Warning: The Sex Drug Startup Revolution May Have Side Effects
Originally published in Forbes
Men’s wellness brand Hims gained notoriety this year with its subway-to-Pornhub ad campaign featuring, um, erect cacti. But in changing the way millions approach sexual wellness, many already in the space are wondering just who will get pricked.
Thanks to the racy ad campaign, and the company’s novel approach to sexual health — connecting men with online doctors who can prescribe generic versions of erectile dysfunction medications like Viagra and Cialis — Hims became an overnight media sensation.
Then, in late October, the company announced the launch of Hers, a new brand which would provide women with access to supplements, skincare and birth control — as well as access to Addyi, the controversial “female Viagra.”
In just six months, the landscape for sexual wellness has shifted dramatically, and raises a larger question. Does the easing access to sex drugs like Viagra and Addyi present a net positive for sexual health?
Educators and entrepreneurs working in sexual wellness are wary.
“One of the primary reasons for ED in men under the age of 40 is anxiety,“ says Dr. Uchenna Ossai, a pelvic health physical therapist on faculty of the University of Michigan’s Sexual Health Certificate Program. “Increasing access without more thorough medical assessment is putting a lot of men at risk, while also missing an opportunity to expand the national dialogue on sex and sexuality.”
Reports of erectile dysfunction by young men have risen in recent years, as has the use of ED meds like Viagra. Hims promises “no awkward conversations” in doctors offices, but Ossai, who is also the founder of YouSeeLogic, a sex ed platform for adults, fears that an approach with a predetermined solution could leave the actual causes — such as depression, diabetes, high cholesterol and thyroid disease — undiagnosed and untreated.
Hims asks medical questions using a bot, which relays the answers to a doctor who approves or disapproves the application. But there is little to no one-on-one interaction. As a result, the process can feel less focused on getting a diagnosis, and more about whether or not the specific prescription can be approved.
Brianna Rader, founder of Juicebox, an app which provides anonymous and confidential sexual health counseling, says that most of the young men her company works with benefit from understanding ED in context.
“A lot of erectile issues are mental and emotional,” she says. “Hims has a one-size-fits-all model that can be damaging because if the 20mg dose from Hims doesn't work for you, then you're going to feel even more broken.”
As founder of the sexual health platform O.school, I’ve spoken to hundreds of college-aged men who struggle with the expectation to perform — and performance anxiety can masquerade as ED.
Similarly, I’ve spoken with women who blame themselves for lack of satisfactory sex or lack of sexual interest, only to realize later that the issue was lack of education about their own anatomy, or partners who didn’t prioritize their pleasure.
Polly Rodriguez, founder of direct-to-consumer sexual product company Unbound says she, too, is concerned about the lack of education embedded in these processes. Rodriguez points out that Addyi is more akin to an antidepressant than it is to Viagra, and “requires womxn to make significant lifestyle changes, including, but not limited to: not drinking alcohol while on the medication and taking the medication for up to a month before seeing results.”
From an investment perspective, however, the Hims & Hers gambit is a smart move. Anxieties about sexual performance are widespread, and Hims understands that these anxieties — and the fear of discussing them with medical professionals — means a huge untapped market, with the potential for massive, recurring sales.
That potential is bolstered by the rapid expansion of the global telehealth market, which is growing at 13% a year, and expected to reach $19.5 billion by 2025.
And femtech – technologies centered around women’s health, from fertility to aging to sexual wellness — has just reached an all-time funding high of $400 million.
That may look like a large number, but Hims and their more holistic competitor Ro, have raised $200M in just the last six months alone. That’s more than any female founder has raised ever, leaving femtech founders to wonder if the male-dominated VC community isn’t overly focused on cacti.
Dr. Sophia Yen is CEO and co-founder of Pandia Health, which works provides on-demand birth control for women, and has sometimes struggled to raise venture capital, despite a huge potential market.
“It’s been frustrating begging for money for a company that helps 80% of women and to see companies raising for erectile dysfunction easily get the funding,” says Yen. She’s conceded that the VC “boys network” is certainly part of it, but points out that “[male] funders better understand the ED pain point than they understand the pain point that women face each month.”
“I'd really love if we started funding non-binary, femme, and female founders to solve these problems instead of cis white men,” says Rodriguez. “Maybe that's a crass thing to say, but I just fundamentally believe that the founders who are most qualified to solve difficult, gnarly problems are the ones who have personally experienced those problems.”
Should Hims and Hers succeed, it has the potential to create a large enough marketplace to dissuade additional investors from funding female-founded companies with a more nuanced approach to sexual wellness. After all, if so much money can be made with savvy marketing and quickfix telehealth, why invest in more complicated solutions?
Of course, there is a world where people can have easier access to the drugs they need and more access to education, information, and pleasure products. But if companies like Hims don’t invest in both, and consumers are ultimately left unfulfilled, founders may find that initial sky-high investments causing their own form of performance anxiety — one that can’t be solved with an online prescription.