Keeps Review: Overhyped Hair Loss Treatments?

Keeps is a US telehealth service that provides finasteride, minoxidil, and other compounded hair loss formulas online via subscription. In this review, we test each main product, and the claims on its website against clinical research. We also look at the pricing, and dosing. Keeps does sell products with legitimate and evidence-based drugs, but some of its headline figures require further context, and certain supplements they sell have claims that go beyond current evidence, with its topical finasteride warranting a closer look.

Finasteride is one of the ingredients found in many Keeps products, and in two separate one-year trials involving 1,553 men, just 1 mg of finasteride added 107 more crown hairs than placebo after 1 year, and 138 more after the second year [1]. Keeps’s catalog includes products with both finasteride as well as minoxidil, and after an online visit, you’ll typically be prescribed items containing one if not both of these ingredients.

After a thorough review, we’ve found that Keeps is only partially overhyped. These two drugs, minoxidil and finasteride, have decades of scientific research into their effectiveness. Still, despite this, some of Keeps’ marketing numbers, which make some bold claims such as “90% effective”, only make sense if you know exactly what was being measured, and a few of the products leave unanswered questions.

Key Takeaways

• Keeps is convenient and mostly affordable. Included among Keeps’ offers are products with generic finasteride and minoxidil, and their plans start as low as $10 per month. 
• The core drugs are well supported. There’s a lot of scientific backing for both finasteride and minoxidil when it comes to hair loss, although some of Keeps’ claims aren’t fully explained.
• Some formulas are dosed high or vaguely. Keeps’ topical finasteride gel, as well as the company’s melatonin spray, may have the drug in higher doses than is necessary for the scalp’s needs, and some of its newer offers have no listed doses at all.

What Causes Male Pattern Hair Loss?

Most of the time, a hormone called dihydrotestosterone, or DHT, which is made from testosterone, is responsible for any crown or hairline thinning. This occurs because an enzyme called type II 5-alpha reductase turns testosterone into DHT, and DHT shrinks genetically sensitive scalp follicles over many hair cycles [2]. This, in turn, causes thick hairs to become short, fine ones, usually at the crown, hairline, or both. 

Without treatment, the process keeps going. In the 5-year finasteride trials, every man in the placebo group lost hair by count [2]. The treatments with the best evidence either lower DHT, as finasteride does, or push follicles to grow longer and thicker hairs, as minoxidil does.

What Does Keeps Offer?

Keeps lists 14 hair products on its website, from topical gels to sprays and oral options and supplements, as well as styling and wash products. Newer chewable tablets and scalp drops combine finasteride or dutasteride with minoxidil and other ingredients. We chose six products with enough public detail to check. 

Pricing on the Keeps’ site, however, is sometimes unclear. Most pages list no prices, and most products just say that “many of our treatment plans cost as low as $10/month.” Keeps does list prices for a few of its products; specifically, a three-month supply of the minoxidil spray is $135 for the first cycle, and its chewables are “as low as $2/day.”

Its newer products are compounded, meaning that they are created by a pharmacist without the FDA’s involvement, so they are not FDA-approved. 

Keeps Finasteride (1 mg Oral)

Formulation

Keeps’ offering of oral finasteride is a generic 1 mg tablet taken once a day, which is the same dose as Propecia, the brand-name tablet the FDA approved for male pattern hair loss in men [2].

How Does Finasteride Work?

Finasteride is able to lower DHT in the scalp and blood by blocking the aforementioned enzyme, type II 5-alpha reductase. A short study in 1999 gave 249 male participants who had hair loss either finasteride doses or placebo for 42 days. At just 1 mg daily, researchers saw scalp DHT fall by 64.1% and blood DHT by 71.4% [3]. On placebo, scalp DHT fell by only 13.0%.

Clinical Effectiveness

In 2 one-year placebo-controlled trials published in 1998, 1,553 men aged 18 to 41 took finasteride 1 mg or placebo [1]. Of these, 1,215 continued into a blinded second year.

Finasteride added 107 hairs in a 1-inch circle at the crown compared with placebo at 1 year, and 138 at 2 years, while the placebo group kept losing hair [1]. By the 5-year mark, the FDA label reports a 277-hair difference between the groups [2].

