Keeps Best Alternatives for Each Use Case

What Keeps Actually Prescribes

Keeps offers two FDA-approved medications: oral finasteride 1 mg daily and topical minoxidil 5% solution or foam. Finasteride is a 5-alpha reductase inhibitor that blocks conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for follicular miniaturization in androgenetic alopecia. A key 2-year trial by Kaufman et al. (1998) demonstrated that finasteride 1 mg increased hair count by 107 hairs/cm² compared to a continued decline in the placebo group (N=1,553).

Minoxidil works through a separate mechanism. It is a potassium channel opener that prolongs the anagen (growth) phase and increases follicular blood flow. A meta-analysis published in the Journal of the American Academy of Dermatology confirmed that 5% topical minoxidil produces superior regrowth compared to 2% concentration in men.

Keeps does not offer compounded combination products, oral minoxidil, dutasteride, or adjunctive therapies like ketoconazole shampoo as part of its formulary. That limitation matters. For patients who want a broader toolkit or who have not responded to first-line monotherapy, an alternative platform may serve them better.

Is Keeps Legit?

Yes. Keeps operates as a licensed telehealth service, connects patients to board-certified physicians, and dispenses FDA-approved medications through licensed pharmacies. The company has been in operation since 2018 and holds proper state-level telehealth authorizations. Its prescriptions are real prescriptions filled by real pharmacies.

The clinical question is not legitimacy but adequacy. A 2019 guideline from the American Academy of Dermatology recommends combination therapy (finasteride plus minoxidil) as more effective than either agent alone for moderate-to-advanced androgenetic alopecia. Keeps does offer both drugs, but as separate products without the compounded topical formulations that combine finasteride and minoxidil into a single application, which some patients prefer for convenience and potentially enhanced local finasteride delivery.

Alternative 1: Hims (Best for Combination Topical Therapy)

Hims offers a compounded topical spray containing finasteride 0.1%-0.3% and minoxidil 6%-8% in a single formulation. This is the primary differentiator from Keeps. For patients who want both active ingredients applied topically (avoiding systemic finasteride exposure), Hims provides a formulation Keeps does not.

Pricing for the Hims topical spray runs approximately $30-50/month on a subscription. Oral finasteride through Hims costs roughly $30/month, comparable to Keeps. A randomized controlled trial by Jimenez-Cauhe et al. (2022) found that topical finasteride 0.25% applied daily produced similar scalp DHT reduction to oral finasteride 1 mg while generating lower serum DHT suppression, suggesting a potentially improved side-effect profile.

Hims also offers a broader product catalog including ED medications, mental health prescriptions, and skincare. If you want a single telehealth provider for multiple conditions, Hims has wider coverage. The trade-off: Hims charges more for bundled plans, and the consultation process can push add-on products aggressively.

Alternative 2: Ro (Roman) (Best for Integrated Primary Care)

Ro, operating its hair loss vertical under the Roman brand, prescribes oral finasteride and topical minoxidil at prices comparable to Keeps. Where Ro separates itself is clinical breadth. Ro provides weight management (GLP-1 prescriptions), cardiovascular screening, and lab work through the same platform.

For a man whose hair loss coincides with metabolic concerns or who wants testosterone levels checked alongside a hair loss evaluation, Ro offers a more integrated clinical experience. A 2020 study in JAMA Dermatology confirmed that male-pattern hair loss severity correlates with cardiovascular risk markers, making a platform that can address both domains simultaneously a practical advantage.

Ro's finasteride pricing sits around $17-20/month. The platform also offers synchronous video consultations for follow-up, which some patients prefer over the asynchronous photo review model used by Keeps.

Alternative 3: Cost Plus Drugs (Best for Price-Conscious Patients)

Mark Cuban's Cost Plus Drugs pharmacy sells generic finasteride 1 mg at roughly $4-6 for a 30-day supply. That is substantially cheaper than any subscription telehealth platform. The catch: Cost Plus Drugs is a pharmacy, not a prescriber. You need a prescription from your own doctor or a separate telehealth service.

For patients who already have a prescriber relationship (primary care physician or dermatologist), pairing a $20-30 telehealth consultation with Cost Plus Drugs fills can reduce annual hair loss treatment cost to under $100/year for finasteride alone. Generic topical minoxidil 5% is available over the counter at most pharmacies for $15-25/month, requiring no prescription.

According to GoodRx pricing data and FDA Orange Book listings, generic finasteride 1 mg has been off-patent since 2006 and is manufactured by more than a dozen generic producers. The drug itself is identical regardless of source.

Alternative 4: Happy Head (Best for Compounded Multi-Agent Formulations)

Happy Head specializes in compounded topical solutions that combine finasteride, minoxidil, retinoic acid (tretinoin), and sometimes additional agents like latanoprost into a single daily application. This is the most pharmacologically aggressive topical approach available through telehealth.

