Strut Best Alternatives for Each Use Case

What Strut Offers and Where Gaps Exist

Strut Health operates as a telehealth platform paired with a compounding pharmacy. Patients complete an online consultation, a licensed prescriber reviews their case, and medications ship directly. The core catalog spans three verticals: hair loss (compounded finasteride/minoxidil topicals), skin (tretinoin and custom acne formulations), and sexual health (compounded sildenafil and tadalafil).

The compounding model gives Strut flexibility to combine active ingredients into single formulations. A topical that blends finasteride 0.1% with minoxidil 5% is one example. These products solve a real convenience problem. They are not, however, FDA-approved finished dosage forms. The FDA has stated that compounded drugs "are not FDA-approved" and "do not undergo FDA premarket review for safety, effectiveness, or quality." This distinction matters. It does not make Strut illegitimate, but it means patients should weigh compounded products against alternatives that carry full regulatory approval.

The gaps worth noting: Strut does not offer GLP-1 medications, hormone replacement therapy, or lab work integration. Patients needing a broader clinical relationship will find the platform limited. Pricing transparency has also drawn criticism in online reviews, with some users reporting charges that exceeded initial quoted amounts.

Best Alternatives for Hair Loss Treatment

Androgenetic alopecia affects roughly 50% of men over age 50 and up to 40% of women by age 50, making it one of the most common reasons patients visit platforms like Strut. The two medications with the deepest evidence base are finasteride and minoxidil, both available through multiple telehealth competitors [1].

Hims offers oral finasteride 1 mg (FDA-approved) starting around $30/month, plus a topical finasteride/minoxidil spray. The oral formulation carries the strongest clinical backing. A key 2-year trial (N=1,553) demonstrated that finasteride 1 mg halted hair loss progression in 83% of men, with 66% showing measurable regrowth on vertex hair counts versus placebo [2]. Hims also provides optional dermatologist photo reviews, a feature Strut lacks.

Keeps focuses exclusively on hair loss and prices generic finasteride at roughly $25/month. The narrow focus means faster onboarding for patients who already know what they need. Keeps ships FDA-approved generics, not compounded versions.

Ro (Roman) bundles hair loss treatment with broader men's health services, including ED and metabolic health. Oral finasteride through Ro runs approximately $20-30/month. The platform also provides ongoing clinician messaging at no extra charge.

For patients specifically wanting topical finasteride to reduce systemic exposure, a 2022 systematic review in the Journal of the American Academy of Dermatology found that topical finasteride 0.25% significantly reduced scalp DHT while producing lower serum DHT suppression than oral dosing [3]. Both Strut and Hims offer this formulation. The difference is price: Strut's compounded topical typically costs $50-85/month, while Hims prices a comparable product around $40-50/month.

Best Alternatives for Acne and Anti-Aging

Tretinoin is the cornerstone of both acne and photoaging treatment. A Cochrane review of topical retinoids for acne confirmed that tretinoin reduces inflammatory and non-inflammatory lesions with high certainty of evidence [4]. For photoaging, the AAD guidelines list tretinoin as a first-line topical with Level I evidence for improving fine wrinkles, dyspigmentation, and skin texture [5].

Curology remains the most direct Strut competitor in this space. Curology's model is nearly identical: an online consultation followed by a custom compounded formula. Typical Curology formulations combine tretinoin (0.01%-0.05%), azelaic acid, and clindamycin or niacinamide. Pricing starts around $30/month for the subscription, including prescriber access. Curology's scale advantage (over 1 million subscribers reported) translates to a more developed feedback loop between patients and providers.

Apostrophe (now Honeydew) differentiates by offering both compounded and FDA-approved prescription options. A patient can receive brand-name tretinoin 0.05% cream if they prefer an FDA-approved product, or choose a compounded multi-ingredient formula. Pricing ranges from $75-150 for a 90-day supply of standard tretinoin.

Nurx provides tretinoin prescriptions starting around $25/month, focusing on straightforward prescribing rather than custom compounding. For patients who want proven concentrations (0.025%, 0.05%, or 0.1%) without additives, Nurx is efficient.

Dr. Jenny Liu, a board-certified dermatologist at the University of Minnesota, has noted that "the efficacy of tretinoin in both acne and photoaging is well-established across decades of randomized controlled trials, and the primary variable affecting outcomes is patient adherence rather than formulation vehicle" [6]. This observation cuts against the idea that compounded "custom" blends deliver meaningfully better results than standard tretinoin prescriptions.

Best Alternatives for Erectile Dysfunction

Phosphodiesterase type 5 (PDE5) inhibitors remain first-line therapy for erectile dysfunction, with AUA guidelines recommending sildenafil, tadalafil, vardenafil, or avanafil as initial pharmacotherapy [7]. The evidence base is extensive: a meta-analysis of 130 trials (N=36,476) published in the European Urology journal found PDE5 inhibitors improved erectile function scores by a mean of 8.3 points on the IIEF-5 scale versus 3.5 for placebo [8].