Are There Any Side Effects?

The label also mentions reports of sexual issues that continue after stopping, as well as depression [2], which is why it's important for your provider to review your medical history before you start taking anything.

Does the Science Support Keeps' Claims?

Claim 1: "Blocks the production of DHT, the hormone responsible for male pattern baldness"

Conclusion: True, but needs context.

Finasteride does not outright stop DHT production, but it does lower it significantly. According to the 1999 study, scalp DHT fell by about 64% with 1 mg doses [3]. 

Claim 2: "Works on a receding hairline and for overall hair thinning"

Conclusion: True, but needs context.

In a 1-year trial of 326 men who had thinning at the front and middle of the scalp, finasteride beat placebo on hair counts, but it has not been shown to work for bitemporal recession (receding at the temples) [2].

Claim 3: "90% effective at treating hair loss according to clinical studies"

Conclusion: True, but needs context.

Though there is scientific backing for this claim, Keeps provides no source. But it is seen in the results of a five-year photo study, which found that after five years, 48% of men on finasteride had more hair and 42% had no visible change, which, taken together, is 90% [2]. So, in this claim, “effective” includes men whose loss simply stopped, and 35% of men still lost hair by count over the five years [2]. 

Claim 4: "Results within 4-6 months of consistent use"

Conclusion: True, but needs context.

Though finasteride results begin to appear after three or so months, the gains continue beyond that [2], with the results being more dramatic at two years compared to one [1].

Claim 5: "In clinical studies, 3.8% of patients noticed sexual side effect (versus 2.1% of patients taking the placebo)"

Conclusion: True.

These figures match the 1-year trial data in the FDA label exactly [2]. We give Keeps credit for printing them on the product page.

Bottom Line: Though Keeps does not always cite the sources for the claims behind its oral finasteride, they are accurate, with strong trial support. 

Keeps Minoxidil Solution (5%)

Formulation

Keeps sells a 5% minoxidil solution and a foam, and recommends using them twice daily. Its own FAQs note that topical minoxidil is FDA-approved for hair loss at the crown.

How Does Minoxidil Work?

Strangely enough, we still don’t fully understand how minoxidil is able to regrow hair, but it began as a blood pressure medicine that relaxes the muscle in blood vessel walls [4]. The effectiveness of minoxidil relies heavily on how much of a specific enzyme called sulfotransferase you have, which is what activates the drug. People with more sulfotransferase tend to respond better [5].

Clinical Effectiveness

One 2002 trial involving 393 men gave them 5% or 2% minoxidil, or placebo, for 48 weeks and found that the 5% solution was most effective, with 45% more regrowth than the 2% solution [6]. The higher strength minoxidil, however, resulted in side effects occurring more often, specifically itching and irritation. 

Twenty years later, a 2022 meta-analysis of 23 studies found that 1 mg of finasteride produced larger gains in thick, full-length hair at 48 weeks than either topical minoxidil strength [7].

Does the Science Support Keeps' Claims?

Claim 1: "Increases new hair growth in men with male pattern baldness"

Conclusion: True.

In the aforementioned 48-week trial, 5% minoxidil regrew more hair than placebo [6].

Claim 2: "Increases hair growth by up to 35% according to clinical studies"

Conclusion: True, but needs context.

Keeps doesn’t specify what the 35% measures or what it was compared with, and we couldn’t match the figure to a specific trial. "Up to" also indicates a best-case result.

Claim 3: "Works at the crown and middle of the head"

Conclusion: True, but needs context.

The FDA has approved minoxidil to help with hair loss at the crown, but it's often used at the front too with positive results. One study in 2016 found that men using 5% minoxidil foam for just over 2 years experienced hair count and width at the templates and hairline increase significantly by weeks 52 to 76, then fall back to where they started [8].

Bottom Line: This is standard 5% minoxidil with solid evidence behind it. The marketing numbers are vague, and on its own it tends to do less than finasteride.

Keeps Minoxidil Foam (5%)

Keeps presents the foam as offering the same benefits as the solution, applied as half a capful twice daily. In a 2007 trial, 352 men used 5% minoxidil foam or placebo for 16 weeks [9]. The foam group had a significant rise in hair counts and rated their own improvement higher.

