A testosterone or estradiol that sits at the bottom of a broad reference range is not the same as a level that lets you feel well again. Optimization is the work of reading the whole network — not settling for “technically normal.”
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Care · Sexual Vitality & Fertility
Sexual Vitality & Fertility For Women & Men
Changes in desire and intimacy are a signal, not just “aging” or “in your head”
When desire fades, arousal is harder to reach, comfort changes, or fertility becomes a question, the cause is usually upstream — in the same hormones and metabolism that govern energy, mood and weight. Eterna reads sexual wellness as a health signal, measures it with a 70+ biomarker panel, and holds the conversation with discretion and without embarrassment. Physician-led care for women and men, 100% virtual across 12 licensed U.S. states.
In Plain Terms
Why Do Libido And Intimacy Change — And Is It Treatable?
Desire, arousal and comfort are physiological events governed by hormones, blood flow and metabolic health — not by willpower or how you feel about your partner. In women, shifting estradiol, progesterone and testosterone through perimenopause and menopause change libido, sensation and vaginal comfort; in men, declining testosterone and vascular changes blunt desire and reliable arousal. Insulin resistance, thyroid slowdown, chronic stress, sleep loss and certain medications quietly compound all of it in both sexes. So yes — in most cases these changes are treatable, because they trace back to measurable factors rather than an unchangeable fact of age. Physician-led care reads those signals, addresses the ones that are off, and treats a fading sex life as a health signal worth investigating — discreetly, and for women and men alike.
Why “Everything Looks Normal” Misses It
The Distance Between “In Range” And How You Actually Feel
Told your labs are normal, handed a prescription for the mood instead of the cause, or advised that low desire is simply what happens with age — the pattern is the same one behind unexplained fatigue and stubborn weight. Sexual wellness runs on a connected network of signals: sex hormones, thyroid, cortisol, blood sugar and the vascular health that carries blood where arousal needs it. Read one value at a time, that network stays invisible. Read together, it explains the low libido, the difficult arousal, the discomfort and the flatness that a single “in-range” result never accounted for.
“It’s Just Age”
- Low desire dismissed as inevitable or psychological
- One hormone checked, if any, and read in isolation
- Sex hormones, thyroid, metabolism never seen together
- Vascular and metabolic contributors to arousal left unassessed
- An awkward, rushed conversation — or none at all
Reading It As A Health Signal
- Desire and arousal treated as measurable physiology
- Sex hormones set inside a 70+ biomarker panel
- Hormones, thyroid, metabolism and vascular health read as one network
- What is behind it identified before anything is prescribed
- A private, unhurried, physician-led conversation
Estradiol & Progesterone
- In women, the decline and swing of estradiol and progesterone through perimenopause and menopause reshape libido, sensation, lubrication and tissue comfort — changes that are common, physiological, and often overlooked until they affect intimacy.
Testosterone
- Testosterone shapes desire, arousal and energy in both men and women. When it drifts low — gradually in men, and around midlife in women — libido, motivation and stamina often fade with it. It is a signal to measure and interpret, not a number to chase.
Vascular & Metabolic Health
- Arousal depends on healthy blood flow, and blood flow depends on metabolic health. Insulin resistance and vascular changes blunt arousal and erectile function in men and genital response in women — which is why intimacy can be an early read on cardiometabolic health.
Thyroid, Cortisol & Sleep
- An underactive thyroid, a stress-driven cortisol rhythm and broken sleep all lower desire, drain energy and dampen mood in women and men. These everyday factors are measurable and modifiable — and routinely missed when only one system is examined.
Service · Discreet & Physician-Led
Sexual Vitality & Health
Desire, arousal, comfort and performance are health, not vanity — and for women and men, changes in them are often the most honest signal that hormones or metabolism have shifted. Eterna addresses sexual wellness the way it addresses any other system: measure each system and treat the ones that are off, and hold the conversation with the privacy and plain language it deserves.
A Health Signal, Not A Vanity Concern
Low desire, difficult arousal or changed comfort are read as clinical information — a window onto hormones, thyroid, blood sugar and vascular health. Treating them means investigating what changed, not managing embarrassment or accepting “that’s just how it is now.”
For Women And For Men
Women in perimenopause, menopause, low libido or changes in comfort, and men noticing fading desire, energy or reliable arousal, are cared for with the same systems-based approach — the specifics tailored to each person’s physiology, life stage and goals.
A Private, Non-Embarrassing Conversation
This is a clinical conversation with a physician, held virtually and in confidence. Dr. Renée asks the questions directly and answers plainly, so nothing has to be hinted at or left unsaid. Nothing about intimacy is off-limits or awkward in this room.
