Strut Health Prescription Process: How the Online Intake Works and What to Expect

How the Strut Health Online Intake Works

Strut Health follows the same asynchronous telehealth pattern used by Hims, Ro, and similar platforms. Patients select a treatment category, answer a structured medical questionnaire covering health history and current medications, upload photos if prompted, and submit. A licensed prescriber reviews the submission and either approves a prescription, requests more information, or declines treatment.

No live video or phone consultation is required for most Strut Health orders. The American Telemedicine Association's 2023 practice guidelines note that asynchronous (store-and-forward) encounters can be appropriate for low-acuity conditions when the clinical information collected is sufficient for safe prescribing [1]. Hair loss and stable erectile dysfunction generally fall into this category. The ATA guidelines do specify, however, that the provider must have a mechanism to escalate to synchronous evaluation when clinical complexity warrants it [1].

One point that separates Strut Health from some competitors is the use of compounded formulations. Rather than dispensing brand-name finasteride 1 mg tablets, Strut Health often ships proprietary compound blends (for example, topical finasteride combined with minoxidil). The FDA does not review compounded drugs for safety or efficacy the same way it reviews FDA-approved products [2]. Patients should understand this distinction before starting therapy.

What Conditions and Medications Does Strut Health Prescribe?

Strut Health concentrates on three verticals: androgenetic alopecia, erectile dysfunction, and skincare. Each category involves prescription medications that carry real clinical considerations.

For hair loss, the primary agents are finasteride and minoxidil. Finasteride 1 mg daily is the dose supported by the landmark Kaufman et al. trial, which demonstrated that 83% of men maintained or increased hair count over five years compared to placebo [3]. The Strut Health model typically offers this drug in topical compound form. A 2022 randomized trial published in the Journal of the American Academy of Dermatology (N=458) found that topical finasteride 0.25% reduced scalp DHT by 40% while producing lower serum DHT suppression than oral finasteride, suggesting a potentially improved side-effect profile [4].

For ED, Strut Health prescribes sildenafil and tadalafil. Both are PDE5 inhibitors with decades of safety data. The AUA's 2018 guideline on erectile dysfunction recommends PDE5 inhibitors as first-line pharmacotherapy and states that prescribing should include cardiovascular risk assessment and a medication interaction review [5]. Whether an asynchronous questionnaire captures this information as reliably as a clinical interview is a question worth examining.

Skincare offerings include tretinoin and combination acne formulations. These carry lower clinical risk but still require accurate history-taking to avoid contraindicated use during pregnancy (tretinoin is FDA pregnancy category X) [6].

Asynchronous Prescribing: What the Evidence Says About Safety

The core question with any questionnaire-based telehealth platform is whether the intake captures enough clinical data to prescribe safely. This matters most for medications with significant drug interactions or contraindications.

PDE5 inhibitors interact dangerously with nitrates. Concurrent use of sildenafil and nitroglycerin can cause severe hypotension, and deaths have been reported [7]. The AUA guideline explicitly states that nitrate use is an absolute contraindication to PDE5 inhibitor therapy [5]. An asynchronous form can ask about nitrate use, but it cannot probe the way a live clinician would. A patient might not recognize that their "heart spray" is nitroglycerin, or might omit an intermittently used medication.

A 2021 cross-sectional study in JAMA Internal Medicine evaluated 40 direct-to-consumer telehealth platforms and found that only 65% of encounters for ED included a documented medication interaction check [8]. The study's authors noted that "the absence of real-time dialogue may reduce the likelihood of identifying contraindications that patients do not spontaneously report."

Finasteride carries its own informed-consent obligations. The FDA added warnings about persistent sexual side effects to the finasteride label in 2012, and the Endocrine Society recommends that prescribers discuss the risk of decreased libido, erectile dysfunction, and ejaculatory disorders before initiating 5-alpha-reductase inhibitor therapy [9]. A checkbox on a form is not equivalent to a conversation. Some men on these platforms report learning about post-finasteride syndrome only after starting the medication, according to patient experience surveys published on independent review sites.

For context, a 2019 meta-analysis in the Journal of Sexual Medicine pooled data from 17 RCTs (N=17,454) and found that the absolute risk of sexual adverse effects with finasteride 1 mg was 2.1% above placebo, with most cases resolving after discontinuation [10]. The risk is real but modest. The issue is not whether finasteride should be prescribed online but whether the consent process is adequate.

How Strut Health Compares to Alternatives

The direct-to-consumer men's health telehealth space includes Hims, Ro, Keeps, and several others. Comparing them requires looking at three dimensions: clinical rigor, pricing, and product formulation.

On clinical rigor, most platforms in this category use the same asynchronous model. Hims and Ro both offer optional video visits but do not mandate them for hair loss or ED prescriptions. Keeps similarly relies on a photo-and-questionnaire intake. None of these platforms routinely require baseline lab work before prescribing finasteride, though the Endocrine Society recommends checking baseline PSA in men over 40 before starting a 5-alpha-reductase inhibitor because these drugs reduce PSA by approximately 50%, which can mask prostate cancer detection [9].

On pricing, Strut Health positions itself competitively. Generic finasteride 1 mg costs approximately $3 to $10 per month at retail pharmacies with a GoodRx coupon [11]. Strut Health's compound topical formulations typically run $35 to $75 per month, which reflects the compounding markup. Sildenafil 20 mg (generic) costs roughly $1 to $2 per dose at retail, while Strut Health's compound ED formulations range from $40 to $85 monthly depending on the product. Patients paying out-of-pocket should compare these prices against retail generics with discount programs.