Keeps does not publish the foam's inactive ingredients, so we cannot confirm what base it uses.

Bottom Line: The foam suits men who find solutions irritating or greasy, and Keeps should still list its full ingredients.

Keeps Minoxidil+ Spray

Formulation

The Minoxidil+ spray contains 5% minoxidil, 0.01% tretinoin, 0.2% caffeine, and 0.1% melatonin, applied once a day. It is a prescription compound that Keeps notes is "not FDA approved." One section of the page lists caffeine at 2% rather than 0.2%, so the labeling could be clearer.

Clinical Effectiveness

Out of the three add ons in this product, the vitamin A derivative tretinoin has the best evidence. In a 2019 study, researchers found that 5 days of topical tretinoin turned 43% of predicted minoxidil nonresponders into responders; assumed to be from raising sulfotransferase in the follicle [5]. 

You’ll find less scientific backing for caffeine. A 2017 trial involving 210 men compared a 0.2% caffeine liquid with 5% minoxidil and found the anagen ratio (the share of hairs in the active growth phase) improved by 11.68% with minoxidil and 10.59% with caffeine [10]. The trial was not blinded, so people knew which treatment they were using.

The best evidence for melatonin comes from a 20024 pilot trial [11]. In the trial 40 women applied a daily 0.1% minoxidil solution for 6 months, which was found to raise the share of growing hairs in certain scalp areas when compared to the placebo group. There hasn’t been a similar trial done in men.

Does the Science Support Keeps' Claims?

Claim 1: "Topical minoxidil improves blood flow to hair follicles to boost hair regrowth by up to 35%"

Conclusion: True, but needs context.

Minoxidil does widen blood vessels, but a 2004 review on potassium channel opening and direct effects on follicle cells, and judged the link of blood vessel widening to hair regrowth as unproven [4]. The 35% figure is the same unsourced number from the solution page.

Claim 2: Tretinoin "gently exfoliates to enhance minoxidil's efficacy"

Conclusion: True, but needs context.

Tretinoin has been shown to improve minoxidil's results in trials. The consensus is enzyme activation inside the follicle, with exfoliation playing at most a minor part [5].

Claim 3: Caffeine "supports thicker, healthier hair growth"

Conclusion: Potentially misleading.

The caffeine trial only tracked the growth phase, so this wording goes beyond the evidence [10].

Claim 4: Melatonin "has been shown in clinical studies to facilitate scalp hair growth"

Conclusion: True, but needs context.

The evidence just comes from a small pilot study in women, which measured hair cycle changes, and while it's promising, this is not enough evidence to support the claim [11].

Bottom Line: Adding tretinoin to minoxidil is evidence-based from a randomized trial, while the caffeine and melatonin add-ons have much less evidence, and the melatonin strength is higher than it needs to be.

Keeps Topical Finasteride and Minoxidil Gel

Formulation

This prescription gel combines 0.25% finasteride and 5% minoxidil. Keeps recommends applying one pump once daily and waiting 2 to 4 hours before wetting the hair or lying down. The page doesn’t specify how much gel one pump dispenses.

Clinical Effectiveness

Minoxidil might actually work better when paired with a DHT blocker. One 2018 randomized trial involving 40 men who used either a solution combining 0.25% finasteride with 3% minoxidil or 3% minoxidil alone for 24 weeks found that the combination led to greater increases in hair density and thickness [12]. 

You can also use topical finasteride on its own if, for any reason, you want to avoid using minoxidil. In a 2022 phase III trial, 458 men were randomly assigned to use a 0.25% finasteride spray, take oral finasteride, or receive a placebo for 24 weeks [13]. The spray increased target-area hair counts by 20.2, nearly matching the tablet, compared with 6.7 for the placebo.

Does the Science Support Keeps' Claims?

Claim 1: "Finasteride stops hair loss by blocking the production of DHT, the hormone responsible for male pattern baldness"

Conclusion: True, but needs context.

Topical finasteride lowers scalp DHT. At this strength, though, it also lowers DHT in the blood, so its effects are not confined to the scalp [13].

Claim 2: "Minoxidil increases blood flow to hair follicles to stimulate hair regrowth"

Conclusion: True, but needs context.

As with the spray, blood flow is one proposed route, and the mechanism is still unproven [4].

