate all three, explain the options, and only recommend hormone therapy when it’s a good fit — then monitor closely.

Are these conversations private?

Yes. We’re a small, boutique practice, and these appointments are private, respectful, and judgment-free.

Do you take insurance?

True You is a cash-based practice, so your care isn’t limited by insurance rules on testing or time. We’re transparent about costs during your consultation.

How do I get started?

Book an initial appointment. Your first visit and lab work are in person at our Fredericksburg office, and many follow-ups can be virtual.

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