Strut Health Clinical Gaps and Limitations: What They Miss

Strut Health's Business Model: Cash-Pay Compounding

Strut Health operates as an asynchronous telehealth platform connecting patients with licensed prescribers who evaluate questionnaire responses and photos. No video visit is required for most consultations. The company then fulfills prescriptions through affiliated compounding pharmacies, shipping directly to the patient.

This model has clear convenience advantages. Patients in rural areas or those without insurance get access to prescription treatments for hair loss, erectile dysfunction, and certain dermatologic conditions without an in-person visit. The American Telemedicine Association has documented that asynchronous models can reduce barriers to care for conditions amenable to remote evaluation [1].

The limitation is structural. Compounding pharmacies operate under state boards of pharmacy, not FDA premarket approval. The FDA has repeatedly noted that compounded drugs are not FDA-approved and do not undergo the same rigorous testing for safety, efficacy, or manufacturing consistency [2]. A 2023 FDA safety communication specifically warned about risks associated with compounded semaglutide products, including dosing errors and sterility failures [3]. While Strut does not currently offer compounded semaglutide, the underlying principle applies to any compounded medication on their formulary.

No Baseline Lab Work: The Biggest Clinical Gap

Strut Health does not require blood work before prescribing. That is a significant departure from guidelines.

For men presenting with hair loss, the American Academy of Dermatology recommends evaluating for iron deficiency, thyroid dysfunction, and hormonal imbalances before initiating treatment, particularly in diffuse or atypical patterns [4]. Androgenetic alopecia can overlap with telogen effluvium secondary to hypothyroidism or iron-deficiency anemia. Starting finasteride without checking a baseline DHT, free testosterone, or TSH means treating a symptom without confirming the diagnosis.

For erectile dysfunction, the American Urological Association's 2018 guideline states that clinicians should assess for cardiovascular risk factors, fasting glucose, lipid profiles, and testosterone levels as part of the ED workup [5]. ED in men under 40 may be the first clinical sign of undiagnosed type 2 diabetes or subclinical atherosclerosis. A JAMA Internal Medicine study of 1,757 men found that ED preceded a cardiovascular event by a mean of 3 years in men aged 40 to 49 [6].

Skipping labs does not just miss the diagnosis. It misses the opportunity for early intervention on conditions far more consequential than hair loss or ED. Dr. Arthur Burnett, Professor of Urology at Johns Hopkins, has stated: "Erectile dysfunction is a sentinel marker for cardiovascular disease, and any evaluation that bypasses vascular risk assessment is clinically incomplete."

Narrow Formulary: What Strut Prescribes (and What It Cannot)

Strut's prescription menu centers on compounded topical finasteride, compounded topical minoxidil combinations, compounded sildenafil or tadalafil troches, tretinoin creams, and select peptide formulations. The variety sounds broad. The actual therapeutic range is narrow.

For hair loss, Strut does not offer oral dutasteride, which a 2019 meta-analysis in the Journal of the American Academy of Dermatology showed produced superior hair count increases versus finasteride at 24 weeks (standardized mean difference 0.27, 95% CI 0.11 to 0.43) [7]. Strut also does not offer low-dose oral minoxidil (LDOM), which has gained traction after a 2022 systematic review in the Journal of the American Academy of Dermatology documented that oral minoxidil 2.5 to 5 mg daily was effective and well-tolerated for androgenetic alopecia in both sexes [8]. The Endocrine Society's 2019 clinical practice guideline on androgen therapy in women also outlines when anti-androgen therapy might be appropriate for female pattern hair loss, an option absent from Strut's catalog [9].

For ED, Strut does not prescribe FDA-approved brand formulations of sildenafil or tadalafil. It relies on compounded troches and sublingual tablets. The FDA-approved oral tablets (Viagra, Cialis, and their generics) have decades of post-marketing surveillance data. Compounded troches have none. Their bioavailability has not been established in published pharmacokinetic studies.

Strut does not offer injectable testosterone, GLP-1 receptor agonists, or thyroid medications. Patients with hormonal or metabolic drivers of their symptoms are directed elsewhere. This is honest, but it means Strut treats presentations, not root causes.

Asynchronous Prescribing: Convenience vs. Clinical Rigor

The questionnaire-based evaluation model has efficiency benefits. It also has documented failure modes.

A 2021 study published in JAMA Dermatology evaluated direct-to-consumer teledermatology platforms and found diagnostic concordance with in-person dermatologists was only 63% for asynchronous photo-based consultations [10]. For conditions like acne rosacea versus perioral dermatitis, or androgenetic alopecia versus frontal fibrosing alopecia, the distinction matters because the treatments differ.

Strut's model does not include dermoscopy, pull tests, or scalp biopsy referrals. These are standard components of an alopecia workup per AAD guidelines when the diagnosis is uncertain [4]. Patients with scarring alopecias could receive finasteride for months before realizing the underlying condition is progressive and irreversible without immunosuppressive therapy.

