Strut Prescription Process: How the Intake Works, What Gets Prescribed, and Whether It's Worth It

How the Strut Intake Process Actually Works

The intake is entirely digital and asynchronous, meaning you never sit through a live video call unless a provider determines one is necessary. You select a treatment category (hair, skin, or sexual health), answer a structured medical questionnaire covering your health history, current medications, allergies, and treatment goals, then submit. Providers review submissions and either approve a prescription, request additional information, or decline treatment.

This model mirrors what the American Telemedicine Association describes as "store-and-forward" telehealth, where clinical information is collected and transmitted for provider review at a later time rather than in real-time [1]. A 2021 study in the Journal of the American Academy of Dermatology found that asynchronous teledermatology achieved diagnostic concordance with in-person visits in 83% of cases (N=500), supporting the clinical validity of this approach for dermatologic conditions like acne [2].

Photo uploads are required for skin-related consultations. Hair loss consultations ask for scalp images to help providers assess the pattern and severity of thinning. Sexual health consultations rely on the questionnaire alone. The entire submission takes roughly 10 to 15 minutes.

One important distinction: Strut does not accept insurance. All costs are out-of-pocket, bundled into the medication price. There is no separate consultation fee, but the per-month medication cost reflects the provider review, compounding, and shipping.

What Does Strut Prescribe? A Category-by-Category Breakdown

Strut's formulary centers on compounded medications, not brand-name commercial products. This is a defining characteristic of the platform and the primary reason its pricing structure differs from competitors that dispense FDA-approved branded drugs.

Hair loss. Strut's flagship hair product is a compounded topical formulation combining finasteride and minoxidil. Oral finasteride (1 mg daily) remains the first-line pharmacologic treatment for androgenetic alopecia in men, per the American Academy of Dermatology's 2023 guidelines [3]. A meta-analysis published in Dermatologic Therapy (2019) covering 3,000+ patients found that combining oral finasteride with topical minoxidil produced superior hair count increases compared to either agent alone [4]. Strut's compounded topical version aims to reduce systemic finasteride exposure while maintaining scalp-level efficacy. A 2022 randomized controlled trial (N=458) in the Journal of the American Academy of Dermatology showed that topical finasteride 0.25% reduced scalp DHT by 47% with significantly lower plasma finasteride levels than the oral form [5].

Skin care. Strut prescribes compounded tretinoin formulations for acne and anti-aging. Tretinoin is FDA-approved and backed by decades of evidence; a Cochrane review of 12 RCTs (N=2,424) confirmed topical retinoids as effective first-line acne treatment [6]. Strut also offers custom-compounded "super creams" that may combine tretinoin with niacinamide, azelaic acid, or other active ingredients.

Sexual health. For erectile dysfunction, Strut compounds sildenafil or tadalafil into sublingual troches. Both drugs are PDE5 inhibitors with well-established efficacy. A landmark RCT published in The New England Journal of Medicine demonstrated that sildenafil improved erections in 69% of attempts versus 22% for placebo (N=532) [7]. For premature ejaculation, Strut offers compounded sertraline-based formulations, drawing on evidence that SSRIs increase intravaginal ejaculatory latency time by 3- to 8-fold [8].

Is Strut Legit? Evaluating the Regulatory and Clinical Framework

The legitimacy question comes up frequently in online searches, and it deserves a direct answer. Strut operates with U.S.-licensed prescribers and a licensed compounding pharmacy. These are verifiable through state pharmacy board records.

Compounding pharmacies in the United States operate under Section 503A of the Federal Food, Drug, and Cosmetic Act, which permits patient-specific compounding by state-licensed pharmacies with valid prescriptions [9]. This is legal and regulated. The FDA does not approve individual compounded formulations the way it approves commercial drugs, which means compounded products do not undergo the same pre-market clinical trials. The FDA has stated clearly: "Compounded drugs are not FDA-approved. This means that FDA does not verify the safety or effectiveness of compounded drugs" [9].

This regulatory distinction matters. It does not make Strut illegitimate, but it does mean the specific formulations (ratios, bases, absorption profiles) have not been independently validated through Phase III trials the way branded Propecia or Viagra have. Patients should understand this tradeoff.