Rooted In The Hormone & Metabolic Picture
Because sexual wellness sits downstream of the same systems behind fatigue and weight, care is built on the full biomarker picture rather than a single symptom. When hormones, thyroid or metabolic health are off, addressing the source is what makes intimacy improve — and lasts.
Any therapy is considered only after evaluation and only when clinically appropriate for you; it is one part of care, never a guaranteed result, and never a one-size prescription.
Service · Before Conception
Preconception & Fertility Support
Fertility struggles are frequently a signal from the same hormonal and metabolic systems — not a verdict, and not only a woman’s concern. Eterna’s role here is squarely before conception: optimizing hormonal and metabolic health and building nutrition and lifestyle foundations in women and men, then coordinating with your OB-GYN or fertility specialist for care during conception and pregnancy. This is educational, optimization-focused support — it does not diagnose infertility and makes no promise of pregnancy.
Optimizing Health Before Conception
The months before trying are when metabolic and hormonal health matter most. Care focuses on insulin sensitivity, thyroid function, inflammation and nutrient status — the foundations of reproductive health in both partners — read from the 70+ panel and addressed while there is time to make a difference.
For Both Partners
Reproductive health is shared. Women’s hormonal balance, cycle patterns and metabolic health, and men’s hormonal and metabolic health, are each part of the picture. Supporting both partners — rather than treating fertility as one person’s responsibility — is the more complete approach.
Nutrition & Lifestyle Foundations
Nutrient status, blood-sugar stability, sleep, stress and movement shape the environment conception depends on. Guidance is practical and matched to your labs — correcting deficiencies and steadying metabolism — the groundwork that supports reproductive health in women and men.
Coordinated, Not Freelanced
Eterna works alongside your OB-GYN, reproductive endocrinologist or fertility clinic — not in place of them. Once you are trying to conceive, are pregnant, or are breastfeeding, care during that window belongs with your reproductive and obstetric team, and Eterna coordinates rather than duplicates it.
An important safety note
Testosterone and a number of hormone therapies are contraindicated during pregnancy, while actively trying to conceive or planning pregnancy, and while breastfeeding. If you are pursuing pregnancy, tell your physician early: some therapies are paused or avoided well before conception, and preconception care is planned specifically around that. Eterna’s preconception support is about optimizing health before conception and coordinating care — it does not include therapies intended for use during conception attempts or pregnancy, and no medication doses are described here or prescribed without evaluation.
How Eterna Approaches It
Measured, Treated, And Held In Confidence
Sexual vitality and preconception support are read from the same physiology as the rest of Eterna’s care — measured the same way, followed the same way, and discussed with the same discretion. It starts upstream, with data, not with assumptions about age.
The 70+ Biomarker Panel
- Sex hormones — estradiol, progesterone, testosterone and related markers — alongside thyroid, cortisol, fasting insulin and glucose, and inflammatory and nutritional markers, read together to see the whole network behind desire, arousal and reproductive health.
Physician-Led & Discreet
- A board-certified physician interprets the panel, holds the conversation in private, and decides whether and when any therapy is appropriate — women and men alike. Direct questions, plain answers, and confidentiality throughout.
Personalized To You
- Care is matched to your sex, life stage, goals and — where relevant — your plans for pregnancy, so recommendations fit your biology and your circumstances rather than a template. Preconception plans are built around timing and coordination.
Monthly Monitoring
- Hormones, metabolic markers and symptoms are reviewed on an ongoing monthly basis, so care is checked against your data and refined over time — toward vitality that holds, not a single adjustment left to run.
Screening begins with the Ground Zero Screening ($247). Ongoing care is offered through concierge membership; a standalone Physician Lab Report is available.
Sexual Vitality
Intimacy Is A Health Signal, Not A Given
Desire, arousal and connection are driven by hormones, blood flow and metabolic health — all of which we can read and restore.
Sexual Vitality & Fertility
Vitality, Restored At The Root.
Desire, performance and fertility are hormone-driven for women and men alike. We treat the cause — with discretion and real physician time.
Where This Care Begins
Ground Zero Screening & Personalized Roadmap™
A private, physician-led screening where Dr. Renée reviews your symptoms, history and goals — and your labs, if you have them — without embarrassment or a rushed clock. You leave with a written Personalized Roadmap that maps the hormones and metabolism behind your sexual wellness or preconception health, and names the next steps, whether or not you continue.
$247
Video visit · written roadmap · HSA/FSA eligible · 100% virtual across 12 states
Book Your Ground Zero Screening
Questions, Answered
Frequently Asked Questions
Is low libido really a medical issue, or just part of getting older?