For ED specifically, the AUA guideline recommends a focused physical examination including genital, prostate, and peripheral vascular assessment in the initial evaluation [5]. Peyronie's disease, for example, affects an estimated 3 to 9% of men and can cause ED. It requires physical examination to diagnose. No questionnaire captures plaque palpation.

Peptide Offerings: Limited Transparency

Strut has expanded into peptide therapy, including BPC-157 and certain growth hormone secretagogues. The category deserves scrutiny.

BPC-157, a synthetic pentadecapeptide derived from gastric juice, has shown tissue-healing effects in rodent models across multiple organ systems [11]. Zero completed randomized controlled trials in humans have been published as of May 2026. The gap between animal data and clinical prescribing is wide. The FDA issued a warning letter in 2023 regarding peptide products marketed without approved applications [12].

Strut's website does not publish which specific peptides are available in every state, the compounding pharmacy source for each peptide, third-party purity testing results, or post-treatment monitoring protocols. Patients ordering peptides through any telehealth platform should ask for certificates of analysis and verify that the compounding pharmacy holds current state and federal registrations.

How Strut Compares to Guideline-Concordant Alternatives

The comparison that matters is not Strut vs. other telehealth brands. It is Strut vs. what the clinical guidelines recommend.

The Endocrine Society's 2018 guideline on testosterone therapy in men with hypogonadism requires two morning total testosterone measurements below 300 ng/dL before initiating treatment, plus screening for contraindications including polycythemia, untreated sleep apnea, and active prostate cancer [13]. Strut does not prescribe testosterone, so this comparison highlights a category gap rather than a quality gap within existing offerings.

For hair loss, the 2019 British Association of Dermatologists' guideline on male androgenetic alopecia recommends discussing the natural history, setting realistic expectations with photographic documentation, and offering finasteride 1 mg daily or minoxidil 5% topical as first-line, with combination therapy for inadequate responders [14]. Strut covers the basic pharmacology. It misses the structured follow-up.

A 2020 Cochrane review of interventions for female pattern hair loss identified minoxidil 5% topical as having the strongest evidence, while noting that spironolactone and cyproterone acetate may benefit select patients [15]. Strut does not offer hormonal anti-androgens for women.

Dr. Wilma Bergfeld, former president of the American Academy of Dermatology, has noted: "The most common error in alopecia management is treating before you have a firm diagnosis. A biopsy costs less than six months of the wrong medication."

Published Outcomes: The Missing Data

Strut Health has not published any clinical outcomes data, patient satisfaction surveys with validated instruments, or treatment response rates in peer-reviewed journals. This is not unique to Strut. Most direct-to-consumer telehealth platforms have the same deficit.

But the absence matters. A 2022 analysis in the Annals of Internal Medicine found that DTC telehealth companies prescribed antibiotics at higher rates than in-person visits for conditions where watchful waiting was appropriate [16]. Without outcomes tracking, there is no mechanism to detect overprescribing, underprescribing, or treatment futility.

For context, the STEP-1 trial (N=1,961) established that semaglutide 2.4 mg produced 14.9% mean body weight loss at 68 weeks versus 2.4% for placebo [17]. That kind of transparent, published, peer-reviewed evidence is what separates treatments with demonstrated efficacy from treatments with presumed efficacy. Compounded formulations prescribed through DTC platforms operate in the latter category until proven otherwise.

Cost Transparency and Insurance Gaps

Strut's pricing ranges from approximately $30 per month for topical hair loss treatments to $95 per month for combination ED formulations. Consultation fees are typically included in the product price. No insurance is accepted.

This is competitive with other DTC telehealth platforms. It is not competitive with generic finasteride (roughly $4 to $10 per month at retail pharmacies with a GoodRx coupon) or generic tadalafil 5 mg daily ($8 to $15 per month). The premium pays for convenience, compounded formulations, and the telehealth consultation. Whether the compounded formulations offer clinical advantages over standard generics has not been established in comparative trials.

Patients with insurance that covers dermatology or urology visits may actually pay less out of pocket for a guideline-concordant workup (including labs and an in-person examination) than for a year of Strut subscriptions without any lab work.

The Bottom Line on Strut Health

Strut is a licensed, legal telehealth operation filling a real convenience gap for men seeking hair loss and ED treatment without insurance or in-person visits. The prescribers are licensed. The compounding pharmacies are regulated at the state level.

The clinical gaps are real. No labs. No physical exams. A narrow formulary excluding oral dutasteride, low-dose oral minoxidil, injectable testosterone, and hormonal anti-androgens. No published outcomes. Peptide offerings without published human trial data. These are not minor omissions for a platform treating YMYL health conditions.

Patients considering Strut should request that their prescriber order baseline labs (CBC, CMP, lipid panel, testosterone, TSH, ferritin) even if the platform does not require them, and should establish care with a primary care physician for cardiovascular risk screening if they are being treated for ED. The AUA guideline is explicit: a PDE5 inhibitor prescription without cardiovascular risk assessment is an incomplete evaluation [5].