cost

Hims vs Keeps vs Roman for Hair Loss: Finasteride and Minoxidil Compared (2026)

Male pattern hair loss (androgenetic alopecia) is the most common hair loss diagnosis and the most-prescribed condition in male-focused telehealth. Three operators dominate the category in 2026: Hims, Keeps, and Roman (Ro). The underlying medications (finasteride 1mg, minoxidil 2-5%) are inexpensive generics, so pricing differences come from service fees, custom compounds, and dutasteride availability. This guide explains the practical differences a patient choosing between them should know.

TL;DR

› Keeps is cheapest at $25/month for finasteride + minoxidil. Roman is $44, Hims is $59.
› Roman is the only major US telehealth offering dutasteride ($69/month) for finasteride non-responders.
› Hims offers custom compounded topical finasteride + minoxidil ($42-$59/month) - reasonable for patients worried about systemic side effects.
› Direct from Costco or Walmart with PCP prescription runs $12-$17/month total - cheapest option.
› For most first-time patients, Keeps is the best telehealth value; Roman if dutasteride is on the table.

The Three Clinics at a Glance

Hims: Largest by marketing spend and brand recognition. Sells finasteride, minoxidil (oral and topical), and a custom compounded "topical finasteride and minoxidil" combination. Subscription model with monthly or quarterly delivery. Owns the Hims & Hers brand. Public company (NYSE: HIMS).

Keeps: Owned by Thirty Madison, hair loss is their core competency (not a generalist telehealth like Hims and Ro). Often the cheapest of the three for basic finasteride + minoxidil protocols. Strong adherence to evidence-based prescribing. No flashy custom compounds.

Roman (Ro Mens Health): Part of the Ro family (also Ro Body for GLP-1). Strong physician network. Offers finasteride, minoxidil, and recently added dutasteride for non-responders. Mid-tier pricing.

Cost Comparison 2026

Monthly costs for the standard finasteride 1mg + minoxidil 5% protocol:

- Keeps: $25/month for both medications. Cheapest of the three. - Roman: $44/month for both. - Hims: $59/month for both ($30 finasteride + $29 minoxidil).

For the upgraded "custom compound" or premium tier: - Hims Custom Topical (finasteride + minoxidil combined): $42 to $59/month. - Keeps does not offer custom topical compounds. - Roman offers dutasteride at $69/month for finasteride non-responders.

Annualized: Keeps at $300/year is the cheapest path. Roman at $528/year and Hims at $708/year cost meaningfully more for the same FDA-approved generic medications. The premium pricing buys marketing polish and (for Hims) the custom compounded topical product, not improved clinical outcomes.

Dutasteride Availability

Dutasteride is a more potent 5-alpha reductase inhibitor than finasteride (blocks both Type I and Type II isoforms). It is FDA-approved for benign prostatic hyperplasia, not hair loss, but is prescribed off-label for finasteride non-responders or patients seeking more aggressive treatment.

Roman: Offers dutasteride 0.5mg daily at $69/month. The only major US hair loss telehealth that offers it as a standard protocol option.

Hims: Does not offer dutasteride. Refers patients to in-person providers for off-label dutasteride.

Keeps: Does not offer dutasteride. Sticks to FDA-approved finasteride and minoxidil.

For patients who have tried finasteride for 12+ months without adequate response, Roman is the only major telehealth path for dutasteride. Alternatively, in-person dermatologists or hair restoration specialists will prescribe it.

Custom Compounded Topicals: Worth It?

Hims aggressively markets a "Custom Topical Finasteride and Minoxidil" combination at $42 to $59/month. The pitch is convenience (one bottle instead of two) and reduced systemic finasteride exposure compared to oral.

The clinical evidence for topical finasteride is real but limited. Studies suggest topical can reduce systemic 5-alpha reductase inhibition by 40 to 60 percent while delivering local scalp efficacy comparable to oral. For patients concerned about sexual side effects from oral finasteride, topical is a reasonable harm-reduction option.

Downsides: Less efficacy than oral in head-to-head studies (about 70-80% of oral efficacy). Higher monthly cost. Compounded products lack standardized FDA-approved labeling.

For most patients, oral finasteride 1mg from Keeps at $15/month plus generic 5% minoxidil topical from any pharmacy at $10/month is the clinically and economically optimal protocol. The custom compound is a premium product solving for a specific concern (systemic side effects) rather than a meaningful efficacy upgrade.