Strut compounds sildenafil and tadalafil into sublingual troches, claiming faster absorption. These troches are not FDA-approved, and published bioequivalence data comparing sublingual troches to standard oral tablets is limited. Patients should weigh convenience against the regulatory gap.

BlueChew offers chewable sildenafil and tadalafil tablets. Plans start at approximately $20/month for sildenafil (6 tablets). Like Strut, BlueChew uses compounded formulations.

Hims provides both FDA-approved generic sildenafil ($2-4/dose) and compounded options. Generic sildenafil 20 mg tablets (prescribed off-label, originally approved as Revatio for pulmonary hypertension) are often the most cost-effective choice. A prescription for thirty 20 mg tablets through Hims or a GoodRx coupon at a retail pharmacy can cost under $15.

Ro (Roman) sells generic sildenafil starting around $2/dose and tadalafil (daily 5 mg or as-needed) at competitive prices. Ro also integrates cardiovascular screening questions and can order labs if risk factors are present.

The Endocrine Society's 2018 clinical practice guideline on testosterone therapy states: "In men with ED, we suggest PDE5 inhibitors as first-line therapy rather than testosterone, unless there is clear evidence of hypogonadism" [9]. For patients considering Strut's ED offerings, confirming that testosterone levels are adequate before starting PDE5 therapy is a step many telehealth platforms skip. HealthRX includes baseline labs in its evaluation.

Compounded vs. FDA-Approved: What the Evidence Shows

The compounding question sits at the center of any Strut evaluation. Compounded medications serve an important clinical role for patients who need dosage forms or ingredient combinations not commercially available. The National Academies of Sciences, Engineering, and Medicine published a comprehensive report acknowledging that compounding fills genuine gaps but noted that "the quality of compounded preparations is inherently more variable than that of FDA-approved drugs" [10].

Several high-profile safety events have sharpened this concern. The FDA's 2023-2024 actions against compounding pharmacies producing compounded semaglutide highlighted sterility failures, dosing inaccuracies, and adverse events tied to compounded products [11]. While these cases involved injectable peptides rather than topical or oral formulations like Strut's catalog, they illustrate systemic quality risks.

For hair loss specifically, patients choosing between Strut's compounded topical finasteride/minoxidil and an FDA-approved oral finasteride tablet should know this: the oral tablet has undergone full phase III evaluation with 5-year follow-up data. The Prostate Cancer Prevention Trial (N=18,882) provides long-term safety data that no compounded topical can match [12]. Compounded topicals may reduce systemic side effects, but that benefit is supported by smaller studies and pharmacokinetic modeling, not large randomized trials.

Cost Comparison Across Platforms

Price is often the deciding factor. Below is a representative comparison for the three most common treatment categories, based on publicly listed prices as of early 2026.

Hair loss (finasteride-based treatment, monthly cost): Keeps offers generic oral finasteride at approximately $25. Hims prices oral finasteride at $30 and its topical finasteride/minoxidil spray at $40-50. Ro lists oral finasteride at $20-30. Strut's compounded topical finasteride/minoxidil runs $50-85.

Tretinoin for acne or anti-aging (monthly cost): Nurx starts at $25 for standard tretinoin. Curology runs $30 for a custom compound. Apostrophe charges $25-50 depending on formulation. Strut prices tretinoin-containing compounds at $35-60.

Sildenafil for ED (per-dose cost): Hims offers FDA-approved generic sildenafil at $2-4/dose. Ro prices generic sildenafil similarly at $2-3/dose. BlueChew's chewable sildenafil starts at roughly $3-5/dose on subscription. Strut's compounded sublingual troches cost approximately $5-10/dose.

A pattern emerges. Strut's compounded formulations consistently price at a premium over competitors offering the same active ingredients, either as FDA-approved generics or as comparable compounds. The premium buys a specific formulation type (sublingual troche, multi-ingredient topical), but not necessarily better clinical outcomes.

How to Choose the Right Platform

The best Strut alternative depends on what you are treating and what you value.

If clinical evidence weight matters most, choose platforms dispensing FDA-approved generics. For hair loss, that means oral finasteride from Keeps, Hims, or Ro. For ED, generic sildenafil from Hims or Ro. For acne, standard tretinoin from Nurx or Apostrophe. These carry the full regulatory backing of bioequivalence testing and post-market surveillance.

If you want a compounded combination product for convenience, Curology (skin) and Hims (hair) offer comparable formulations to Strut at lower price points. Both have larger user bases and longer track records.

If you need a broader clinical relationship that includes labs, metabolic health, or hormone evaluation, platforms like HealthRX or Ro provide a more complete picture. The Endocrine Society recommends baseline testosterone, metabolic panel, and PSA screening before initiating certain therapies [9]. A platform that integrates lab ordering into its workflow reduces the chance of missed diagnoses.

Patients with insurance should also check whether their plan covers FDA-approved generics at a retail pharmacy. A GoodRx coupon for generic finasteride at CVS or Walgreens can bring the cost under $10/month, significantly cheaper than any telehealth subscription.

The final consideration is state licensing. Strut and its competitors operate under varying state-by-state prescribing regulations. Confirm that your chosen platform is licensed in your state before starting a consultation.