The Soft Sell
New York magazine|October 25 - November 7, 2021
The healthcare brand Hims wants to leverage young men’s anxiety over erections and hair loss into a multibillion-dollar empire. It’s been harder than expected.
Jesse Barron

AT SOME point in the past few years, I looked around at my male friends and realized that they were on drugs.

Not Lexapro or benzodiazepines or Wellbutrin—which everybody was also on—but the kinds of drugs that are taken for age-related complaints. The most common seemed to be Viagra. For a few years in the 2010s, my friend Paul, then barely out of his teens, was buying it over the counter at airport pharmacies in Mexico. He consumed it like an anti-venom for the other drugs he took, to have sex when he was drunk, or high on MDMA. Alex, a TV writer in his early 30s, kept generic Viagra in his wallet for big dates. Without it, he was too nervous to perform with women he’d just met. Lucas took it during group-sex encounters, to fortify himself. Diego, a musician in his late 20s, had started generic Viagra in 2020, when the chemical steroids he used for his workouts unintendedly tanked his testosterone levels, which screwed up his sexual function. He would swallow a pill in the car on the way to his girlfriend’s house, or he’d slip into the bathroom right before they went to bed. As far as he could tell, she never knew.

I was hearing about testosterone therapy, too. Testosterone, to treat a supposed hormone deficiency called “low T,” had risen from a negligible market in 2000 to a multibillion-dollar one in 2020, driven partly by demand from cis males, many of them young. One acquaintance of mine, a trans man who works in health care, wittily described these new practices as “gender for men.” He meant that the act of modifying one’s body chemistry based on sex had previously been associated with women (birth control) and the trans community (estrogen and T).

There was another drug I heard about often: minoxidil, the active ingredient of Rogaine. My friends were not buying Rogaine-branded products, because having a bottle of Rogaine in the shower was not a seductive quality in a young male. Rogaine suggested the kind of guy who, standing in front of the mirror each morning, made a pistol with his finger and shot at his reflection while clicking his tongue. But here was Noah, a contemplative sound engineer in his late 20s, sitting across from me at a bar in East Williamsburg telling me his minoxidil tale. “I was complaining about my hairline, and my iPhone heard me,” he said, “and a couple days later, I’m getting bombarded with these ads.” I studied his hairline. Receding. He was typical of the new minoxidil customer: a man who wouldn’t walk out of a drugstore with a Rogaine bottle but was willing to buy it on an app.

While researching minoxidil, Noah had considered a stronger drug, finasteride, one of the most popular prescriptions in the States for older men. Finasteride raises the level of testosterone in such a way that promotes hair growth. But Noah had read online that finasteride could have sexual side effects. His situation resembled one of those puzzles presented in an undergraduate ethics class, where you find yourself at the wheel of a train that’s on track to run over six people if you do nothing—or you can actively divert the train and kill a single person. Would he rather have hair without erections, or erections without hair? As Noah wrestled with his decision, he ordered a natural hair-loss-prevention shampoo from the company that had served him the minoxidil ad: a San Francisco start-up called Hims. Noah was happy with his purchase. He liked that the packaging was discreet.

Hims was one of a flock of direct-to-consumer telemedicine companies— basically, apps that connect you with doctors who can write prescriptions—that had been founded in the late 2010s to offer minoxidil, generic Viagra, and finasteride to young men. At first glance, the competitors seemed similar, even down to their ads. Hims, which launched in 2017, featured close-up shots of clear-skinned millennials, sometimes embracing; another company, Roman, featured queer couples lounging in the morning-after sheet tangle. One possible exception was a third firm, BlueChew, which sold itself as a rough-and-ready erection-pill merchant with traditional gender roles in mind. In one ad, a husband who cleans the house is rewarded with a BlueChew packet, then starts making out with his wife.

BlueChew had the narrowest business model: It sold sildenafil (as generic Viagra is called) for a low cost and didn’t bother with distractions. Roman pursued a broader strategy, offering so many different medications and supplements— smoking cessation aids, vitamins—that sildenafil comprised a minority of its revenue. Its average customer was 46 years old.