Tretinoin added to minoxidil may enhance minoxidil absorption. A study by Ferry et al. (1990) showed that tretinoin 0.05% combined with minoxidil 0.5% outperformed minoxidil alone in promoting terminal hair regrowth, likely by upregulating sulfotransferase enzyme activity required for minoxidil's conversion to its active sulfate form.

Happy Head runs approximately $49-79/month depending on the formulation tier. This is more expensive than Keeps but delivers compounds unavailable through standard telehealth platforms. Patients who have failed monotherapy with either finasteride or minoxidil alone are the best candidates for this option.

Alternative 5: In-Person Dermatologist (Best for Advanced or Refractory Hair Loss)

No telehealth platform replaces a board-certified dermatologist for cases involving diagnostic uncertainty, scarring alopecia, diffuse thinning without a clear male-pattern distribution, or failure of standard therapy after 12 months.

An in-person evaluation allows dermoscopy (trichoscopy), scalp biopsy if indicated, and access to treatments like platelet-rich plasma (PRP) injections, low-level laser therapy, and off-label oral minoxidil dosing. The American Hair Loss Association and AAD guidelines both recommend specialist evaluation for patients not responding to first-line therapy within 6-12 months.

Oral minoxidil at low doses (2.5-5 mg daily) has gained substantial clinical interest. A retrospective study by Vano-Galvan et al. (2021) evaluating 1,404 patients on low-dose oral minoxidil reported efficacy rates above 60% with a manageable side-effect profile including mild hypertrichosis (unwanted hair growth) in approximately 15% of patients. This option is not available through Keeps or most D2C platforms but can be prescribed by a dermatologist.

Alternative 6: HealthRX (Best for Clinical Depth and Provider Oversight)

HealthRX pairs FDA-approved hair loss medications with physician oversight that extends beyond the photo-review model. Patients receive structured follow-up, lab work recommendations when clinically indicated (testosterone, DHEA-S, thyroid function), and access to combination protocols tailored to Norwood stage and treatment history.

For patients with concurrent hormonal concerns (low testosterone, thyroid dysfunction) contributing to hair thinning, a platform that can evaluate and treat across domains offers an advantage over single-condition services. The Endocrine Society's 2018 clinical practice guideline on testosterone therapy notes that hypogonadism can contribute to hair changes and should be evaluated as a potential cofactor.

How to Choose: Decision by Use Case

The right alternative depends on your clinical situation, budget, and treatment history.

First-time treatment, budget-conscious: Cost Plus Drugs with a separate telehealth or PCP prescription delivers the lowest annual cost. Expect to pay under $100/year for generic finasteride.

First-time treatment, convenience-focused: Keeps or Hims offer the easiest onboarding with asynchronous consultations and home delivery. Choose Hims if you want a compounded topical; choose Keeps if oral finasteride plus OTC minoxidil is sufficient.

Failed monotherapy, seeking escalation: Happy Head's multi-agent compounded topicals add tretinoin and other enhancers. Alternatively, ask a dermatologist about low-dose oral minoxidil.

Concurrent health concerns: Ro or HealthRX provide broader clinical scope. If you need testosterone evaluation, metabolic screening, or GLP-1 access alongside hair loss treatment, a multi-condition platform saves time and consolidates care.

Advanced hair loss or diagnostic uncertainty: See a dermatologist. Teledermatology visits can bridge the gap, but Norwood V-VII or suspected scarring alopecia warrants in-person trichoscopy and possible biopsy.

Side Effects and Monitoring

All finasteride prescribers should discuss the same side-effect profile. In the key Phase III trials, finasteride 1 mg produced sexual side effects (decreased libido, erectile dysfunction, decreased ejaculate volume) in 3.8% of treated men versus 2.1% on placebo. These effects resolved in most men who discontinued the drug and in 58% of those who continued it.

The concept of "post-finasteride syndrome" (persistent sexual, neurological, and psychological symptoms after drug cessation) has been reported in case series but has not been confirmed in controlled prospective trials. The FDA added a warning regarding 5-alpha reductase inhibitors in 2012, noting reports of sexual dysfunction that continued after discontinuation.

Minoxidil's primary side effects are local: scalp irritation, dryness, and initial shedding (telogen effluvium) during weeks 2-8 of use. Oral minoxidil carries additional systemic risks including fluid retention, pericardial effusion (rare at low doses), and hypertrichosis. Baseline ECG and periodic blood pressure monitoring are recommended for oral minoxidil by most prescribing dermatologists.

Regardless of which platform you choose, request PSA screening discussion if you are over 40 and starting finasteride, as the drug reduces PSA levels by approximately 50%, which can mask prostate cancer detection if your urologist is unaware of finasteride use.