Keeps Review 2026: Online Finasteride and Minoxidil, Checked Against the Evidence

Keeps is an online prescription service for men's hair loss in the US. You fill in a medical questionnaire and send three photos of your scalp, a licensed provider reviews them, and generic finasteride, minoxidil or ketoconazole shampoo arrives by post every 3, 6 or 12 months. Unlike most products we review, what Keeps sells has strong evidence: finasteride and minoxidil are the two drugs with years of placebo-controlled trials for male pattern hair loss. The service itself adds convenience and a reasonable price, not a better drug. The trade-offs are no refunds, finasteride side effects you should understand before starting, and no service outside the US.

What the service is and what it sells

Keeps is owned by Thirty Madison, which also runs other US telehealth brands. It treats male pattern baldness only; its own FAQ says it is not the right service for hair loss from chemotherapy. The core range is small and sensible: generic finasteride 1 mg tablets, minoxidil 5% foam or solution, and 2% ketoconazole shampoo. It also sells oral minoxidil tablets, a compounded topical finasteride and minoxidil gel, newer compounded chews and drops that mix finasteride or dutasteride with minoxidil and other ingredients, and cosmetic thickening shampoos and a supplement.

How the online consultation works

1. Pick a plan on the site or take the hair-loss quiz.
2. Answer a medical questionnaire and upload three photos of your head. Keeps says only your provider sees the photos.
3. A licensed US medical provider reviews your answers, usually within 24 to 48 hours per Keeps' FAQ, and prescribes if the treatment suits you. The first consultation is free.
4. The first shipment arrives 5 to 7 business days after you order. On a 3-month plan the first refill is processed 75 days after the first order.
5. You can message the provider during the year, and change, pause or cancel the plan from your account or by phone.

This is an asynchronous consult: forms and photos, not a video appointment. That is enough for typical male pattern hair loss, which is usually diagnosed by how it looks. It is not enough if your hair loss is unusual, which is why the 'who should use a doctor instead' list below matters. Keeps also says that if you already have a prescription from your own doctor, you still need to go through its consultation.

Pricing (checked 29 Sept 2026)

• The first order showed about 30% off: finasteride came to $14 a month on the 12-month plan, minoxidil foam to $8.92.
• Finasteride and minoxidil together on 12-month plans comes to about $393 a year at full price, plus shipping.
• Generic finasteride is an old, cheap drug. If a GP or dermatologist will prescribe it, check a pharmacy discount price before prepaying a year. Minoxidil 5% foam is sold over the counter, so you do not need a subscription for it.
• Because all sales are final, start with a 3-month plan. The per-month saving on 12 months is small next to the risk of stopping early because of side effects.

What the marketing overclaims

• '90% effective at treating hair loss.' Keeps' own FAQ narrows this to slowing or stopping further loss and says about 66% of men get some regrowth, and at best recover up to 20% of the hair they lost. The trials support real benefit, not a 90% success rate for regrowth.
• 'Regrow hair in as fast as 3 months.' The trials measured results at 1 to 2 years for finasteride and 48 weeks for 5% minoxidil. Keeps' FAQ says 4 to 6 months to see results, which is closer.
• 'Clinically-proven' and 'FDA-approved treatments' used across the range. That is true of finasteride and minoxidil. It is not true of the compounded 4-in-1 and 11-in-1 formulas or of oral minoxidil for hair loss, which Keeps' own disclaimer says is not FDA-approved for that use.
• 'Half the cost of your local pharmacy.' That depends on the pharmacy and on discount cards. Compare before assuming it.

Side effects to understand before you start

• Finasteride, short term: in the 1-year trials, 3.8% of men reported lower libido, erection problems or less ejaculate, against 2.1% on placebo (FDA label). A review of 12 trials found about 1 extra case of erectile dysfunction for every 82 men treated (PMID 20956649).
• Finasteride, persisting effects: some men report sexual and mood symptoms that continue after stopping. In one health system's records, 0.8% of men aged 16 to 42 on low-dose finasteride had erectile dysfunction lasting at least 90 days after stopping (PMID 28289563). How often this happens is disputed, and a 2015 review found the original trials reported side effects poorly (PMID 25830296).
• Finasteride and mood: WHO reporting data show a signal for suicidality in young men using it for hair loss (PMID 33175100). The FDA label lists depression and suicidal ideation among post-marketing reports, and in May 2026 the UK's MHRA strengthened its warnings and told men on 1 mg to stop and contact a doctor if they develop depression or suicidal thoughts.
• Finasteride lowers PSA, the prostate cancer blood test. Tell any doctor who orders one that you take it.
• Women who are or may be pregnant should not handle crushed or broken finasteride tablets.
• Topical minoxidil: scalp itching and irritation, more with 5% than 2% (PMID 12196747).
• Oral minoxidil: unwanted hair growth on the face and body in 15% to 49% of users in studies, plus occasional lightheadedness, fluid retention and a fast heartbeat (PMIDs 33639244, 38598226).

Who should use a GP or dermatologist instead

• Anyone whose hair loss is patchy, sudden, follows an illness, new medicine or stress, or comes with an itchy, scaly or sore scalp. These need a diagnosis in person, and the drugs Keeps sells do not treat most of them.
• Anyone with a history of depression, anxiety or suicidal thoughts. Finasteride may still be possible, but it should come from a prescriber who knows your history and will follow you up.
• Anyone with heart disease, low blood pressure or on blood pressure tablets who is offered oral minoxidil.
• Women. Keeps treats men only, and finasteride is not for women who are or may become pregnant. Topical minoxidil is the evidence-based option for female pattern hair loss.
• Anyone under 18.
• Anyone with insurance or a GP who will prescribe generic finasteride. It may cost less that way, and you keep an in-person relationship if side effects appear.

In the UK

Keeps is not available in the UK: it does not ship outside the US, and its providers are licensed only there. The same drugs are available here. Minoxidil 5% foam and solution are sold over the counter in pharmacies. Finasteride 1 mg needs a prescription; the NHS says finasteride and minoxidil are the main treatments for male pattern baldness but are not all available on the NHS, so most men pay privately through a private prescriber or an online pharmacy with a UK-registered prescriber. Every UK finasteride pack now carries the MHRA patient card on psychiatric and sexual side effects. Read it.

Verdict

Keeps sells the right drugs. Finasteride and minoxidil are the two hair-loss treatments with strong, long-running trial evidence, and Keeps prices them fairly and delivers them with little friction. What you are paying for is convenience: a quick online consult and a subscription. That suits a US man with ordinary pattern hair loss, no mood history, who has read the finasteride warnings and wants to start. Start on a 3-month plan because there are no refunds, stick to the core drugs rather than the compounded formulas, and stop and speak to a doctor if your mood or sex drive changes. If your hair loss is unusual, you have a mood history, or you are in the UK, go through a GP or dermatologist instead. Our guide to finasteride vs minoxidil covers the trial evidence in more detail.