Strut Review: Honest Look at Pricing, Compounds, and Pros/Cons

The most discussed product at Strut is its topical finasteride formulation, and the pharmacological reasoning behind it is solid. Oral finasteride works systemically - it is absorbed into the bloodstream, circulates throughout the body, and inhibits 5-alpha reductase everywhere, including in tissues that have nothing to do with hair loss. This systemic inhibition is responsible for the sexual side effects (libido changes, ED, ejaculatory dysfunction) that affect a reported 3.8% of men in clinical trials. Topical finasteride takes a different route. Applied directly to the scalp, it inhibits 5-alpha reductase in the hair follicles - exactly where it needs to work. Because the delivery is local rather than systemic, blood levels of finasteride are dramatically lower. A 2018 study in the Journal of the European Academy of Dermatology and Venereology compared plasma finasteride levels in men using topical 0.25% finasteride versus oral 1mg finasteride and found plasma levels approximately 97% lower with the topical formulation while achieving comparable scalp DHT reduction. At 97% lower systemic exposure, the sexual side effect risk is substantially reduced. This is not zero risk - some finasteride does enter the bloodstream from topical application - but it represents a meaningful safety improvement for patients who want finasteride efficacy without full systemic exposure. Strut formulates topical finasteride at various concentrations (0.25%, 0.3%, 0.5%) in a proprietary vehicle designed for scalp penetration. Providers select the appropriate concentration based on patient history, degree of hair loss, and sensitivity considerations. This customization is what compounding enables - the ability to adjust dose and formulation to the individual rather than prescribing from a fixed commercial product.

One of the practical advantages of compounding is the ability to combine ingredients that are typically separate products into a single topical treatment. Strut offers finasteride+minoxidil as a combined spray or solution, allowing patients to apply both active ingredients in a single daily application rather than managing two separate treatments.

Finasteride blocks DHT, slowing follicle miniaturization - the primary mechanism of androgenetic alopecia. Minoxidil stimulates blood flow to follicles and extends the anagen growth phase. The two mechanisms are complementary: finasteride addresses the hormonal cause while minoxidil directly stimulates regrowth. Combination treatment is the most evidence-supported protocol for androgenetic alopecia.

Strut's combination formula typically contains topical finasteride 0.3% and minoxidil 5-6% in a lightweight, fast-drying vehicle formulated for scalp application. The single-product delivery removes the common patient problem of forgetting one component, applying them at different times, or not allowing adequate drying time between separate applications.

For men who have not responded adequately to oral finasteride alone, adding topical minoxidil through a combination formula is a natural escalation. For men starting treatment for the first time who want to address both mechanisms from the beginning, the combination formula makes clinical sense.

Strut offers a tiered approach to hair loss treatment that allows providers to match treatment intensity to the patient's degree of hair loss and risk tolerance:

Standard topical minoxidil (5% or 6%): The entry-level option for patients who want topical treatment without finasteride. Useful for patients who are ineligible for finasteride, prefer to start conservatively, or are managing mild early thinning. Priced at approximately $40-50/month.

Topical finasteride alone (0.25-0.5%): For patients who want DHT blockade without systemic exposure and are not yet ready to add minoxidil. Approximately $55-70/month.

Topical finasteride + minoxidil combination: The flagship Strut formula for male pattern baldness. One product addressing both the hormonal driver and direct follicle stimulation. Approximately $65-99/month.

Oral finasteride + topical minoxidil: For patients who prefer the established track record of oral finasteride and want to combine it with topical minoxidil. This is the most evidence-supported protocol for androgenetic alopecia, and Strut supports it as an option. Lower cost since oral finasteride is inexpensive.

Custom formulations for women: Topical minoxidil formulated for female pattern hair loss, at concentrations appropriate for women (2% or 5%). Topical spironolactone is also available as an alternative to oral spironolactone for women who want anti-androgen therapy without systemic effects.

The range of options and the ability to customize concentration and delivery format make Strut unusually flexible compared to platforms that offer one or two fixed products.

Strut prescribes standard ED medications (sildenafil, tadalafil) but also offers compounded formulations that take a different approach. The most distinctive are:

Sildenafil and tadalafil both work by inhibiting PDE5, but tadalafil has a 36-hour half-life versus sildenafil's 4-6 hours - which is why daily low-dose tadalafil can be combined with as-needed sildenafil for enhanced and more flexible ED management.

Topical trimix gel: The injectable trimix formulation (a combination of alprostadil, papaverine, and phentolamine) has long been used for severe ED that does not respond to PDE5 inhibitors. Strut offers a topical gel version that is absorbed through the penile skin, providing the vasodilatory effects of the ingredients without self-injection. This is a niche but clinically valuable option for patients who cannot use PDE5 inhibitors (due to nitrate medications or hemodynamic contraindications) or have not responded to them.

Oxytocin nasal spray: Oxytocin has emerging evidence for enhancing emotional connection and addressing the psychological component of sexual dysfunction. Strut offers it as a compounded nasal spray - an unusual option not available through mainstream telehealth platforms.

These compounded ED formulas are not for everyone - most patients with ED will do well on standard sildenafil or tadalafil at a much lower price. But for patients who have tried standard medications and need something different, or who have contraindications to first-line options, Strut's compounding flexibility is a genuine clinical resource.

