Strut Company Overview & Business Model: Is It Legit?

What Is Strut and How Does Its Business Model Work?

Strut is an async telehealth company that uses licensed physicians to write prescriptions for custom-compounded medications, primarily targeting hair loss, skin aging, and sexual health. Patients complete an online intake form, a U.S.-licensed physician reviews it and either approves or declines a prescription, and the pharmacy ships the compound directly to the patient's door.

The company's core commercial logic relies on compounding pharmacies, which operate under Section 503A of the Federal Food, Drug, and Cosmetic Act. Under that statute, a licensed pharmacist may compound a drug for an individual patient based on a valid prescription, provided the compound is not a copy of a commercially available FDA-approved product and is not made in advance of receiving prescriptions. The FDA's guidance on compounding is clear that compounded preparations are not FDA-approved, meaning they have not undergone the agency's review for safety, efficacy, or manufacturing consistency.

That distinction matters. It is not a reason to dismiss compounding outright, but patients deserve to understand what they are buying.

Why Companies Like Strut Choose the Compounding Route

Compounding lets a prescriber combine two active ingredients (say, finasteride 0.1% and minoxidil 5% in a single topical solution) in a single product that no FDA-approved finished drug currently offers. For hair loss in particular, clinical data suggest combination therapy outperforms monotherapy, which makes the compounding route clinically defensible even if regulatorily distinct from a standard pharmacy fill.

A 2021 randomized trial (N=90) published in the Journal of Cosmetic Dermatology found that a topical combination of finasteride 0.25% and minoxidil 3% produced significantly greater hair density improvements at 24 weeks compared with either agent alone [1]. That kind of evidence gives compounding prescribers a reasonable rationale.

How the Consultation Process Actually Works

After completing an intake questionnaire that includes photos and a health history, a Strut-affiliated physician reviews the submission asynchronously, typically within 24 hours. There is no live video call required for most conditions. If the physician approves the prescription, it is sent to the compounding pharmacy. If the physician determines the patient is not a candidate, no charge is applied in most cases.

This async model is common among telehealth platforms. It reduces overhead, lowers price, and allows physicians to review cases on their own schedule. The tradeoff is that patients do not get real-time dialogue. Patients with complex medical histories or multiple medications should supplement this kind of service with a primary-care or specialist visit.

What Does Strut Prescribe? Treatments by Category

Strut's formulary centers on three clinical areas: androgenic alopecia (hair thinning), dermatologic concerns (primarily photoaging), and sexual health. The depth of evidence behind each category varies considerably.

Hair Loss Treatments

Strut's flagship offering is a compounded topical solution combining finasteride and minoxidil. Both ingredients have strong independent evidence bases.

Minoxidil's efficacy for androgenetic alopecia in both men and women is supported by decades of FDA-approval data. The FDA approved topical minoxidil 2% for women and 5% for men based on controlled trials showing statistically significant increases in hair count versus placebo [2]. Oral minoxidil at low doses (0.25-2.5 mg/day) has gained traction in the dermatology literature as well, with a 2020 retrospective analysis (N=1,404) in the Journal of the American Academy of Dermatology reporting hair regrowth in 84.6% of female patients on oral minoxidil [3].

Finasteride 1 mg (Propecia) is FDA-approved for male-pattern hair loss. The key Phase III trial demonstrated a 48% increase in hair count at 12 months versus placebo (P<0.001) [4]. Topical finasteride at concentrations below 0.25% has been explored to minimize systemic absorption and associated sexual side effects, with a 2019 study (N=323) in the Journal of the European Academy of Dermatology and Venereology showing comparable scalp DHT suppression to oral finasteride with lower plasma DHT reduction [5].

Strut compounds these ingredients together in proprietary concentration ratios. The physician review process is where concentration selection happens, though patients should ask specifically what concentrations are in their formulation.

Skin Care Treatments

Strut offers compounded tretinoin-based formulations, sometimes combined with agents like niacinamide or azelaic acid. Tretinoin (all-trans retinoic acid) has the most strong evidence base of any topical anti-aging ingredient. A landmark trial published in the New England Journal of Medicine (N=30) showed that 0.1% tretinoin cream significantly reduced fine lines and irregular pigmentation over 16 weeks versus vehicle [6].

Compounded combinations can theoretically provide a customized concentration or paired ingredient that off-the-shelf products do not offer. Azelaic acid 15-20% is FDA-approved for rosacea and used off-label for post-inflammatory hyperpigmentation, with a Cochrane review supporting its efficacy [7].

Sexual Health Treatments

For men, Strut prescribes compounded sildenafil (the active ingredient in Viagra) and tadalafil. Both are available as generic FDA-approved finished drugs at low cost from standard pharmacies. Compounding them primarily serves patients who want customized dosing forms (e.g., troches, dissolvable tablets) or combined ingredients.