Which Clinic Should You Choose?

Pick Keeps if: you want the cheapest path with evidence-based prescribing of FDA-approved medications. Their entire brand is built around hair loss specifically, not generalist telehealth.

Pick Roman if: you might need dutasteride (because you have already tried finasteride without adequate response or you want the option), or you prefer Ro's overall ecosystem.

Pick Hims if: you want the custom compounded topical combination product specifically (which neither competitor offers), or if you value the larger brand recognition.

For most first-time patients without specific compound needs, Keeps is the value choice. Roman is the right choice if dutasteride is on the table.

What About Going Direct to Costco or HIM-S Generics?

For patients optimizing purely on cost, direct purchase from a retail pharmacy or warehouse club is dramatically cheaper than any telehealth subscription.

Finasteride 1mg via a one-time prescription from your primary care provider: Costco runs $7 to $12 per month, GoodRx prices vary from $8 to $20. Walmart, CVS, and Walgreens all stock generic finasteride.

Minoxidil 5% topical: Available over-the-counter at Costco, Walmart, Amazon. Kirkland brand at Costco is $30 for a 6-month supply ($5/month equivalent).

Total cost via this path: $12 to $17 per month. About 50 percent of what Keeps charges, 30 percent of what Hims charges. The telehealth subscription fee is buying convenience (recurring delivery, prescription renewal automated, no annual PCP visit) at a $10 to $40 monthly markup.

For patients who want maximum cost optimization, get an initial prescription from your PCP, then refill at Costco or via GoodRx going forward.

Frequently Asked Questions

Which is cheapest, Hims or Keeps or Roman? +

Keeps at $25/month for finasteride + minoxidil is the cheapest of the three telehealth options. Roman is $44/month, Hims is $59/month. Going direct via Costco or GoodRx with a PCP prescription is even cheaper at $12-$17/month.

Does Hims really work for hair loss? +

Yes, Hims prescribes FDA-approved finasteride 1mg and minoxidil 5% which have decades of clinical evidence. The medications are the same generics any other clinic prescribes. You are paying for the brand and the subscription convenience, not different or better medication.

What is the difference between Hims and Keeps? +

Both prescribe finasteride and minoxidil. Hims is a generalist telehealth (also sells ED, mental health, weight loss) at higher monthly cost ($59 vs $25). Hims offers a custom compounded topical product. Keeps focuses specifically on hair loss and sticks to FDA-approved generics. Clinical outcomes are equivalent because the medications are identical.

Should I try finasteride or dutasteride first? +

Start with finasteride 1mg daily. About 60-70 percent of men respond adequately. Wait 6-12 months to assess response. If you have not seen meaningful results by month 12, dutasteride is a reasonable next step. Roman is the only major US telehealth offering dutasteride; alternatives are in-person dermatology.

Is topical finasteride better than oral? +

Not better, but trades efficacy for reduced systemic exposure. Topical delivers about 70-80 percent of oral efficacy with 40-60 percent less systemic 5-alpha reductase inhibition, which means fewer sexual side effects in some patients. For patients without side effects, oral is more cost-effective. For patients concerned about side effects, topical (or topical + lower-dose oral) is reasonable.

Can I get hair loss medications without telehealth? +

Yes. Get an initial prescription from your primary care provider. Refill at Costco ($7-12/month for finasteride), GoodRx, or any retail pharmacy. Minoxidil 5% is over-the-counter. Total cost: $12-17/month. Most cost-effective path if you do not need ongoing clinician support.

Bottom Line

For most men starting hair loss treatment in 2026, the right path is Keeps at $25/month for the cheapest evidence-based telehealth option, or direct via Costco/GoodRx at $12-$17/month for the cheapest path overall. Choose Roman if dutasteride is likely on the table due to finasteride non-response. Choose Hims if you specifically want their custom compounded topical product or value the larger brand. All three deliver clinically equivalent outcomes when prescribing the same FDA-approved generics; the differences are price, formulation options, and adjacent service offerings.

Sources

Hims website (hims.com), Keeps website (keeps.com), Roman website (ro.co/men/hair-loss), Q1 2026 pricing. (Current pricing)
FDA prescribing information for finasteride 1mg (Propecia) and minoxidil 5% (Rogaine). (Standard hair loss medications)
Caserini et al. Topical Finasteride in Androgenetic Alopecia: A Systematic Review. JEADV, 2021. (Topical finasteride efficacy)