They cram multiple drugs into the same pill, add supplements, and often make the meds taste like candy. That allows telehealth providers to sell their own unique branded pills, which are more profitable and better for customer retention than just flipping cheap generics that are available at any pharmacy.\u00a0<\/p>\n
But these combo pills \u2014 for example, one Hims \u201c5-in-1\u201d pill combines hair-loss and ED medications along with two different B vitamins and the amino acid L-theanine \u2014 haven\u2019t been officially studied for safety or efficacy and aren\u2019t reviewed or approved by the FDA. In some cases, they even pair medications that FDA labeling specifically warns against taking together. And some of the combinations make doctors who spoke with Sherwood News uneasy.<\/p>\n
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Screenshots of a telehealth reporter\u2019s Instagram feed (Sherwood News)<\/p>\n
In a traditional healthcare setting, a person struggling with erectile dysfunction may be prescribed generic Cialis or Viagra made by a manufacturer like Teva Pharmaceuticals<\/a>. If they\u2019re on a telehealth platform, it\u2019s increasingly common they might be lured in by a combination of the two ED treatments.<\/p>\n Hims, Ro, BlueChew, and many others have products that combine sildenafil, the active ingredient in Viagra, and tadalafil, the active ingredient in Cialis.\u00a0<\/p>\n Taking full doses of sildenafil and tadalafil isn\u2019t recommended, including on Hims\u2019 and Ro\u2019s own informational<\/a> blogs<\/a>. FDA labeling for tadalafil<\/a> and sildenafil<\/a> explicitly states that combining them with other ED treatments hasn\u2019t been studied, and it says not to take them with other ED treatments. Some of the combination ED pills on the market have what\u2019s considered to be a moderate or large dose of each drug in one pill.<\/p>\n Doctors working outside of a direct-to-consumer platform generally wouldn\u2019t prescribe that kind of combination because it could cause more negative side effects, said Dr. Jessica Yih, a professor of urology at the University of California, Irvine. While it\u2019s not recommended to combine the two, some patients do have prescriptions for generic Viagra and Cialis, but it would typically be prescribed as two generic pills at low dosages rather than a combined version, she said.\u00a0<\/p>\n \u201cThere\u2019s also risk of overprescribing without assessing for contraindications or potential side effects, especially in patients with complex medical histories,\u201d Yih said.\u00a0<\/p>\n More puzzling to some urologists are pills that combine hair-loss treatments with ED treatments, Yih said. Hims has offered that combination since last August,\u00a0 as do some smaller providers, too.\u00a0<\/p>\n \u201cThese pills do very different things,\u201d said Alan Shindel, a urologist at the University of California, San Francisco. \u201cI understand the marketing of it, but it doesn\u2019t make a lot of sense medically.\u201d<\/p>\n Screenshots of a telehealth reporter\u2019s Instagram feed (Sherwood News)<\/p>\n It\u2019s unclear how often the companies are actually prescribing the combination pills they promote so aggressively.\u00a0<\/p>\n A person familiar with Hims\u2019 prescribing practices told Sherwood that combination tadalafil and sildenafil is generally reserved for patients who have failed on other medications or smaller doses, and that most physicians will push back if a patient demands them. Hims providers get AI-generated alerts that flag when a patient may not be a good candidate for a treatment, the person said.<\/p>\n Dr. Peter Stahl<\/a>, Hims\u2019 head of men\u2019s sexual health and urology, said in a statement that many customers come to Hims seeking help for both ED and hair loss.\u00a0<\/p>\n \u201cErectile dysfunction and hair loss commonly occur together, so this treatment, which uses doctor-trusted ingredients, can be a suitable option for men experiencing mild to moderate erectile dysfunction and male pattern hair loss,\u201d he said.<\/p>\n BlueChew did not respond to a request for comment. A spokesperson for Ro said that patients \u201ccan message their Ro-affiliated clinician at any time with questions or concerns.\u201d<\/p>\n \u201cWhen a compounded medication is prescribed, patients receive written counseling that includes important safety information about the ingredients,\u201d they added.\u00a0<\/p>\n Dr. Irwin Goldstein, director of the San Diego Sexual Medicine clinic, said the fact that there haven\u2019t been trials studying how these combinations interact with each other puts patients at risk. \u201cThis is a no-brainer,\u201d he said.<\/p>\n The rise of Franken-pills<\/b><\/p>\n Telehealth\u2019s favorite word these days is \u201cpersonalization,\u201d and Hims \u2014 the only company in its peer group that\u2019s publicly traded \u2014 is doubling down on it.\u00a0<\/p>\n Hims saw explosive growth in its weight-loss segment thanks to its temporary ability to sell exact copies of Wegovy. But now that the shortage of the medication has ended<\/a>, Hims is limited in how much of the blockbuster drug it can sell to its customers.