Claim 3: The topical combination "may have a lower risk of these side effects, such as sexual dysfunction, depression and suicidal thoughts"

Conclusion: True, but needs context.

In the phase III spray trial, blood levels of DHT fell by 34.5% with the spray, compared to 55.6% with the tablet [13]. That is less whole-body exposure, but it's still a large drop, and a 24 week trial is too short to conclude whether the spray has a lower risk of rare side effects.

Bottom Line: The combination approach is sound and convenient. The 0.25% strength behaves more like a whole-body drug than many buyers expect.

Keeps Daily Hair Defense Supplement

Formulation

These tablets, taken as 2 a day, contain a host of different supplements, including saw palmetto, biotin, vitamins A, B6, B12, C, and D, along with calcium, selenium, and zinc. 

Clinical Effectiveness

While there’s some evidence supporting saw palmetto as a DHT blocker, its effectiveness is not quite as high as finasteride. One 2012 study compared 320 mg of saw palmetto with 1 mg of finasteride in 100 men over two years. Participants knew which treatment they were taking, and there was no placebo group. By the end of the study, 38% of the saw palmetto group had improved, compared with 68% of the finasteride group [14].

And though this product has a host of different nutrients and minerals, you’ll really only benefit from them if you have some kind of deficiency. A 2019 review focusing on people with a deficiency found that too much vitamin A or selenium could cause hair loss [15]. Another 2017 review of biotin found that in all 18 cases of benefits, people had an underlying cause [16]. 

Does the Science Support Keeps' Claims?

Claim 1: Saw palmetto "stabilizes hair loss and promotes healthy hair growth"

Conclusion: Potentially misleading.

The evidence is from small or uncontrolled studies, and Keeps doesn't disclose its own dose. Our comparison of saw palmetto and finasteride goes into more detail about why we don't treat it as a substitute.

Claim 2: Calcium, selenium and zinc "support hair growth, strength, and overall body health"

Conclusion: Potentially misleading for hair.

The evidence for hair centers on correcting deficiencies. In fact, too much selenium can actually cause hair loss [15].

Bottom Line: It's a multivitamin with a saw palmetto dose that we can't verify. It's unlikely to change the course of genetic-driven male pattern hair loss.

Problems with Keeps' Approach: Our Recommendations

Keeps makes generic finasteride and minoxidil easy to access, which we see as a plus. We think three changes could make the experience better for customers.

1. Better Guidance on Results Timelines and Escalation

Although Keeps often says results typically take 4-6 months on almost all its product pages, finasteride gains can keep building into the second year, so 4-6 months might not be the best time to judge results [1]. If there’s no improvement by twelve months, it might be worth trying another option.

If finasteride doesn’t work, the next step is typically dutasteride, which blocks both type I and type II 5-alpha reductase. A 2014 trial involving 917 men who took one of three dutasteride doses, 1 mg of finasteride, or a placebo for 24 weeks found that dutasteride at 0.5 mg increased hair counts more than finasteride [17]. Keeps now includes dutasteride in its Chew+ and Drop+ products, although its product pages don’t list the dosage. Ulo has dutasteride in 0.5, 1.5, and 2.5 mg doses, which makes the dose very clear so you and your provider can consider each dosage level.

2. More Flexibility With High-Dose Topicals

The 0.25% finasteride gel is the first concern, since each mL contains 2.5 mg of finasteride. What that means is that if a single pump delivers even 0.5 mL, you'd get more than the 1 mg dose in an oral tablet. This is important because even very small oral doses can lower DHT. A 1999 study found that just 0.05 mg finasteride per day reduced blood DHT by 49.5% [3].

If you’re focused only on scalp hair loss, you should consider a smaller dose. Ulo’s topical finasteride has both a low-dose version with 0.005% as well as 0.2%. It also contains no propylene glycol and can be combined with 7% minoxidil and tretinoin. 

Melatonin raises a similar question. The 0.1% spray by Keeps has 1 mg of melatonin per mL, and a 2004 pilot trial found that a 0.1% solution increased melatonin levels [11]. So using it at day time could increase melatonin levels when your body usually naturally keeps levels low, so we'd use it at night or maybe choose a lower strength. Ulo's optional booster has 0.01% melatonin, just 1/10th the concentration in Keeps' spray.