On formulation, Strut Health differentiates through compounding. Compound topical finasteride/minoxidil blends offer convenience (one application instead of two products), but patients should know that compounded drugs do not undergo the same FDA review as commercially manufactured generics [2]. The FDA has issued multiple warning letters to compounding pharmacies for quality violations, including potency failures and contamination [12].

Lab Work and Monitoring Gaps

One area where direct-to-consumer telehealth platforms consistently fall short is longitudinal monitoring. Strut Health does not require lab work before prescribing finasteride or PDE5 inhibitors. This approach has trade-offs.

For finasteride, the primary monitoring concern is PSA. The AUA and Endocrine Society both recommend that men over 40 taking 5-alpha-reductase inhibitors have baseline and periodic PSA testing [5][9]. Finasteride reduces PSA by about 50% within 6 months, so any subsequent PSA value must be doubled to estimate the true level [13]. A man using Strut Health who gets a PSA test from his primary care physician might receive a falsely reassuring result if the doctor is unaware of the finasteride use. This disconnect is not unique to Strut Health. It exists across all asynchronous telehealth prescribers of finasteride.

For ED medications, the ACC/AHA recommends cardiovascular risk assessment before prescribing PDE5 inhibitors, since ED itself is an independent predictor of future cardiovascular events [14]. A 2018 meta-analysis in the European Heart Journal found that men with ED had a 43% increased risk of cardiovascular events (RR 1.43, 95% CI 1.30 to 1.57) [15]. Treating the ED symptom without evaluating the underlying vascular risk is a missed clinical opportunity. Brick-and-mortar physicians typically check blood pressure, lipids, and fasting glucose during an ED evaluation. Online questionnaires cannot replicate this assessment.

Is Strut Health Legitimate?

Strut Health is a legally operating telehealth company. It uses licensed prescribers and ships medications from licensed pharmacies. That makes it legitimate in the regulatory sense. Whether it meets the standard of care for every patient interaction is a separate question.

The Federation of State Medical Boards' 2023 policy on telehealth prescribing affirms that an appropriate provider-patient relationship can be established through telehealth, including asynchronous modalities, provided the encounter meets the same standard of care as an in-person visit [16]. The FSMB also states that providers must use clinical judgment to determine when a synchronous encounter or in-person referral is necessary.

Patient reviews on independent platforms (Trustpilot, Reddit, BBB) are mixed but skew positive for convenience and shipping speed. Common complaints include difficulty reaching customer support, auto-renewal charges, and limited prescriber interaction. These complaints are nearly universal across the DTC telehealth category, not specific to Strut Health.

The bottom line: Strut Health is a real company prescribing real medications through a legal framework. It is not a scam. But "legitimate" and "optimal" are different standards. Patients with complex medical histories, multiple medications, or cardiovascular risk factors may be better served by a platform offering synchronous visits or, ideally, by a physician who can perform a physical examination and order labs.

Who Should and Should Not Use Strut Health

Strut Health works best for younger men (under 40) with straightforward androgenetic alopecia or situational ED, no significant medical history, and no current medications that interact with finasteride or PDE5 inhibitors. This profile describes the majority of Strut Health's customer base.

Patients who should think twice include men over 50 (where PSA monitoring matters most), men taking nitrates or alpha-blockers, men with a personal or family history of breast cancer (finasteride alters hormonal pathways relevant to male breast cancer risk) [9], and anyone with uncontrolled hypertension or recent cardiovascular events. For these patients, the AUA recommends an in-person evaluation before starting PDE5 inhibitor therapy [5].

The FDA Modernization Act 2.0 and evolving state telehealth laws continue to shape what platforms like Strut Health can and cannot do. Some states now require at least one synchronous encounter before prescribing controlled substances, though finasteride and PDE5 inhibitors are not scheduled drugs [17]. Patients should verify that their state permits asynchronous prescribing for their desired treatment.

Compounding Pharmacy Considerations

Strut Health relies heavily on compounded medications. This business model allows product differentiation (custom blends, novel delivery systems) and higher margins than dispensing generic tablets. Patients benefit from convenience but absorb specific risks.

The FDA distinguishes between 503A pharmacies (which compound for individual prescriptions) and 503B outsourcing facilities (which can compound in larger batches under more oversight) [2]. Patients should ask Strut Health which type of facility fills their prescriptions. A 503B facility operates under current good manufacturing practice (cGMP) requirements and FDA inspection, while a 503A pharmacy does not.

A 2020 FDA survey found that 28% of tested compounded drug samples failed quality testing for potency, sterility, or content uniformity [12]. This does not mean all compounded drugs are unsafe, but it does mean that a patient receiving compounded topical finasteride from Strut Health may receive a product with more dosing variability than an FDA-approved generic tablet manufactured under cGMP.

For patients who prefer FDA-approved formulations, retail generic finasteride 1 mg and generic sildenafil 20 mg remain available at low cost through traditional pharmacies or telehealth platforms that dispense commercial generics rather than compounds. The clinical efficacy data for finasteride [3] and sildenafil [7] was generated using the FDA-approved formulations, not compounded versions.