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Hormonal health is a massive opportunity: Where are the unicorns?
Gaslighting is a form of psychological abuse, but Elizabeth Ruzzo says she experienced it firsthand after telling a doctor that she suffered from suicidal ideation after taking birth control pills.
Hormonal health sits at the center of conversations around personalized medicine and women’s health: By 2025, women’s health could be a $50 billion industry, and by 2026, digital health more broadly is estimated to hit $221 billion.
Ruzzo’s doctor told her there was no connection between birth control and self-harm, but she decided to stop taking the pill to see if her mental health improved. When it did, Ruzzo grasped the disconnect between women’s unique hormonal makeup and blanket-statement practices from medicine today.
Her realization led her to found Adyn Health, a startup that proactively helps women make health decisions that complement their hormonal state and background. The company started with, of course, helping people pick more personalized birth control.
Ruzzo is part of a group of growing entrepreneurs who are betting that hormonal health is the key wedge into the digital health boom. Hormones are fluctuating, ever-evolving and diverse — but these founders say they’re also key to solving many health conditions that disproportionately impact women, from diabetes to infertility to mental health challenges.
Many believe it’s that complexity that underscores the opportunity. Hormonal health sits at the center of conversations around personalized medicine and women’s health: By 2025, women’s health could be a $50 billion industry, and by 2026, digital health more broadly is estimated to hit $221 billion.
Still, as funding for women’s health startups drops and stigma continues to impact where venture dollars go, it’s unclear whether the sector will remain in its infancy or hit a true inflection point.
The future is proactive
Ruzzo views Adyn as a precision medicine startup. Its main product is an at-home test that tracks hormone levels, assesses genetic risk for specific side effects, and then gives recommendations for which birth control methods best suits the customer with the fewest side effects.
By Ruzzo’s estimates, 98% of sexually active women use birth control for 30 years of their life. That sort of lifetime value proposition made the company look like a sweet deal to founders, and Adyn raised a $2.5 million seed in April 2021 in a round co-led by Lux Capital and M13.
The moonshot, though, is using that as a way to become a trusted partner in a woman’s life, helping understand baseline hormone levels throughout those 30 years.
“My hope is that we can use precision medicine approaches, including looking at genetic markers to identify reliable diagnostic criteria, that can remove that uncertainty and pain and diagnostic odyssey that people have to go through,” Ruzzo said.
If Adyn becomes a trusted partner with teenage women, it could reach a point where it can detect changes in hormone levels over time.
“The hormone reference ranges that are used [in labs] are too broad to be personalized, let alone prescriptive,” she said. “And so what we’re hoping to do is correct for things that we know affect hormone levels like age, weight, ethnicity and compare you to your own expectations.”
If the first wave of digital health was a company like Ro, which answers consumers when they have a condition such as erectile dysfunction or hair loss, the second wave will look more like Adyn, which helps consumers navigate their health before getting diagnosed with a condition or experiencing issues.
The industry standard is still to wait for consumers to realize they have a condition, and then go to the doctor to manage their symptoms or look for a cure. A new startup that recently graduated from Y Combinator is finding its way into hormonal health through that angle.
One-tenth of all women are impacted by a hormonal condition
Veera Health is a startup that wants to help women in India manage polycystic ovary syndrome, or PCOS. The hormonal condition can cause irregular periods, infertility or gestational diabetes in women, as well as acne, weight gain and excessive hair growth. Plus, PCOS is far from rare, impacting one in 10 women.
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Ro makes the weight loss product Plenity commercially available to everyone in the US
In what could be the first step in the development of a significant new line of business for the telemedicine prescription provider Ro, the company is finally announcing the general commercial availability of weight loss product, Plenity.
Developed by Gelesis, a biotech company that makes treatments for gastro-intestinal disorders, Plenity is a weight loss treatment that uses citric acid and cellulose to create a non-toxic paste that makes people feel more full after they ingest it. Taken before meals, the pill becomes a substance that expands to take up about 25% of the stomach, so people eat less.
The product has been approved by the U.S. Food and Drug Administration and is available for a much broader segment of the population than other weight loss products. While most prescription medicines are intended for people who are obese, the Gelesis product is made for people who are overweight, too.
“That’s adults who have a BMI from 25 up to 40. That’s 150 million Americans,” according to Gelesis chief commercial and operating officer, David Pass.
Plenity received FDA approval last April, and Gelesis started working with Ro soon after, according to Pass. The idea was to craft a strategy that could get the treatment, which is classified as a medical device and not a drug, in the hands of as many patients as quickly as possible.
For Ro, the agreement with Gelesis is a sign of potential things to come. The company is the exclusive online provider of the Plenity treatment and Ro founder Zachariah Reitano said that there’s an incredible potential to engage in more of these types of deals.
“We would love to be able to partner with pharmaceutical companies to decrease the cost of distribution,” said Reitano. “We were excited to build an exciting treatment solution for weight management. Our high-level mission is to be the patient’s first call.”
With the Gelesis partnership Ro can add another highly desirable treatment to its roster of therapies — and one that can be a contributing factor to increasing the severity of other conditions that the company already provides treatment for, Reitano said.