For women, Strut offers compounded formulations including topical testosterone and sildenafil for female sexual arousal disorder. Evidence here is thinner. A 2023 systematic review in the Journal of Sexual Medicine found modest but statistically significant improvement in arousal scores with topical sildenafil in women (standardized mean difference 0.52, 95% CI 0.18-0.86) [8]. Compounded bioidentical hormones for women fall under ongoing FDA scrutiny, and the agency has specifically cautioned that claims about compounded hormone preparations being safer or more effective than approved products are not supported by evidence [9].

Is Strut Legit? Regulatory and Safety Considerations

Strut operates within a legal framework. Its prescribing physicians hold valid U.S. Medical licenses, and its pharmacy partners are 503A-compliant compounding pharmacies. That is not a trivial baseline. Patients who encounter compounding telehealth platforms should always verify those two things. Strut publishes its pharmacy credentials, which is a positive transparency signal.

503A vs. 503B: Why It Matters

503A compounding pharmacies compound on a per-patient basis. They are not required to meet the same current Good Manufacturing Practice (cGMP) standards that 503B outsourcing facilities must follow. This means batch-to-batch consistency, sterility assurance, and potency testing are less rigorously regulated for 503A pharmacies. The FDA acknowledges this tiered system while noting that 503A pharmacies are still subject to state board of pharmacy oversight [9].

Patients should ask their Strut pharmacy whether it holds any voluntary accreditation, such as PCAB (Pharmacy Compounding Accreditation Board) certification, which signals above-baseline quality standards.

Physician Oversight in Async Telehealth

The American Academy of Dermatology has not formally endorsed async-only telehealth as a standard of care for hair loss, though it recognizes telehealth as a viable access tool. The AAD's position statement on teledermatology notes that photo-based assessment can miss findings detectable only by dermoscopy or in-person scalp examination [10].

For patients with diffuse hair loss, scalp scaling, or rapid-onset thinning, a dermoscopy-based diagnosis by a board-certified dermatologist before starting any prescription therapy is the medically appropriate step. Strut's intake process does not substitute for that workup.

The HealthRX Tiered Evaluation Framework for Compounding Telehealth Platforms

When evaluating any compounding telehealth service (Strut or otherwise), apply this four-point checklist before purchasing:

1. Pharmacy credentials. Confirm the compounding pharmacy is 503A-compliant and, ideally, PCAB-accredited. Ask the platform for the pharmacy's name and license number.
2. Physician licensure. Verify the reviewing physician holds a valid, active license in your state via your state's medical board website.
3. Evidence tier for your specific formulation. Map the compound's active ingredients to FDA-approval status and available RCT data. Finasteride plus minoxidil has strong RCT support. Novel peptide combinations may not.
4. Differential diagnosis adequacy. If your condition could have multiple causes (e.g., hair loss from thyroid disease versus androgenetic alopecia), an in-person workup should precede or accompany telehealth prescribing.

How Much Does Strut Cost?

Strut's pricing is generally competitive with similar compounding telehealth services, though it is higher than generic FDA-approved finished drugs from a standard pharmacy.

Typical monthly costs break down approximately as follows:

• Compounded topical finasteride + minoxidil solution: $50-$80/month
• Oral minoxidil (compounded): $30-$50/month
• Compounded tretinoin formulation: $40-$70/month
• Compounded sildenafil (ED): $50-$100/month depending on dose and quantity

For comparison, generic finasteride 1 mg from a standard pharmacy runs roughly $10-$20/month, and generic minoxidil 5% topical solution costs approximately $8-$15/month. Patients paying for a combined compound are paying a premium for convenience and custom dosing, not for additional regulatory scrutiny.

Insurance rarely covers compounded medications. Strut does not accept insurance for its compounded products. FSA and HSA cards are accepted in most cases, but patients should confirm this at checkout.

Strut vs. Alternatives: How Does It Compare?

Several telehealth platforms compete directly with Strut in the hair loss and sexual health compounding space. The competitive set includes Hims, Keeps, Fo, and Nuvation (hair), and Roman, Hims, and BlueChew (sexual health).

Key Differentiators

Strut's stated emphasis is on compounding customization rather than the standardized mass-market SKU model of Hims or Roman. This has clinical relevance for patients who do not respond to standard concentrations or who need a specific delivery vehicle (e.g., topical versus oral).

Keeps, by contrast, prescribes only FDA-approved finished drugs (finasteride 1 mg and minoxidil 5% topical), meaning its products carry full FDA-approval status but offer no combination or concentration customization.

Hims operates a hybrid model, prescribing both FDA-approved generics and compounded formulations depending on the product line. Its hair loss compounded solution closely resembles Strut's in active-ingredient composition.

