Erectile Dysfunction
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Hims, the telehealth startup, saw its shares slip in their trading debut — and that’s fine with its CEO
Hims & Hers, a San Francisco-based telehealth startup that sells sexual wellness and other health products and services to millennials, began trading publicly today on the NYSE after completing a reverse merger with the blank-check company Oaktree Acquisition Corp.
Its shares slipped a bit, ending the day down 5% from where they started, but the company, which was founded in 2017 and now claims nearly 300,000 paying subscribers for its various offerings, has never been focused on a splashy headline about its first-day performance, co-founder and CEO Andrew Dudum told us earlier today.
On the contrary, Dudum says that while Hims might have once imagined a traditional IPO, it decided to go the special purpose acquisition company (SPAC) route because of their pricing mechanisms and because it was approached by a SPAC led by renowned money manager Howard Marks, the founder of the global alternative investment firm Oaktree Capital Management. (“We fell in love with the Oaktree team and the capital market experience and deep resources they have.”)
We talked with Dudum about that SPAC’s structure; the lockups involved now that Hims’ shares are trading; and how much of the business still centers around one of its first offerings, which was a generic version of erectile dysfunction pills. Our conversation has been edited lightly for length and clarity.
TC: You’re a Bay Area-based company selling to a mostly U.S. audience. How are you thinking about expanding that footprint geographically?
AD: We do have a small operation selling in the U.K.; we’re getting our feet wet in that market and building out a team and infrastructure and fulfillment. If you look at the regulatory landscape, there’s a huge amount of room [to grow] in Europe, Australia, Canada, the Middle East and Asia, and so in that order, we’ll start to [move into those markets].
TC: What is your average customer cost?
AD: It has come down from $200 when we first launched, to roughly $100 last year, and we make, on average, close to $300 in the first couple of years in terms of a patient’s lifetime value.
TC: How quickly do customers churn?
AD: We break down lifetime value projections by quarter cohorts, and quarter over quarter, year over year, we’re monetizing each of these cohorts better, with high-margin profiles.
As of last quarter, the business was growing 90% year-over-year, with 76% gross margins and greater cash efficiency, and that’s because as we provide more offerings, there is more cross-purchasing. Also, word of mouth is becoming more of a dynamic, with more than 50% of the traffic to the site free at this point because we have built a brand with a young demographic.
TC: When are you projecting that you’ll turn profitable?
AD: We’ve reduced our annual burn and increased our margin efficiency and organic growth, so on a quarterly basis, we think in the next couple of years is a real possibility.
Image Credits: Hims & Hers
TC: Hims’ first wellness offerings included pills for male pattern hair loss and erectile dysfunction. How much revenue does that ED business account for?
AD: What we’ve disclosed is that roughly half [of our revenue] is that sexual health category — which includes [medicines for] generic erectile dysfunction, birth control, STDs, UTIs and premature ejaculation. The other half is predominately dermatology, including hair care [to address hair loss] and acne, and we’ve more recently moved into primary care and behavioral health.
TC: For retail investors, how do you differentiate the business from that of your rival Ro, which heavily promotes its ED products?
AD: There are a number of core differences between us and public and private players. First is our real focus on diversifying our offerings. With our focus on sexual health, dermatology, primary care and behavioral health, it’s in our DNA to quickly expand into new businesses.
We also think we’re different from most [rivals] in that we really invest time in building deep relationships with [those who represent] the future of healthcare markets — people in their teens, 20s and 30s. This demographic has a different set of tech expectations and consumer expectations than people in their 40s, 50s and 60s, and if we want to build for the future, that means building for the largest body of payers in the future.
Traditional healthcare companies monetize only the sick, but optimizing around that demographic precludes you from understanding what the next generation really needs and wants. I’ve never seen such a divergence between a patient population and legacy experience, and that’s a real advantage to us as a business.
TC: Hims just went public through a SPAC in a deal that gives the company around $280 million in cash — $205 million of that from Oaktree’s blank-check company and another $75 million through a private placement deal. How much runway does that give you?
AD: The company doesn’t burn a tremendous amount — between $10 million and $20 million a year — so a relatively long runway if we keep operating the business as is. But it does allow us to expand and grow into new businesses, too, including into big categories like sleep, infertility, diabetes and other chronic conditions.
TC: What about acquisitions?
AD: We’ll keep an eye open for strategic opportunities and consolidation opportunities. More than a dozen businesses a month come to us to be consolidated into the brand, but generally speaking, we’ve had the belief that so much is in front of us that we don’t want to be distracted.
TC: Is there a lockup period for anyone?
AD: There’s a traditional lockup for executives and employees and the board.
TC: Did your SPAC sponsors get a board seat?
AD: No.
TC: How much do they now own of the company, and can they sell?
AD: Oaktree owns a couple percent and [the syndicate they brought to do the private placement] [owns] 12%. But the very reason we went with them was the quality of the team and the organization . . . and they have the added incentive for the next year or two from a compensation standpoint for the company to succeed and to prove [out their thesis that Hims is a smart investment].
