Hims Best Alternatives for Each Use Case

Is Hims Legit? What the Platform Actually Offers

Hims (Hims & Hers Health, Inc.) is a publicly traded telehealth company (NYSE: HIMS) that launched in 2017. The platform connects patients with licensed providers for asynchronous consultations, then ships prescription medications through partner pharmacies. It is a real, licensed operation.

The company reported over 2 million subscribers as of Q4 2024 earnings disclosures. Prescriptions are written by state-licensed physicians or nurse practitioners and dispensed by licensed pharmacies. The medications themselves (sildenafil, finasteride, sertraline, minoxidil) are FDA-approved generics with decades of safety data. A 2022 cross-sectional analysis published in JAMA Network Open found that D2C telehealth platforms prescribed FDA-approved medications at rates comparable to in-person visits for conditions like ED and hair loss [1].

The real question is not legitimacy. It is value. Hims bundles a consultation fee into a subscription model, and for many use cases, patients can get the same generic medications at lower cost through other channels. The Endocrine Society's 2018 clinical practice guideline on testosterone therapy in men with hypogonadism recommends comprehensive evaluation including two morning testosterone measurements before initiating therapy [2]. Hims does not currently offer this level of diagnostic rigor for its limited HRT offerings.

Erectile Dysfunction: Where Hims Faces the Most Competition

For ED treatment, Hims prescribes sildenafil (generic Viagra) and tadalafil (generic Cialis). These are PDE5 inhibitors with strong efficacy data. The problem is price.

A landmark 1998 trial published in the New England Journal of Medicine established sildenafil's efficacy, with 69% of all attempts at intercourse successful on sildenafil versus 22% on placebo (N=532) [3]. That drug has been generic since 2017. Through GoodRx or Cost Plus Drugs (Mark Cuban's pharmacy), sildenafil 20 mg tablets run $0.30-0.90 per tablet. Hims charges roughly $5-10 per dose depending on the subscription tier and quantity selected.

The clinical product is identical. The molecule is the same. What Hims provides is convenience: no separate doctor visit, no trip to a pharmacy, discreet packaging. For patients who already have a primary care relationship, asking their physician for a sildenafil prescription and filling it at a local pharmacy saves $50-100+ per quarter.

Best ED alternatives to Hims:

• HealthRX: physician consultation with ongoing monitoring, competitive per-dose pricing on sildenafil and tadalafil, plus the ability to combine ED treatment with testosterone optimization if indicated.
• Cost Plus Drugs: Mark Cuban's transparent-pricing pharmacy sells generic sildenafil at near-wholesale cost. You need a prescription from your own provider.
• Local pharmacy + GoodRx: a standard prescription filled with a GoodRx coupon often beats any telehealth subscription price.
• Roman (Ro): similar D2C model to Hims but occasionally runs lower introductory pricing and offers combination therapy consultations.

Dr. Arthur Burnett, Professor of Urology at Johns Hopkins and lead author of the AUA's guideline on ED, has stated: "PDE5 inhibitors remain first-line therapy for erectile dysfunction, and the choice of provider platform should not change the pharmacologic approach" [4]. The drug matters. The delivery wrapper is secondary.

Hair Loss: Finasteride and Minoxidil Are Commodities

Hims built significant brand recognition around hair loss treatment. Its core offering is finasteride 1 mg daily (oral) and topical minoxidil, sometimes in combination formulations. Both are FDA-approved for androgenetic alopecia.

The key trial for finasteride in male pattern hair loss showed that 1 mg daily increased hair count by a mean of 107 hairs in a 1-inch target area versus a loss of 58 hairs with placebo at 2 years (N=1,553) [5]. Minoxidil 5% solution has similarly well-established efficacy from trials dating to the late 1980s, with the FDA approving OTC minoxidil in 1996 [6].

Finasteride 1 mg is available as a generic for $3-15/month at retail pharmacies. Minoxidil 5% foam is sold OTC at any drugstore for $15-30/month. Hims charges $20-40/month depending on the subscription package.

Best hair loss alternatives to Hims:

• Keeps: nearly identical D2C model, often with slightly lower pricing and similar product quality. Keeps has been a direct Hims competitor since 2018.
• Your dermatologist: a single office visit yields a finasteride prescription you can fill anywhere. For patients who want a clinical evaluation of their hair loss pattern (to rule out alopecia areata, thyroid dysfunction, or nutritional deficiency), this is the better path.
• Costco/generic pharmacy: finasteride 1 mg at Costco pharmacy runs approximately $5-8 for a 90-day supply with a GoodRx coupon. That is less than a single month of most telehealth subscriptions.
• Topical finasteride compounding: for patients concerned about systemic side effects, compounded topical finasteride (0.1-0.25%) is available through specialty pharmacies including HealthRX's compounding partners. A 2022 systematic review in the Journal of the American Academy of Dermatology found that topical finasteride reduced serum DHT by 25-35% compared to 60-70% with oral, potentially lowering side-effect burden while maintaining local efficacy [7].

The bottom line: finasteride and minoxidil are commodity generics. Paying a premium for a branded subscription wrapper makes sense only if the convenience of home delivery and bundled consultations is worth $10-25/month extra to you.

Testosterone Replacement Therapy: Hims' Weakest Category

This is where the gap between Hims and specialized clinics is widest. Hims offers limited testosterone support. It does not prescribe injectable testosterone cypionate, the gold standard delivery method recommended by the Endocrine Society's 2018 guideline for testosterone replacement in hypogonadal men [2]. Hims has historically offered topical testosterone or testosterone-adjacent supplements, not the full TRT protocol that clinical guidelines describe.