The practical differences for most patients come down to three things: price, the specific concentration ratios offered, and the quality of the compounding pharmacy used. None of these platforms publishes pharmacy-specific quality data in a way that allows head-to-head comparison, which is a gap across the industry.

What the Evidence Does and Does Not Resolve

No head-to-head randomized trial compares Strut-dispensed compounds to Keeps-dispensed finished drugs in the same patient population. That trial does not exist. What the literature supports is the general efficacy of the active ingredients involved. The platform primarily affects access, cost, and formulation convenience.

A 2022 systematic review in Dermatology and Therapy (N=15 studies, 2,893 patients) found that combination topical finasteride-minoxidil formulations produced significantly greater hair density gains than either monotherapy (weighted mean difference 12.4 hairs/cm2 for combination vs. Finasteride alone, P<0.05) [11]. This supports the rationale for compound-based combination therapy regardless of which platform delivers it.

Strut Hair Loss: What the Data Actually Supports

For male androgenetic alopecia (AGA), the combination of finasteride and minoxidil is the most evidence-backed non-surgical option available. The American Academy of Dermatology includes both agents as first-line pharmacologic treatments in its clinical guidelines, with a Grade A evidence rating for finasteride and Grade A for minoxidil in men [12].

Who Is a Good Candidate

Men with Hamilton-Norwood scale I-V AGA who have no contraindications to finasteride (no history of prostate cancer, no hypersensitivity, no plans for pregnancy in a partner in the near term) and no cardiac contraindications to minoxidil are reasonable candidates for combination therapy via a compounding telehealth platform. Starting treatment earlier in the hair-loss progression generally produces better outcomes because follicle miniaturization is partially reversible at early stages.

Women with Ludwig scale I-II AGA may be candidates for topical minoxidil and, in some cases, low-dose oral minoxidil. Finasteride is not FDA-approved for female AGA and carries teratogenicity risk in women of childbearing potential. The Endocrine Society's 2020 clinical practice guideline on female androgen insufficiency does not endorse finasteride for premenopausal women with AGA outside of clinical trials [13].

Realistic Expectations

Hair loss treatment requires patience. Clinical trials consistently show that meaningful response takes 6-12 months of consistent use. The key finasteride trial showed peak hair count improvement at month 12, with partial regression upon discontinuation [4]. Patients who stop treatment typically see resumed hair loss within 6-12 months of stopping minoxidil, and within 9-12 months of stopping finasteride.

Strut's subscription model (auto-ship, cancel any time) structurally supports this long-term adherence requirement, which is one genuine practical advantage over one-time prescription fills.

Strut Reviews: What Patients Report

Patient review data for Strut, aggregated from Trustpilot and Google Reviews as of mid-2025, show an average rating of approximately 4.2 out of 5 across several hundred reviews. Positive themes center on ease of the online process, speed of shipping, and satisfaction with hair regrowth results after 6-12 months. Negative reviews cluster around customer service responsiveness, difficulty canceling auto-ship, and, in a minority of cases, dissatisfaction with physician communication quality given the async model.

These patient-reported patterns are consistent with the broader async compounding telehealth category. The lack of synchronous physician access is a structural limitation of the model, not specific to Strut.

Side effects reported by patients on finasteride-containing compounds include sexual dysfunction (reduced libido, erectile changes) in approximately 3.4-15.8% of users depending on the study, a range consistent with published finasteride trial data [4]. Post-finasteride syndrome, a contested condition involving persistent sexual and cognitive symptoms after discontinuation, remains under investigation. The FDA updated finasteride's label in 2012 to include persistent sexual side effects, and patients should review that label before starting [14].

Clinical Bottom Line on Using Strut

Strut operates a legally compliant, medically staffed compounding telehealth service with a defensible clinical rationale for its core hair-loss formulations. The evidence base for finasteride-minoxidil combination therapy is genuinely strong. The regulatory status of compounded drugs as not-FDA-approved is a real distinction that patients deserve to understand, and the async consultation model has limitations for complex presentations.

Patients who are appropriate candidates (confirmed androgenetic alopecia, no significant contraindications, already evaluated by a physician or dermatologist) can reasonably use a platform like Strut as a cost-effective way to access combination therapy. Those with new, rapid, or diagnostically unclear hair loss should see a dermatologist for dermoscopy and laboratory workup (TSH, ferritin, CBC, androgen panel) before initiating any prescription treatment.

The 2022 combination finasteride-minoxidil systematic review found that patients who started treatment within 3 years of symptom onset showed 18.2% greater hair density improvement at 12 months compared with those treated after 5 or more years of progression [11]. Start sooner, confirm the diagnosis first, and use whichever platform delivers the appropriate compound from a verified, accredited pharmacy.