Thirty Madison made the waiting room optional

A man notices that his hair is thinning. His problem is medical, but much of the work ahead is administrative: finding someone to ask, arranging an appointment, getting a prescription, remembering the refill. Thirty Madison began by treating that sequence as a design problem. The interesting question was how many of its steps could disappear.

Start with the bathroom mirror

Steven Gutentag and Demetri Karagas founded Thirty Madison in 2017. Keeps launched in January 2018, offering men a route to hair-loss treatment without the usual appointment choreography. The founders were experiencing hair loss themselves. They had picked a customer they understood and a comparatively straightforward place to learn healthcare’s rules.

The promise concerned the entire experience: assessment, treatment, delivery, follow-up. A patient could arrive with an embarrassing question and leave with a plan. The medicine did not need a new origin story. Getting it could have a better one.

Keeps also behaved like a consumer business. Early investor Maveron points to podcast advertising as one of its unconventional early choices for reaching millennial men. That detail matters. A treatment service must be clinically credible, but it also has to turn up somewhere its prospective patients actually spend time.

Three doors into the same idea

Cove followed in January 2019, targeting migraine. Evens arrived that September for acid reflux. Each condition got its own name and language. Behind them sat the larger ambition: build a repeatable system for conditions that keep coming back.

Today, Keeps combines online evaluation with prescription and over-the-counter hair-loss options. Cove offers remote migraine assessment and treatment options for prevention and acute attacks. Nurx, which merged with Thirty Madison in 2022, spans contraception, skin care, mental health, weight management, and other services. Patients enter through the brand that recognizes their particular problem.

This places Thirty Madison between the local specialist’s office, the pharmacy, and consumer platforms such as Hims & Hers and Ro. Its distinguishing choice was separate brands organized around conditions. The proposition is especially useful for someone seeking ongoing management who finds repeat visits inconvenient. It depends on the service being appropriate for that person’s needs.

The price has more than one line

There is no single Thirty Madison subscription that buys everything. Its business combines care fees with medication purchases and recurring treatment, with insurance rules varying across services. Consider Nurx’s published birth-control pricing: a $28 consultation includes a year of messaging about that care. Medication starts at $15 a month without insurance; with coverage, it can be $0.

Those are different charges for different things. Nurx says it does not submit the consultation fee to insurance. The practical benefit is easier access and continuing communication; the financial benefit depends on the prescription and the patient’s coverage. Anyone comparing services should compare the whole bill, including subsequent care and refills.

Then the system had to grow up

The expansion required capital. Thirty Madison announced a $47 million Series B in August 2020, then a $140 million Series C in June 2021. At that point it reported $210 million raised and a valuation above $1 billion. Its announcement said revenue had tripled in 2020. The next year brought the Nurx merger and the launch of dermatology brand Facet.

Growth exposed less photogenic work. In a founder retrospective, Karagas recalled running out of minoxidil, a core Keeps product. A polished online experience still depended on a supplier having medicine available. Rapid hiring and remote work also strained the organization. In August 2022, the company confirmed a 10% workforce reduction.

“You have to be able to make those calls to say this isn’t working.”

Demetri Karagas, co-founder

The retreat became visible in the products. Picnic stopped operating in 2023, according to a company representative. Facet’s patient site says it ceased providing care and treatment in April 2025 and points visitors toward Nurx for dermatology. A brand could be retired while its former patients still needed records and another route to treatment.

Partnerships offered another way to expand. In April 2024, Nurx and Cove named Talkspace a recommended therapy partner. In April 2025, Nurx announced an integration with Gifthealth, LillyDirect’s pharmacy provider, for eligible patients prescribed Zepbound single-dose vials. Adding access did not always require adding another standalone brand.

The number on the sale

In September 2025, Remedy Meds announced an agreement to acquire Thirty Madison in an all-stock transaction valued just above $500 million. The announcement described Thirty Madison as profitable, with annual revenue exceeding $220 million. Oregon approved the transaction in October; its filings identify Remedy’s parent, Better Life Health, as the legal acquirer.

That price belongs beside the earlier billion-dollar valuation with care. They describe different transactions at different moments. The acquisition figure was stock consideration, not a fresh cash injection. Remedy brought a weight-management business; Thirty Madison brought established specialty-care brands. Combining them was a bet that shared operations could support a broader business.

The lesson a reader can borrow is specific: begin with one recurring problem, make every step easier, then test the next category on its own merits. Shared software does not settle questions about staffing, supply, or patient demand. The approach loses its appeal when remote assessment cannot meet a patient’s needs or when acquiring and serving customers costs too much. For the person watching the medicine cabinet, the test remains wonderfully concrete: can I get the right help, and will it still be there when I need it again?