3. Clearer Prices and Ingredient Lists

Most Keeps product pages show neither a price nor the strength of every active ingredient. Ulo lists both. Its topical minoxidil costs $49 a month, or $34 a month on a 12-month plan, and its topical finasteride costs $59 a month, or $41 a month on a 12-month plan.

Final Remarks

Keeps isn’t inherently overhyped when it comes to their products like oral finasteride and 5% minoxidil which are standard and proven doses backed by evidence. They also list out side effects accurately. The exaggerations lie in the unsourced percentages and claims about add-ons and supplements.

If you decide to go with Keeps, give any regimen 12 months and ask your provider how much finasteride the topical gel actually delivers. If you’re looking for more transparent disclosed doses, a low dose finasteride option, and adjustable add ons, we recommend Ulo topical finasteride or Ulo topical minoxidil.

References

1. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39(4 Pt 1):578-589. https://doi.org/10.1016/s0190-9622(98)70007-6
2. Organon LLC. Propecia (finasteride) tablets, 1 mg: prescribing information. Revised October 2024. https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/6f904709-65aa-44ce-b144-b4c8a0416e36/spl-doc
3. Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC, et al. The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol. 1999;41(4):550-554. https://doi.org/10.1016/S0190-9622(99)80051-6
4. Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186-194. https://doi.org/10.1111/j.1365-2133.2004.05785.x
5. Sharma A, Goren A, Dhurat R, Agrawal S, Sinclair R, Trüeb RM, et al. Tretinoin enhances minoxidil response in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes. Dermatol Ther. 2019;32(3):e12915. https://doi.org/10.1111/dth.12915
6. Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47(3):377-385. https://doi.org/10.1067/mjd.2002.124088
7. Gupta AK, Venkataraman M, Talukder M, Bamimore MA. Relative efficacy of minoxidil and the 5-α reductase inhibitors in androgenetic alopecia treatment of male patients: a network meta-analysis. JAMA Dermatol. 2022;158(3):266-274. https://doi.org/10.1001/jamadermatol.2021.5743
8. Kanti V, Hillmann K, Kottner J, Stroux A, Canfield D, Blume-Peytavi U. Effect of minoxidil topical foam on frontotemporal and vertex androgenetic alopecia in men: a 104-week open-label clinical trial. J Eur Acad Dermatol Venereol. 2016;30(7):1183-1189. https://doi.org/10.1111/jdv.13324
9. Olsen EA, Whiting D, Bergfeld W, Miller J, Hordinsky M, Wanser R, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007;57(5):767-774. https://doi.org/10.1016/j.jaad.2007.04.012
10. Dhurat R, Chitallia J, May TW, Jayaraaman AM, Madhukara J, Anandan S, et al. An open-label randomized multicenter study assessing the noninferiority of a caffeine-based topical liquid 0.2% versus minoxidil 5% solution in male androgenetic alopecia. Skin Pharmacol Physiol. 2017;30(6):298-305. https://doi.org/10.1159/000481141
11. Fischer TW, Burmeister G, Schmidt HW, Elsner P. Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial. Br J Dermatol. 2004;150(2):341-345. https://doi.org/10.1111/j.1365-2133.2004.05685.x
12. Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia. J Eur Acad Dermatol Venereol. 2018;32(12):2257-2263. https://doi.org/10.1111/jdv.15171
13. Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, et al. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022;36(2):286-294. https://doi.org/10.1111/jdv.17738
14. Rossi A, Mari E, Scarno M, Garelli V, Maxia C, Scali E, et al. Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study. Int J Immunopathol Pharmacol. 2012;25(4):1167-1173. https://doi.org/10.1177/039463201202500435
15. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The role of vitamins and minerals in hair loss: a review. Dermatol Ther (Heidelb). 2019;9(1):51-70. https://doi.org/10.1007/s13555-018-0278-6
16. Patel DP, Swink SM, Castelo-Soccio L. A review of the use of biotin for hair loss. Skin Appendage Disord. 2017;3(3):166-169. https://doi.org/10.1159/000462981
17. Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014;70(3):489-498.e3. https://doi.org/10.1016/j.jaad.2013.10.049