Strut offers compounded semaglutide and tirzepatide for weight loss, consistent with the broader telehealth market. The approach is the same: weekly subcutaneous injection, titrated dosing protocol, provider monitoring. What Strut brings to this category is the compounding expertise it applies to formulation - the semaglutide or tirzepatide is sourced from FDA-registered 503B outsourcing facilities, and Strut's pharmacy team has experience with the quality requirements for injectable compounding.

Pricing for compounded semaglutide at Strut is approximately $199-249/month depending on dose, competitive with the broader market. Monthly check-ins with providers are included.

The differentiator Strut potentially offers in weight loss, though it is not as well-developed in this category as in hair loss, is the ability to compound supportive medications alongside the GLP-1. Ondansetron for GI management, B12 injections for energy support during aggressive caloric reduction, and other compounds can be added to the protocol by Strut providers - something a standard GLP-1 platform without compounding capabilities cannot easily do.

For weight loss specifically, platforms with more developed behavioral support infrastructure (Ro Body, Henry Meds) may offer better ongoing program support. Strut's advantage is in the compounding flexibility and the ability to add supportive treatments to the core GLP-1 protocol.

Strut follows the standard telehealth model: you complete an intake form with your health history and specific concerns, a licensed provider reviews it, and a prescription is issued if appropriate. The consultation is typically asynchronous - form-based rather than a scheduled video appointment. For straightforward cases (male pattern baldness with no complicating health conditions, ED without cardiac contraindications), the review is usually completed within a few hours during business days.

What is distinctive about the Strut consultation is the provider guidance on formulation selection. Rather than simply choosing between finasteride and no-finasteride options, the provider reviews your history and recommends the appropriate concentration and delivery format. A patient with a history of libido changes on oral finasteride gets a different recommendation than a patient starting treatment for the first time. This customization requires a provider who understands the compounding options available rather than filling a checkbox form.

Ongoing prescriptions at Strut are managed through the portal. If you need a dose adjustment, you message the provider, who evaluates the request and can modify the compounded formulation if appropriate. This ongoing customization capability is what distinguishes a compounding pharmacy model from a prescription fulfillment model.

Shipping is direct from the compounding pharmacy - typically 5-7 business days for initial orders, 3-5 days for refills. The packaging is discreet. Refrigeration is not required for most topical formulas.

Strut pricing varies by formula but is generally competitive with other telehealth hair loss platforms:

Topical minoxidil (standard): $40-50/month Topical finasteride alone: $55-75/month Combination topical finasteride + minoxidil: $65-99/month Oral finasteride + topical minoxidil: $50-70/month (oral finasteride is inexpensive) Compounded ED formulas: $60-150/month depending on formula Compounded semaglutide: $199-249/month

Consultation fees: Strut charges a one-time consultation fee ($29-59 depending on category) for new patients. Follow-up consultations for dose adjustments are free within the subscription.

The subscription model ships medication monthly and bills automatically. Cancellation is straightforward through the patient portal - no contracts or cancellation fees. If you pause treatment for medical or personal reasons, you can pause shipments without cancelling your account.

Compared to hims: hims oral finasteride plus minoxidil runs approximately $50-80/month depending on the specific products chosen. Strut's topical combination formula at $65-99/month is moderately more expensive but offers the topical delivery advantage for patients concerned about systemic finasteride exposure.

Strut partners with licensed 503A and 503B compounding pharmacies - the legal framework that governs compounding for individual patients and for outsourcing to healthcare providers respectively. This is the highest standard of quality assurance available for compounded medications. 503B outsourcing facilities are registered with the FDA, subject to FDA inspection, and must follow current Good Manufacturing Practice (cGMP) standards - the same standards applied to pharmaceutical manufacturers, adapted for the compounding context. These facilities undergo periodic unannounced FDA inspections and must meet stringent testing requirements for sterility, potency, and contamination. For injectable medications (semaglutide, tirzepatide), 503B facility sourcing is particularly important because sterility is critical for subcutaneous injections. Strut uses 503B-sourced active pharmaceutical ingredients for its injectables. Topical formulas (finasteride-minoxidil combinations, trimix gel) are compounded under 503A rules, which are slightly less stringent but still require licensed pharmacist oversight and adherence to USP quality standards. The potency testing requirements ensure that the 0.3% finasteride you receive is actually 0.3% finasteride. Strut is transparent about its pharmacy partnerships on its website, which allows patients to verify the facility credentials if they choose to do so.

Strut is a strong fit for specific patient profiles:

Topical finasteride achieves scalp DHT reduction comparable to oral finasteride, but with substantially lower systemic absorption - reducing the risk of sexual side effects that occur with systemic DHT suppression. For patients concerned about finasteride side effects, this is Strut's primary clinical advantage.

Men who have had partial response to oral finasteride and want to optimize: Adding topical minoxidil to an existing finasteride regimen through a combination formula, or switching to a compounded formulation with customized dosing, represents treatment escalation that standard platforms cannot provide.

Patients who have not responded to standard oral PDE5 inhibitors for ED: The compounded formulas (topical trimix, combination sildenafil-tadalafil) provide options for patients who have genuinely tried and failed first-line treatments.

Women seeking topical anti-androgen therapy without systemic effects: Topical spironolactone for female pattern hair loss provides the anti-androgenic benefit without the systemic effects (diuresis, electrolyte changes, blood pressure effects) of oral spironolactone.

Strut is a less compelling choice if you want the lowest-cost option with standard oral finasteride and minoxidil - platforms like Keeps or hims can do that at lower cost - or if you want extensive behavioral support for weight loss rather than just medication access.