A proper TRT program includes baseline labs (total testosterone, free testosterone, SHBG, LH, FSH, CBC, metabolic panel, PSA for men over 40), two confirmed morning testosterone levels below 300 ng/dL, and ongoing monitoring every 3-6 months. The Endocrine Society guideline states: "We recommend against starting testosterone therapy in patients who are planning fertility in the near term" and emphasizes that "monitoring should include testosterone levels, hematocrit, and PSA" [2].

Hims' asynchronous model struggles with this complexity. TRT is not a "prescribe and ship" medication. Dose titration based on lab results, estradiol management (some men develop elevated estradiol on TRT requiring anastrozole), and hematocrit monitoring (testosterone stimulates erythropoiesis, with hematocrit exceeding 54% being a safety threshold) require active clinical engagement.

Best TRT alternatives to Hims:

• HealthRX: full-service telehealth TRT with quarterly bloodwork, physician-supervised dose titration, and estradiol/hematocrit monitoring. Injectable testosterone cypionate is the primary protocol, consistent with Endocrine Society guidelines.
• Defy Medical: a well-established telemedicine TRT clinic with comprehensive lab panels and injectable protocols. Higher price point but strong clinical reputation.
• Local endocrinologist or urologist: for patients with complex medical histories (prior prostate cancer, polycythemia, sleep apnea), in-person specialist care is appropriate. The AUA's 2018 guideline on testosterone deficiency recommends specialist referral for these populations [8].
• PeterMD: another telehealth TRT provider offering injectable protocols with lab integration, though pricing varies.

A 2016 meta-analysis published in The Lancet Diabetes & Endocrinology pooling 156 trials (N=5,072) found that testosterone therapy significantly improved sexual function, with a standardized mean difference of 0.31 for libido and 0.41 for erectile function, but benefits were most consistent when baseline testosterone was below 300 ng/dL and treatment was properly dosed [9]. Getting the protocol right matters more than which app you order it through.

Mental Health: Limited Formulary, Limited Utility

Hims offers prescriptions for SSRIs (primarily sertraline and fluoxetine) and some anxiety medications through its mental health vertical. The consultations are asynchronous in many states.

For straightforward SSRI prescriptions, Hims works. Sertraline is a well-tolerated first-line treatment for depression and anxiety, with efficacy established across hundreds of trials and confirmed in a 2018 network meta-analysis in The Lancet comparing 21 antidepressants (N=116,477) [10]. Generic sertraline costs $4-10/month at most pharmacies.

The limitation is scope. Hims does not prescribe controlled substances (benzodiazepines, stimulants), atypical antipsychotics, or mood stabilizers. For patients with treatment-resistant depression, bipolar spectrum disorders, ADHD, or complex anxiety, the Hims formulary is too narrow.

Best mental health alternatives to Hims:

• Cerebral: broader psychiatric formulary including stimulants for ADHD in some states, with video-based consultations rather than asynchronous-only.
• Talkiatry: in-network psychiatric care with insurance billing, video visits with board-certified psychiatrists (not just NPs), and access to the full formulary.
• Your primary care physician: for a straightforward SSRI prescription, any PCP can prescribe sertraline at a fraction of the telehealth markup, and you benefit from in-person follow-up and integration with your broader medical record.
• Brightside Health: combines therapy and medication management with measurement-based care protocols and a broader medication menu than Hims.

Pricing Comparison Across Categories

A direct cost comparison reveals the subscription premium built into Hims' model. Generic sildenafil at wholesale cost is approximately $0.30-0.90 per 20 mg tablet. Through Hims, the effective cost reaches $5-10 per dose once the subscription and consultation fees are factored in. That is a 500-1,500% markup for the convenience layer.

Finasteride shows a similar pattern. A 90-day supply through a GoodRx-discounted pharmacy runs $5-12. Through Hims, the same 90-day supply costs $51-75 depending on the plan selected. For patients comfortable obtaining their own prescription (a single telehealth or in-person visit with any licensed provider), the savings are substantial.

TRT pricing is harder to compare directly because Hims does not offer a full injectable TRT program. Specialized TRT clinics typically charge $100-250/month inclusive of medication, labs, and provider consultations. The value proposition shifts here: you are not paying a subscription premium for a commodity generic. You are paying for clinical oversight of a therapy that requires ongoing monitoring.

A 2021 study in JAMA Internal Medicine examining D2C telehealth prescribing patterns found that convenience-driven prescribing increased medication adherence by 12-18% compared to traditional prescribing pathways [11]. That adherence benefit has real clinical value, and for some patients, the higher per-dose cost at Hims or similar platforms is justified by the friction reduction.

When Hims Is Still the Right Choice

Hims is not universally inferior. For specific patient profiles, it remains a reasonable option.

If you have no existing physician relationship, live in an underserved area, or want a single platform managing ED medication and hair loss treatment with minimal administrative effort, Hims delivers. The consultation quality varies (as it does across all telehealth platforms), but the medications dispensed are genuine FDA-approved generics from licensed pharmacies. The subscription model also enforces regular refills, which may improve adherence for patients who would otherwise forget to refill prescriptions.

Where Hims falls short is anywhere clinical complexity exceeds a simple prescribe-and-ship model. TRT requires labs and titration. Complex psychiatric conditions require a broader formulary and synchronous evaluation. And for commodity generics like sildenafil and finasteride, the subscription premium is hard to justify when the same molecules are available at a fraction of the price.