The National Association of Boards of Pharmacy (NABP) maintains accreditation standards for compounding pharmacies. Consumers can verify a pharmacy's standing through NABP's database. Dr. Matthew Seibel, a board-certified dermatologist, has noted: "Compounded topical finasteride is a reasonable option for patients who want to avoid systemic side effects, but patients should know the evidence base is smaller than for oral finasteride."

How Much Does Strut Cost? Pricing Compared to Alternatives

Strut's pricing varies by treatment category. Hair loss formulations typically run $35 to $55 per month. Erectile dysfunction troches range from $35 to $75 per month depending on the active ingredient and dose. Skin care formulations fall between $30 and $50 monthly.

These prices are competitive within the direct-to-consumer telehealth space but not always cheaper than generic alternatives obtained through a traditional pharmacy visit. Generic oral finasteride 1 mg costs as little as $3 to $15 per month at retail pharmacies with a GoodRx coupon [10]. Generic sildenafil 20 mg tablets can be obtained for $0.50 to $2.00 per tablet at retail [10].

The value proposition Strut offers is not raw cost savings on the active ingredient. It is the convenience of bundled consultation, compounding (particularly for combination topicals that are not commercially available), and direct shipping. Whether this convenience premium is worthwhile depends on individual priorities.

| Category | Strut (monthly) | Generic retail (monthly) | Branded retail (monthly) | |---|---|---|---| | Finasteride + minoxidil topical | $35, $55 | Not commercially available as combo | N/A | | Sildenafil (ED) | $35, $75 | $10, $30 (generic tablets) | $400+ (Viagra) | | Tretinoin (acne/anti-aging) | $30, $50 | $25, $75 (generic cream) | $200+ (Retin-A) |

Strut vs. Alternatives: How It Compares to Hims, Keeps, and Ro

The direct-to-consumer telehealth market for hair, skin, and sexual health has become crowded. Hims, Keeps, and Ro are the most frequently compared competitors. The differences are meaningful.

Hims offers both FDA-approved commercial generics and some compounded options. Hims added compounded semaglutide to its formulary before the FDA's June 2024 shortage declaration ended, which drew regulatory scrutiny [11]. Hims uses a mix of synchronous and asynchronous consultations and has a significantly larger provider network.

Keeps focuses almost exclusively on hair loss and prescribes standard generic finasteride and minoxidil. No compounding. Keeps tends to be the lowest-cost option for men who want straightforward oral finasteride.

Ro (Roman) covers a broader clinical range including weight management and smoking cessation. Ro prescribes FDA-approved generics and has an affiliated pharmacy (Ro Pharmacy) but does not emphasize compounding to the degree Strut does.

Strut's differentiator is compounding. If you want a topical finasteride-minoxidil combination in a single formulation, or a sublingual sildenafil troche instead of a standard tablet, Strut is built for that. If you want the lowest possible price on generic oral finasteride, Keeps or a GoodRx coupon at a retail pharmacy will likely cost less. A 2023 cross-sectional analysis of 16 telehealth platforms published in JAMA Dermatology found significant variation in both pricing and prescribing patterns, with compounding-focused platforms charging 20 to 40% more on average but offering formulations unavailable commercially [12].

The Provider Review: What Happens Behind the Scenes

After you submit the intake questionnaire, a licensed prescriber (physician, nurse practitioner, or physician assistant, depending on your state) reviews your medical history, current medications, and treatment goals. The review is not a rubber stamp, at least in principle. Providers can and do decline prescriptions when contraindications exist.

For finasteride, providers should screen for a history of depression, sexual side effects with prior use, and pregnancy exposure risk (finasteride is Category X) [3]. For PDE5 inhibitors, nitrate use is an absolute contraindication; concomitant alpha-blocker therapy requires dose adjustment [13]. A 2020 study in JAMA Internal Medicine (N=40 platform evaluations) found that some telehealth platforms failed to screen adequately for drug interactions in erectile dysfunction prescriptions [14]. Strut's own screening thoroughness is not independently audited in published literature, so patients should proactively disclose all medications.