TC: Do you think the traditional IPO process is broken?
AD: The traditional IPO market hasn’t changed. It takes 12 to 18 months of preparation, which is a crazy amount of time for management to be distracted, then there’s this one-day PIPE that gives institutions a tremendous amount of money instantaneously. Maybe it makes for a good CNBC headline, but at tremendous cost to the company. It’s atrocious. If you were a founder or employee and getting diluted twice as much as you have to be, you’d be really upset. It’s no surprise to me that founders like myself are looking at other modalities with better pricing and better structures.
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Men’s at-home health startup Vault takes in $30 million from Tiger Capital
Vault, an at-home healthcare practice specializing in men’s medicine has announced the raise of $30 million in funding from Tiger Capital Group, Declaration Capital and Redesign Health to reach more potential patients and expand to more areas beyond New York, Florida, Tennessee and Texas, where it currently offers treatments.
Founder and CEO Jason Feldman, who formerly headed Amazon’s Prime Video Direct and Global Innovation teams before launching Vault last summer, told TechCrunch his startup aims to bring specialized medicine into men’s homes to give them “a better body, better sex and a better brain.”
He tells TechCrunch he started the company after noticing how many of his male friends seemed embarrassed about medical conditions or simply didn’t know they could do something about it.
Vault operates on the assumption men face certain barriers to going to the doctor for things like hormonal imbalance and erectile dysfunction. The startup tries to remove these barriers by making it easy to book at-home appointments and get a work-up with a nurse practitioner.
“I want to de-stigmatize men’s health.” Feldman told TechCrunch. “You tell a guy to go see the doctor about his heart health and he likely won’t but you tell him you’ll bring him a doctor to help his penis and it’s a different story.”
Like many new concierge medical services that have popped up in the last few years, Vault does not take insurance, instead signing patients up via membership for $133 to $300 per month, depending on the type of service you sign up for. Compare that to Forward, which caters to both men and women and offers unlimited in-office visits and testing for $149/month or Roman, a men’s “digital clinic,” which offers free online evaluations, $15 doctor’s visits and prescription medications for similar services to Vault like erectile dysfunction, hair loss and testosterone support — although Roman requires patients see a physical doctor of their choosing within the last three years before they’re able to get prescriptions via digital services.
But Feldman doesn’t think his startup is anything like what’s out there right now, claiming it as the first national men’s healthcare provider. Vault offers specialty packages like testosterone therapy or the “sex kit” for an increased sex drive or stronger erections, something that sometimes diminishes as men age.
So far, Feldman has signed up over 500 medical practitioners to come to various home locations and has hired a chief medical officer to ensure medical standards are being met. He now plans to use the new funding to open up operations in 42 cities across the U.S. and work on spreading the word to all men nationwide that Vault is here for them.
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iPharmacy Roman fights stigmas with premature ejaculation meds
There’s a war brewing to become the cloud pharmacy for men’s health. Roman, which launched last year offering erectile dysfunctional medication and recently added a ‘quit smoking’ kit, is taking on $97 million-funded Hims for the hair loss market. Today, Roman launched four new products it hopes to cross-sell to users through a unified telemedicine subscription and pill delivery app. It now sells meds for premature ejaculation, oral herpes, genital herpes, and hair loss at what’s often a deep discount versus your local drug store. And for those who are too far gone, it’s launching a “Bald Is Beautiful, Too” microsite for finding the best razors, lotions, and head shaving tips.
Roman CEO Zachariah Reitano
“It’s unlikely that you’ll buy razors from Bonobos or pants from Dollar Shave Club. But with a doctor, it’s actually the exact opposite” Roman CEO Zachariah Reitano tells me. “As a customer you’re frustrated if they send you somewhere else.” And so what started as a single product startup is blossoming into a powerful product mix that can keep users loyal.
Roman starts with a telemedicine doctor’s visit where patients can talk about their health troubles without the embarrassment of going to their general practitioner. When appropriate, the doc can then prescribe medications customers can then instantly buy through Roman.
“If you have something that’s truly consuming your day-to-day, it makes it really hard or nearly impossible to think about the long-term. If you’re 30 pounds overweight and experiencing erectile dysfunction, [it’s the latter symptom] that’s dominating your head space” Reitano explains. The doctor might focus on the underlying health issue, but most humans aren’t so logical, and want the urgent issue fixed first. Reitano’s theory is that if it can treat someone’s erectile dysfunction or hair loss first, they’ll have the resolve to tackle bigger lifelong health challenges. “We’re hoping to work on this so you can take a deep breath and get the monkey off your back” the CEO tells me.
But one thing Roman won’t do is prescribe homeopathic remedies or spurious remedies. “We will only ever offer products that are backed by science and proven to work” Reitano declares. Taking a shot at Roman’s competitor, he says “Hims sells gummies. Roman does not. No doctor would say Biotin would help you regrow hair”, plus the vitamin can distort blood pressure readings that make it tough to tell if someone is having a heart attack.