\u00a0\u00a0<\/p>\n So it\u2019s shifted some focus back to its core business: ED treatment and hair loss. In its most recent shareholder letter<\/a>, which mentions the word \u201cpersonalization\u201d 16 times, the company said it has been \u201claying the foundation\u201d to convert more of its sexual health patient prescriptions from generics to compounded.<\/p>\n \u201cWe believe this transition with Sexual Health will allow us to bring our subscribers a unique value proposition, ultimately resulting in a higher customer lifetime value and stronger long-term growth,\u201d Hims wrote in the letter.<\/p>\n A screenshot from Hims & Hers\u2019 Q1 2025 shareholder letter<\/p>\n About 4% of men in the US on an ED prescription got it through Hims, a recent Healthline survey found<\/a>. According to Hims, 40% of the subscribers in its sexual health category are on a personalized prescription, up from about 10% in 2023.\u00a0<\/p>\n \u201cGenerally, people want to take less medication, not more,\u201d Hims Chief Finance Officer Yemi Okupe said at the JPMorgan Global Technology, Media and Communications Conference in May. \u201cThe ability to treat multiple conditions in a single solution is something that we\u2019ve seen a lot of success with across our sexual health business.\u201d<\/p>\n Compounding pharmacies, which are either owned and run by companies like Hims and Ro or are independently owned and contract with smaller telehealth companies, take key ingredients in FDA-approved drugs and make custom treatments \u2014 often a dose that isn\u2019t made by the manufacturer or one that avoids certain allergens or dyes.\u00a0<\/p>\n The pharmacies are predominantly regulated by state boards, and the drugs they produce are not FDA-approved, a process that requires lengthy trials of a specific formulation and isn\u2019t built for treatments that are ostensibly tailored for a specific patient.\u00a0<\/p>\n Compounding pharmacies have received increased attention<\/a> in the past couple of years as they filled supply gaps for popular weight-loss drugs made by Eli Lilly<\/a> and Novo Nordisk<\/a>. The active ingredients in those drugs were in a shortage from 2022 to early this year and during that period, the compounding pharmacies, often spurred by telehealth companies, were allowed by the government to sell discounted copies of the popular drugs.<\/p>\n The big drugmakers, worried that compounding pharmacies were eating away at their market share, responded with an attack campaign calling into question the safety and efficacy of compounded drugs, which companies like Hims and Ro market heavily. (There have been some instances of compounding pharmacies producing contaminated drugs<\/a> or inaccurate potency.)<\/p>\n Personalized, customized, precise\u00a0<\/b><\/p>\n The FDA has jurisdiction over the advertisements of pharmaceutical manufacturers, but not healthcare providers. It\u2019s not entirely clear which bucket telehealth companies fall into, said Darshan Kulkarni, a regulatory and compliance attorney who represents FDA-regulated companies.\u00a0<\/p>\n \u201cThe question becomes: at what point have you gone past a healthcare provider to becoming a manufacturer?\u201d he said. \u201cAnd that question is being debated as we speak.\u201d\u00a0<\/p>\n The FDA so far hasn\u2019t regulated telehealth companies and their advertisements as stringently as it does drug manufacturers. This has resulted in telehealth companies getting more wiggle room in what they can say about their products, an enforcement gap some lawmakers are trying to close<\/a>.<\/p>\n Hims sells two-in-one pills that it bills as an ED and \u201ctestosterone support\u201d treatment, which is tadalafil with zinc and B vitamins. It also sells an ED and \u201cclimax control\u201d pill that combines tadalafil with fluoxetine, the active ingredient in the antidepressant Prozac.\u00a0<\/p>\n While fluoxetine has been shown to help with premature ejaculation, a drugmaker isn\u2019t allowed<\/a> to market a drug for a use it\u2019s not explicitly approved by the FDA to treat.\u00a0<\/p>\n If the telehealth companies sold only generic Cialis or Viagra, it would be difficult to squeeze in a margin when those medications are available for lower prices from brick-and-mortar pharmacies or online vendors like Amazon Pharmacy<\/a>. Selling a unique product is also a useful tool to keep customers onboard.\u00a0<\/p>\n Telehealth companies spend big on marketing to differentiate themselves from traditional pharmacies. Hims spent about $679 million on marketing last year, equivalent to about 40% of its revenue. Company executives have said personalization helps with adherence to a regimen \u2014 or, in other words, customer retention.\u00a0<\/p>\n Having medicines that taste like candy doesn\u2019t hurt, either. Hims\u2019 drugs are compounded into Hard Mints, which are various ED treatments that come in what resembles an Altoids tin. Ro has two original ED products: Daily Rise, a fruit-flavored gummy, and Ro Sparks, a bright red tropical-fruit-flavored dissolvable with a flame sign imprinted on it. BlueChew\u2019s dissolvable pills come in fruit punch or mint flavors.\u00a0<\/p>\n<\/p>\n
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