It is usually a medical issue with measurable causes. Desire and arousal are governed by sex hormones, thyroid, cortisol, blood sugar and vascular health — and when those shift with perimenopause, menopause, a gradual testosterone decline, insulin resistance, stress or poor sleep, libido changes as a signal, not an inevitability. In most cases what is behind it can be identified and addressed. “Just age” is rarely the whole explanation.
Is this care for men, or only for women?
Both. Changes in desire, arousal, comfort and performance affect women and men, and Eterna reads the same hormonal and metabolic network for each — estradiol, progesterone and testosterone, thyroid, cortisol and metabolic and vascular health. Care is tailored to your physiology, sex and goals.
Will I have to talk about intimate details? Is it confidential?
You will have a direct clinical conversation with a physician, held virtually and in confidence. Dr. Renée asks the relevant questions plainly and answers the same way, so nothing has to be hinted at. It is a private medical visit — the same discretion you would expect from any physician, on a subject that deserves it.
How do hormones and metabolism affect fertility?
Reproductive health rests on hormonal balance and metabolic health in both partners — thyroid function, insulin sensitivity, inflammation, nutrient status and hormone patterns all shape the environment conception depends on. Optimizing these before conception is the focus of Eterna’s preconception support. It is educational and coordinated with your OB-GYN or fertility specialist, does not diagnose infertility, and makes no promise of pregnancy.
Can I use hormone therapy while trying to conceive or during pregnancy?
No — testosterone and many hormone therapies are contraindicated during pregnancy, while actively trying to conceive or planning pregnancy, and while breastfeeding. If pregnancy is your goal, tell your physician early: some therapies are paused or avoided well before conception, and preconception care is planned around that. Eterna’s support here is about optimizing health before conception and coordinating with your reproductive team — not providing therapy during conception or pregnancy.
Is any treatment guaranteed to work?
No. Care is individualized and any therapy is considered only after evaluation and only when clinically appropriate for you. It is one part of a broader plan, not a guaranteed outcome, and no result — including improved intimacy or pregnancy — is ever promised. What Eterna commits to is measuring each system, treating the ones that are off, and following your progress.
Do I have to live in a particular state?
Eterna is 100% virtual and Dr. Renée is licensed in 12 U.S. states. This care is available to residents of those states by telemedicine. If you live elsewhere, an educational second-opinion consultation may still be an option.
The Evidence
References & Clinical Guidelines
Eterna’s approach is grounded in professional-society guidance and peer-reviewed sexual-medicine and reproductive-health literature. Key sources are listed below by organization, title and year.
View references
1. The Menopause Society (formerly NAMS). “The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society” and “The 2022 Hormone Therapy Position Statement of The North American Menopause Society.” Menopause. 2023 & 2022.
2. International Society for the Study of Women’s Sexual Health (ISSWSH) & The Menopause Society. “The Role of Testosterone Therapy in Women: A Position Statement / Global Consensus Position Statement on the Use of Testosterone Therapy for Women.” Journal of Sexual Medicine / Climacteric. 2019–2021.
3. American Society for Reproductive Medicine (ASRM), Practice Committee. “Optimizing Natural Fertility: A Committee Opinion” and “Prepregnancy Counseling: A Committee Opinion.” Fertility and Sterility. 2022 & 2019.
4. Endocrine Society. “Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.” Journal of Clinical Endocrinology & Metabolism. 2018.
5. American Urological Association (AUA). “Erectile Dysfunction: AUA Guideline” and “Evaluation and Management of Testosterone Deficiency: AUA Guideline.” 2018 (amended 2023).
6. American College of Obstetricians and Gynecologists (ACOG). “Female Sexual Dysfunction (Practice Bulletin)” and “Prepregnancy Counseling (Committee Opinion No. 762).” Obstetrics & Gynecology. 2019.
7. Parish SJ, et al. (ISSWSH). “International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women.” Journal of Sexual Medicine / Mayo Clinic Proceedings. 2021.
8. U.S. Centers for Disease Control and Prevention (CDC). “Preconception Health and Health Care: Recommendations to Improve Preconception Health.” MMWR Recommendations and Reports. Updated guidance.
This page is educational and is not medical advice, a diagnosis, or a substitute for care from your own physician. It does not promise any specific result, including improved intimacy or pregnancy; individual results vary. Testosterone and many hormone therapies are contraindicated in pregnancy, while trying to conceive or planning pregnancy, and while breastfeeding; any therapy is prescribed only after evaluation and only when clinically appropriate. Medically reviewed by Dr. Renée Allen, MD, MHSc, FACOG.
Where To Begin
Read The Signal, Not Just The Symptom
Start with a Ground Zero Screening and a written Personalized Roadmap that reads the hormones and metabolism behind your sexual wellness or preconception health — a private, physician-led conversation, yours to keep whether or not you continue. Not sure yet? The 3-minute assessment points you to the right starting place.
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