“Roman will never slap sugar on vitamins, sell them on Snapchat, and say they’ll regrow your hair” Reitano jabs. Roman also benefits from the fact that Reitano’s father and one of the company’s advisors Dr. Michael Reitano was a lead author on a groundbreaking study about how Valacyclovir could be used to suppress transmission of genital herpes.
So what is Roman selling?
- Erectile Dysfunction – $31/month – Viagra, Sildenafil (generic Viagra), Cialis, or Tadalafil (generic Cialis)
- Premature Ejaculation – $19/month – Sertraline, Tadalafil (generic Cialis), Sildenafil (generic Viagra)
- Hair Loss – $17/month – Finasteride
- Genital Herpes – $14/month Valacyclovir (generic Valtrex)
- Cold Sores / Oral Herpes – $14/month Valacyclovir (generic Valtrex)
With Roman, Hims, Amazon acquisition PillPack, and more, there’s a powerful trend in direct-to-consumer medication emerging. Reitano sees it as the outcome of five intersecting facts.
- The evolution of telemedicine regulation allowing physicians to have a national presence by seeing patients online
- Physicians are being reimbursed less by Medicare, Medicaid, and private insurers for the same activity, pushing them towards telemedicine
- A patent cliff is making many medications suddenly affordable under generic names.
- Insurance deductibles are increasing, turning patients into consumers
- Technology is making it easier and cheaper to start medical startups
Roman’s $88 million Series A it announced last month is proof of this growing trend. Investors see the traditional pharmacy structure as highly vulnerable to disruption.
Roman will have to defeat not just security threats and competitors, but also the status quo of keeping a stiff upper lip. A lot of men silently suffer these conditions rather than speak up. By speaking candidly about his own erectile dysfunction as a side-effect of heart medication, Reitano is trying to break the stigma and get more patients seeking help wherever feels right to them.
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Keeps parent company Thirty Madison raises $15 million to fight male pattern baldness
Thirty Madison, the healthcare startup behind the hair loss brand Keeps, has brought in a $15.25 million Series A co-led by Maveron and Northzone.
The company provides a subscription-based online marketplace for men’s hair loss prevention medications Finasteride and Minoxidil. Keeps sells these drugs direct-to-consumer, working with manufacturers to keep the costs low.
On Keeps, a subscription of Minoxidil, an over-the-counter topical treatment often referred to by the brand name Rogaine, is $10 monthly. A subscription to Finasteride, a prescription drug taken daily, is $25 per month.
“It’s an end-to-end platform that is the single best place for guys who are looking to keep their hair,” Thirty Madison co-founder Steven Gutentag told TechCrunch.
Keeps is tapping into a big market. According to the American Hair Loss Association, two-thirds of American men experience some hair loss by the age of 35.
You may have heard of Hims, a venture-backed men’s healthcare company that similarly sells subscriptions to hair loss treatments, as well as oral care, skin care and treatments for erectile dysfunction. Keeps is its smaller competitor. For now, the company is focused solely on haircare, though with the new funds, Thirty Madison plans to launch Cove, a sister brand to Keeps that will provide treatments to migraine sufferers.
The company was founded last year by Gutentag and Demetri Karagas with a plan to develop several digital healthcare brands under the Thirty Madison umbrella.
“Going through this process myself of starting to experience hair loss, I was not sure where to turn,” Gutentag said. “I went online and looked up ‘why am I losing my hair,’ and if you search on Google, really for any medical condition, you usually walk away thinking you’re going to die … I was so fortunate that I got access to this high-quality specialist who could help me with my problem and I was in the position to afford those treatments, but most people don’t get that access.”
Keeps also provide digital access to a network of doctors at a cost of roughly $30 per visit.
TechCrunch’s Connie Loizos wrote last year that “it’s never been a better time to be a man who privately suffers from erectile dysfunction, premature ejaculation or hair loss” because of advances and investments in telemedicine. Since then, even more money has been funneled into the space.
Hims has raised nearly $100 million to date and is rumored to be working on a line of women’s products. Roman, a cloud pharmacy for erectile dysfunction, raised an $88 million Series A last month and is launching a “quit smoking kit.” And Lemonaid Health, which also provides prescriptions to erectile dysfunction medications and more, secured $11 million last year.
Greycroft, Steadfast Venture Capital, First Round, ERA, HillCour and Two River also participated in Thirty Madison’s fundraise, which brings its total raised to date to $22.75 million.
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Roman is a cloud pharmacy for erectile dysfunction
“When I was 17, I experienced erectile dysfunction.” My interviews with startup founders rarely start so candidly. But to destigmatize the business of his new company, Roman, and empathize with customers, Zachariah Reitano is getting vulnerable. “I think in a good way I’ve become numb to the embarrassment,” says 26-year-old Reitano. Read More
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