“There are a few conditions that we currently treat that are exacerbated by a patient being overweight or obese. People who struggle with weight management will also experience ED. Obesity can lead to heart failure, stroke, coronary heart disease, hypertension, depression,” Reitano said. “The breadth of the label is interesting. Only FDA approved with a BMI from 25 to 40. FDA approved treatment have been between 30 and 40. [It] makes the treatment more accessible to a wider variety of people.”
As the only online provider of the treatment, Ro has developed an onboarding process to ensure that the Plenity therapy isn’t abused by people who suffer from eating disorders.
“During our onboarding we not only ask questions to patients about their weight management. There’s a consecutive set of images that need to be uploaded and taken with the provider. That’s something we’ve taken a lot of time and energy to make sure about,” said Reitano.
Like the other treatments Ro offers, Plenity is a cash-pay prescription, because the weight loss treatments aren’t typically covered by insurance, he said.
The benefit of working with an online pharmacy like Ro to provide distribution for a new therapy was obvious to both startups.
“We turned this market on its head by putting the consumer at the heart of everything we do,” said Pass. The treatment costs $98 per month, compared to other therapies or branded medications that could be as much $300 and $350 per month, according to Pass.
One reason that Gelesis is able to reduce the price of the drug is that it won’t have to hire a massive sales force to pitch it. The company has Ro for that.
“Normally you have a pharmaceutical company that would have to hire a sales force and go door to door and it increases the cost of a new drug. [Ro] can make a new, innovative treatment, like Plenity, available nationwide,” Reitano said.
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Thirty Madison raises $47 million for its direct to consumer treatments of hair loss, migraines and indigestion
Thirty Madison, the New York-based startup developing a range of direct to consumer treatments for hair loss, migraines and chronic indigestion, has raised $47 million in new financing.
After last week’s nearly $19 billion merger between Teladoc and Livongo, remote therapies and virtual care companies are all the rage among the healthcare industry, and Thirty Madison’s business is no exception.
An indicator of just how important these companies are to the future of the healthcare business can be seen in the presence of Johnson & Johnson Innovation – JJDC, Inc. (JJDC) in the latest round for Thirty Madison.
Existing investors Maveron and Northzone also returned to back the company in a deal led by Polaris Partners. Thirty Madison has raised a total of $70 million so far.
Founded just three years ago by Steven Gutentag and Demetri Karagas, Thirty Madison expanded from treating hair loss with its Keeps brand in 2018 to migraine treatments in early 2019 with Cove, and launched Evens (the company’s acid reflux treatment service) later that year.
Thirty Madison has just begun offering urgent care consultations for users on a pay-what-you-will model.
And the company’s founders differentiate Thirty Madison’s business from their better-funded competitors like Hims and Ro by emphasizing that their company provides continuing care after a diagnosis and offers a range of treatment options for the conditions that the company treats. That, coupled with the more narrow focus on a few specific conditions, distinguish Thirty Madison from its peers in the industry.
“Over 59% of Americans suffer from at least one chronic condition, but few resources exist to help them connect the dots of their care,” said Amy Schulman, a partner with Polaris Partners and new director on the Thirty Madison board.
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Digital elective care and telemedicine provider Ro raises $200 million at a reported $1.5 billion valuation
In three years Zachariah Reitano’s startup, Ro, has managed to hit a reported $1.5 billion valuation for its transformation from a company focused on treating erectile dysfunction to a telemedicine service for a range of elective and urgent care-focused treatments.
Through Rory for women’s health, Roman for men’s health and Zero for smoking cessation, Reitano and fellow co-founders Saman Rahmanian, and Rob Schutz, built a company that now treats 20 conditions, including sexual health, weight loss, dermatology, allergies and more, according to a statement from the company.
Image Credit: Zero
Ro also has a new pharmacy business, Ro Pharmacy, which is an online cash pay pharmacy offering more than 500 generic medications for just $5 per month per drug. And the company is getting into the weight loss business through a partnership with the private equity-backed healthcare company, Gelesis.
Ro’s also becoming a gateway into patient acquisition for primary care providers through Ribbon Health, and a test-case for the use of Pfizer’s Greenstone service, which provides certification that a generic drug is validated by one of the major pharmaceuticals.
The company’s $1.5 billion valuation is courtesy of a new $200 million investment from existing investors led by General Catalyst and including FirstMark Capital, Torch, SignalFire, TQ Ventures, Initialized Capital, 3L and BoxGroup. New first-time investor The Chernin Group also participated. In all, Ro has raised $376 million since it launched in 2017.
“This new investment will further our mission to become every patient’s first call. We’ll continue to invest in our vertically-integrated healthcare ecosystem, from our Collaborative Care Center to our national pharmacy operating system. This is just the beginning of Ro’s patient-centered healthcare platform.”
It’s all part of the company’s mission to provide a point of entry into the healthcare system independent of insurance qualifications.