The asynchronous model has a known limitation: it can miss nuances a live conversation would catch. The American Medical Association's 2023 telehealth policy guidelines recommend that asynchronous visits include "a clear mechanism for follow-up when the clinical picture is ambiguous" [15]. Strut does provide messaging access to providers after the initial consultation, which partially addresses this gap.

Strut's Compounding Model: Benefits and Risks

Compounding offers genuine clinical advantages in specific scenarios. Patients who need dose adjustments not available in commercial formulations, who have allergies to inactive ingredients in branded products, or who benefit from combination topicals that are not manufactured commercially can all benefit from compounding [9].

The risks are also real. A 2012 meningitis outbreak linked to the New England Compounding Center killed 76 people and sickened over 750, exposing failures in compounding pharmacy oversight [16]. That tragedy led to the Drug Quality and Security Act of 2013, which created a new category (503B outsourcing facilities) subject to FDA inspection [9]. Section 503A pharmacies like Strut's operate under state board oversight, not direct FDA inspection.

Quality control in compounding is variable. A 2023 FDA survey of 503A pharmacies found that 28% of tested compounded products failed potency or sterility standards [9]. This does not mean Strut's products specifically have quality issues, but it underscores the importance of choosing compounders with strong quality records. Patients can request certificates of analysis for their compounded medications.

Hair Loss Treatment Through Strut: What the Evidence Supports

Androgenetic alopecia affects roughly 50% of men over age 50 and up to 40% of women by age 70 [3]. Strut targets this population primarily with compounded topical finasteride-minoxidil combinations.

The evidence supporting topical finasteride is growing but still less extensive than for the oral form. A Phase II trial (N=458) published in 2022 demonstrated that topical finasteride 0.25% solution applied once daily produced statistically significant hair count increases versus placebo at 24 weeks, with a favorable side-effect profile [5]. Serum DHT suppression was 47% with topical versus 55 to 70% with oral finasteride 1 mg, suggesting lower systemic exposure [5].

Minoxidil 5% solution or foam is FDA-approved for androgenetic alopecia. A meta-analysis of 9 RCTs (N=1,820) confirmed that minoxidil 5% increased hair count by a mean of 18.6 hairs/cm² over placebo at 48 weeks [17]. The combination rationale is mechanistically sound: finasteride blocks DHT-driven follicular miniaturization while minoxidil stimulates follicular blood flow and prolongs anagen phase.

The compounded combination product itself has not been evaluated in a registrational trial. Individual ingredients are well-studied. The formulation as a whole is an extrapolation, which is standard practice in compounding but worth noting.

Skin and Sexual Health: Rounding Out the Formulary

Strut's dermatology offerings rely on tretinoin, the most extensively studied topical retinoid. A 2019 Cochrane systematic review confirmed that tretinoin 0.025% to 0.05% reduces inflammatory acne lesions by 40 to 70% over 12 weeks [6]. For photoaging, a 48-week RCT (N=204) published in Archives of Dermatology showed that tretinoin 0.05% significantly improved fine wrinkles, mottled hyperpigmentation, and skin roughness versus vehicle [18].

For erectile dysfunction, PDE5 inhibitors prescribed by Strut have Level 1 evidence from dozens of RCTs. The American Urological Association's 2018 guidelines designate oral PDE5 inhibitors as first-line pharmacotherapy for ED [13]. Strut's sublingual troche format is designed for faster onset compared to oral tablets. Limited pharmacokinetic data suggest sublingual sildenafil reaches peak plasma concentration in approximately 15 minutes versus 60 minutes for oral tablets, though this has not been tested in a large RCT [19].

Red Flags to Watch For (With Any Telehealth Platform)

No platform deserves blind trust. Patients using Strut or any competitor should watch for these warning signs: prescriptions issued without meaningful review of medication interactions, inability to reach a provider for follow-up questions, compounded formulations that change without notice, and auto-renewal charges that are difficult to cancel.

The FTC received over 37,000 complaints related to subscription telehealth services in 2023, with difficulty canceling auto-renewals being the most common issue [20]. Before subscribing to any telehealth platform, confirm the cancellation process in writing.