Telehealth turned prescription hair loss treatment from a dermatology referral into a form you fill in on your phone. That is a genuine improvement in access. It also created a crowded market where the differences between platforms are smaller than the marketing implies and larger than the price tags suggest.
This page covers four platforms and what each is genuinely best at.
Quick Answer
For most men, a compounded topical finasteride plus minoxidil from Strut Health is the best starting point — it delivers finasteride's benefit with lower systemic exposure, through a LegitScript-certified platform. Happy Head is the pick for custom compounded formulas, MangoRx if you want oral minoxidil, which the big three largely do not offer, and RXSpan MD if you specifically want dutasteride. But if you have insurance and a cooperative GP, generic finasteride through a normal pharmacy is cheaper than all of them.
How This Page Was Assembled
Worth stating before anything else, because it affects how you should read the rest.
The four platforms below are ones we have a commercial relationship with. We also review Hims, Keeps and Ro on this site, and we have no relationship with any of them — so they are not listed here as options with buttons attached, because we would be sending you somewhere we cannot vouch for commercially and earning nothing for the referral either way.
That cuts both ways, and the honest version is worth saying: Keeps and Ro are frequently cheaper than anything on this page for plain generic oral finasteride. If lowest price is your only criterion, read our Keeps review and our Ro review and go with whichever wins on the day. Those reviews are not softened by the absence of a commission, and the pricing in them is not adjusted in our favour.
What the platforms below offer that the big three largely do not is compounded formulations — topical finasteride, minoxidil combined with spironolactone, dutasteride — which a retail pharmacy cannot dispense and which is the main clinical reason to choose one telehealth service over another.
What Actually Matters When Choosing
LegitScript certification. This is the single most useful filter. It signals the platform has been vetted for legitimate pharmacy practice, and it separates real telemedicine from grey-market sellers. See our certification explainer for what the badge means.
Whether a physician genuinely reviews your case. Every platform claims a "licensed physician." What differs is whether that means real review or a questionnaire that auto-approves anyone who does not tick a contraindication box.
What molecule and what dose. "Topical finasteride" is not one product. Concentrations and vehicles differ substantially between compounding pharmacies, and so does absorption. Ask, and get it in writing.
How the subscription cancels. This is where the complaints in this category concentrate. Check before you enter a card, not after.
The Four Platforms
Strut Health — Best Starting Point for Most Men
Strut compounds physician-customised formulas through a LegitScript-certified platform, and its topical finasteride and minoxidil combination is the one we point to most often across this site. The reason is specific: topical finasteride offers the benefit of finasteride with lower systemic exposure than the oral tablet, which matters to the substantial number of men who are put off by finasteride's systemic side effect profile.
Strut also compounds minoxidil with spironolactone for women, which is a genuinely different offering — most platforms do not treat female pattern loss with a prescription formula at all.
The caveat: compounded topical finasteride has a thinner evidence base than the oral tablet, which has decades of trial data behind it. Lower systemic exposure is a real advantage, but you are trading some certainty for it.
Happy Head — Best for Custom Compounded Formulas
Happy Head builds prescription topical formulas around your specific presentation, and will prescribe dutasteride as well as finasteride. If your situation is not standard — you have tried and reacted badly to oral finasteride, or you want several actives in one vehicle — this is the platform with the most formulation flexibility.
The caveat is the same as Strut's, amplified: the more customised the formula, the further you are from anything that has been trialled as a formula. That is a reasonable trade for someone who has already failed the standard options, and a poor one for someone who has not tried them yet.
MangoRx "Grow" — Best for Oral Minoxidil
The thing that actually distinguishes MangoRx is easy to miss behind the mint-chewable marketing: the minoxidil in Grow is oral, not topical.
That is a genuinely different treatment, not a different delivery of the same one. Oral minoxidil is prescribed off-label for hair loss, works systemically rather than on the scalp surface, and is the option many people move to when topical minoxidil is too messy, too irritating, or simply has not worked. It is also not something you can buy over the counter at any price. Hims, Keeps and Ro are all built around topical minoxidil plus oral finasteride, so the platform you would naturally compare MangoRx against mostly does not sell what MangoRx sells. Combining oral minoxidil with finasteride in a single prescription narrows the field further still.
That is the reason to consider it, and the convenience of one chewable is a bonus on top rather than the argument.
Two honest caveats. It sits at the premium end: generic oral finasteride plus topical minoxidil elsewhere typically runs $30–40 a month, and a compounded topical from Strut or Happy Head is comparable or cheaper — so if topical minoxidil suits you fine, this is not the value pick. And the biotin and D3 are marketing rather than mechanism; biotin does nothing unless you are deficient. Oral minoxidil also carries systemic effects topical largely avoids, so read oral vs topical before choosing it.
Our full assessment is in the MangoRx Grow review.
RXSpan MD — Best for Dutasteride
Dutasteride inhibits both type I and type II 5-alpha reductase, where finasteride inhibits mainly type II, and it produces greater DHT suppression. It is not FDA-approved for hair loss in the US, so it is prescribed off-label, and most platforms will not do it. RXSpan MD is one of the few that will.
This is a considered choice, not a default. Greater DHT suppression means a greater chance of the same side effects that make some men stop finasteride, and the evidence base for hair loss is smaller. Read finasteride vs dutasteride before deciding.
How They Compare
| Platform | Best for | Key offering | Watch for |
|---|---|---|---|
| Strut Health | Most men starting out | Compounded topical fin + min; women's min + spironolactone | Topical fin has thinner evidence than oral |
| Happy Head | Non-standard cases | Highly customised compounded formulas; dutasteride | The more custom, the less trialled |
| MangoRx | Oral minoxidil access | Oral minoxidil + finasteride in one chewable | Premium price; systemic effects; biotin and D3 are filler |
| RXSpan MD | Dutasteride access | Off-label dutasteride prescribing | Stronger DHT suppression, more side-effect risk |
When Telehealth Is the Wrong Answer
Three cases where the honest advice is to spend your money elsewhere.
You have insurance and a cooperative GP. Generic finasteride through a normal pharmacy is frequently under $15 a month and is the same molecule as everything above. No subscription beats it on price. Telehealth's advantage is access and compounding, not cost.
You only want minoxidil. It is over the counter. Kirkland foam runs about $12 a month and needs no consultation at all. Paying a subscription for a prescription you do not need is the most common avoidable expense in this category.
Your hair loss is not androgenetic. If your shedding is sudden and diffuse, you may be looking at telogen effluvium, which resolves on its own and calls for blood tests rather than a prescription. Patchy loss, scalp pain or scarring need a dermatologist, not a subscription.
Before you treat, test
Not sure what's driving your hair loss?
If you are not certain what is driving your hair loss, testing first is cheaper than treating the wrong thing — ferritin, thyroid and vitamin D among the markers covered, with a physician's review.
The Big Three, Reviewed Independently
We cover the largest platforms in full, with no commercial relationship to any of them:
- Hims review — widest product range, including topical finasteride
- Keeps review — consistently strong value on oral finasteride and minoxidil
- Ro review — frequently the lowest price on generic finasteride
- Hims vs Keeps vs Ro — the three compared head to head
If one of those is the right answer for you, take it. We would rather you got treated than routed.
The Bottom Line
The platform matters less than the prescription. Decide what you actually want — oral finasteride, topical finasteride, dutasteride, a women's compounded formula — and then pick the platform that dispenses it well.
For most men that is compounded topical finasteride and minoxidil, and Strut is where we would start. If you have insurance and a GP who will write the script, start there instead and keep the difference.