“Telehealth companies like Ro are using technology to address long-standing healthcare disparities that have been exacerbated by COVID-19,” said Dr. Joycelyn Elders, MD, Ro Medical Advisor and Former U.S. Surgeon General. “By empowering providers to leverage their skills as efficiently and effectively as possible, Ro delivers affordable, high-quality care regardless of a patient’s location, insurance status, or physical access to physicians and pharmacies.”
Ro’s new financing is one of several forays by tech investors into reshaping the healthcare system at a time when patient care has been severely disrupted by attempts to mitigate the spread of COVID-19.
Digital medicine is assuming a central position in the healthcare world, with most consultations now occurring online. Reimbursement schemes for telemedicine have changed dramatically and investors see an opportunity to capitalize on these changes by aggressively backing the expansion plans of companies looking to bring digital healthcare directly to consumers.
That’s one of the reasons why Ro’s major competitor, Hims, is reported to be seeking access to public markets through its sale to a special purpose acquisition company for roughly $1 billion, according to Reuters.
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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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ePharmacy Ro launches doc-approved WebMD rival Health Guide
“Whatever your symptom, WebMD says you have cancer.” It’s a long-running joke that underscores the distrust of perhaps the top source of medical advice, stemming from a confusing site clogged with ads that’s been criticized for questionable information and pushing pills from its sponsors.
Health Guide is the new medical handbook for the internet, where 30% of content is written by doctors and 100% is reviewed by them. On a single clean, coherent page for each condition, it lays out a tl;dr summary, what the ailment really is, how to spot the symptoms and what you need for treatment. Rather than pushing you to nervously keep clicking, it just wants to answer the question.
Health Guide officially launches today. It was built by digital pharmacy Ro, which has raised $176 million for medicine brands Roman for men’s health, Rory for women’s health and Zero for smoking cessation. With Ro, patients can get a $15 telemedicine consultation with a doctor, receive an instant prescription and have it filled and sent to you from the startup’s in-house pharmacy operating in all 50 states. A competitor to Hims & Hers, Ro scored a $500 million valuation last year.
Rather than aggressively hawking its own products at the end of articles, Health Guide just lists the medications you could take, insists you ask a doctor what’s right and leaves it up to you to choose where to buy. Ro founder Zachariah Reitano calls Health Guide “a significant investment in trust. There’s not a clear ROI (return on investment) to it but it’s one of those long-term bets . . . Providing education to patients will serve Ro really well in the long-run.” He acknowledges the suspicions of self-dealing, and says “if we don’t do this correctly, it can hurt more than it can help.”
On Health Guide you can search for specific conditions, browse categories like diabetes or hair loss and browse featured articles like “Proven ways to increase the density of your bones” or “How do you test for gonorrhea.” There are no banner ads, so your search about the flu or testosterone won’t immediately lead to you being bombarded with promotions for Mucinex or dicey supplements. “On these other sites . . you have [advertisers] with unregulated supplements and services that are the highest bidder beside medical information, which creates a lot of distrust.”
The simplicity and accuracy of Health Guide has already attracted a sizable audience. It’s on pace to reach 30 million readers this year, with 25% being women despite Roman’s initial focus on aiding men with erectile dysfunction. It already ranks in the top 10 Google results for 300 medical questions. The no-filler entries come signed by the specific doctors that wrote or approved them, and Ro pledges to have them reviewed and updated at least once per year. At the bottom are links to all the original source material, including peer-reviewed medical journals.
Reitano tells me that the idea from Health Guide came after Ro’s physicians and customer service were bombarded with the same patient questions over and over. The easiest move was to put all the answers on an open site they could send patients to. A major goal was to debunk hoaxes other sites often don’t address directly. “For something like vaccines where there is a potential for misinformation, you’ll see us take a strong stance. We won’t let the potential for misinformation spread through Health Guide.”
One thing Health Guide is missing that could keep people coming back to WebMD is a symptom checker. Right now it’s better at research on major conditions or lifestyle choices than figuring out why your throat’s sore. But given it’s day one and Ro has tons of funding, it has plenty of time to improve. There’s sure to be concerns about how it collects data and what treatments Health Guide lists. So as a precaution, it never forcefully makes recommendations besides asking a doctor for personalized advice, and there’s just one button atop the site for visiting its medication marketplace.
Ro is trying to move fast as the ePharmacy space heats up. It plans to launch 10 more products in the next two quarters, with a focus on Rory for women. It just struck an exclusive deal with Pfizer to provide Roman customers with generic Viagra, offering clear supply chain transparency around a drug that’s often counterfeited. And thanks to its licenses across all states, it’s helping new weight loss treatment Plenity launch nationwide atop its diagnosis, prescription and fulfillment technology.
Yet Reitano sees space for multiple startups to succeed in replacing embarrassing and inconvenient in-person trips to the doctor or drug store. “It might be a somewhat cheesy answer but . . . the best thing about competition is it makes everyone build a better experience for patients,” he says, citing NURX and PillClub enhancing birth control access. “I think all this innovation in digital health — it’s an absolutely massive market. No one’s taking market share from someone else. We’re raising the bar for care.”
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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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