Hims set out to chase a younger demographic. While Viagra had been a kind of luxury good for older men—the spokesperson was a Republican senator from Kansas—Hims catered to that man’s woke grandson. In the words of one of the brand’s designers, the core customer was “coastal or urban, with a diverse cohort, aware of what’s going on in culture, cares about how they look.” The Hims Man could order sildenafil while waiting in line for Sweetgreen, changing in the Equinox locker room, obtaining knitwear on Mr Porter. In the first three years, annual revenue grew 128 percent, to $130 million, and the number of patient consultations via the app quadrupled to 2 million by the middle of 2020. Most of the customers were men in their 20s or 30s, and they were spending most of their money on sildenafil. Hims claimed there was an undiagnosed epidemic of erectile dysfunction among men under 40, which made them eager to buy these wares. Or perhaps there was another explanation behind the sales figures, a combination of cultural forces that was changing the way men behaved in secret.

In January 2021, Hims went public in a spac deal, the first millennial telemedicine company to be listed on a stock exchange. There are now almost half a million Hims customers. In a phrase the CEO uses constantly, Hims wants to become the “front door” of the entire health-care system, the country’s main platform for nonemergency medicine. In addition to sildenafil and finasteride, the brand has expanded to virtual visits with therapists, access to psychiatrists who can prescribe antidepressants, betablockers for anxiety, aerosolized lidocaine that is sprayed beneath the penis to delay ejaculation, skin creams, cosmetics, sex toys, a limited form of primary care, and birth-control pills for women (having launched a women’s brand in 2018, the company is now known as Hims & Hers). “We pick up our phone, we click a button, we have full access to the food, the services, the retail—everything we want to buy. It’s a beautiful experience,” the CEO recently told an audience of Wall Street investors. “The only industry where that hasn’t shifted is in health care.” Asked who his core customers were, he said, “The strategy has always been to go after the next generation of health-care consumers: those in their teens, their 20s, their 30s.”

Wall Street has been skeptical so far. Today the company’s stock is down 50 percent from its debut, partly on concerns that it is buying its customers with unsustainably expensive marketing. Hims & Hers is either another scuzzy spac in a year that has seen many of them, or it is about to be the Amazon of health care and everybody is asleep and missing it. Whatever the answer, the company is betting that a new male anxiety could be the seedling of an empire, an empire that will spring to life from the little blue pill.

IN THE WINTER OF 2016, Andrew Dudum, a 29-year-old partner at a start-up incubator called Atomic Labs, was sitting in his office in the idyllic Presidio neighborhood of San Francisco, excitedly following developments in the field of telemedicine law. Dudum grew up in the Bay, raised by Palestinian Christian parents who had fled the 1948 Arab-Israeli War. In high school, he was a music kid, a professional wedding cellist, and an amateur Christian rocker. “It’s a beautiful thing,” he sang in one of his self-released singles, “when the angels fly you to the sky.” As a business-school student at Wharton, he became interested in more earthly forms of ascent, so when he graduated, he went to work at Atomic, which was partially funded by Peter Thiel.

Atomic focused on areas in which the law was shifting, and in 2016, it seemed as though an enormous change was about to occur in the $3.3 trillion healthcare market. For as long as there had been an internet, regulators had been cautious of allowing people to get medical care and medications via the web. In the 1990s, states and the federal government had tried to rein in pirate websites selling counterfeit pills, and in 2008, after an 18-year-old man fatally overdosed on Vicodin that had been prescribed to him online, Congress restricted the selling of controlled substances over the internet unless a patient saw the doctor in person first. But as smartphones became ubiquitous, and network speeds fast enough to handle videoconferencing, regulators were under pressure to relax. In 2016 in Texas, home to one of the most restrictive state medical boards in the country, a telemedicine company was pursuing a successful challenge to the rule that said a patient’s initial visit with a doctor had to occur in person. To Dudum and his Atomic Labs colleagues, it was obvious that soon—much sooner than most people realized—the majority of health-care interactions could take place over an app.

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