In his very early 20s, as an undergraduate student, Isaac would choose whether to attend social events based on how appropriate it would be to wear a hat. He was never seen without one. It was one of two foundational concerns that plagued him. “When I would get high,” he says, “the two things I’d think about were, like, ‘people know you’re gay,’ and, ‘you’re balding.’”

Isaac, who is going by his first name to protect his privacy, had known his fate for years. His father had begun balding as early as senior year of high school. Isaac had tried nearly everything: shampoos, essential oils, advice from Reddit forums. He was too young, and not jacked enough, he feared, to pull off a Jason Statham or Bruce Willis. Then, in 2019, he recalled a subway ride he’d taken in New York the previous year. The entire train had been covered in ads for Hims, an online men’s health service catered specifically to hair loss and erectile dysfunction issues. Isaac searched for a Canadian equivalent, and found Essential Clinic—a company founded just that year out of frustration with the “lack of innovation in our traditional healthcare system,” according to co-founder Hisham Al-Shurafa. “We shop online. We communicate online. We bank online,” Al-Shurafa said in an email to The Local. Why not health care?

That was six years ago. Since then, Isaac has been on finasteride, one of the two most popular pharmaceutical treatments for hair loss. A small fraction of users say the pill has debilitating side-effects, including physical changes to genitals, loss of libido, and suicidal ideation. Isaac hasn’t experienced any such side effects, and is a satisfied customer. He’s also never had a full conversation with a health care professional from Essential Clinic, he says. When I met him in a downtown coffee shop on a freezing November day, the 29-year-old was cheerful and disarmingly honest, with long eyelashes and a hairline that showed no hint of receding.  He describes initially filling out an intake form, and now every year completes a questionnaire sent by a nurse practitioner—a different one every time—who then approves his one-year prescription refill. (In an email response to The Local, Al-Shurafa said, “Check-in and refill timing is determined by our practitioners on a case by case basis. All patients are required to provide an update at least once a year.”)

In 2019, when the Canada-wide wait time for health care treatment had already been rising for years, a Toronto-based startup called Felix Health Inc. received a few million dollars in seed funding for a digital health platform meant to bypass the hassle and embarrassment of in-person health care. Their focus was birth control, erectile dysfunction (ED), skin care, and hair loss. “These categories lend themselves very well to telemedicine,” CEO and founder Kyle Zien told Best Health magazine at the time, because in-person visits for these issues are “really not required from a medical perspective.”

“These are drugs for things that consumers think that they can identify,” says Joel Lexchin, longtime doctor, York University professor, and author on Canadian pharmaceutical policy. “Am I going bald?…Am I fat? Am I anxious? Do I feel depressed? The idea is that you don’t really need to see a doctor to get the diagnosis.”

That makes it easier to sell a particular cure, Lexchin says. “They already know what they want, to a certain extent. You’re just providing an easier avenue for them to get it.”

When the pandemic happened, suddenly conditions were optimal for the telehealth business. The idea of spending weeks or months waiting to talk to your doctor for a rushed 10 minutes—about hair loss, of all things—started to feel absurd. Virtual pharmacies and clinics promised to reduce that wait time to hours, or at most, days.

In 2021, Felix received $10 million in venture capital funding. Months later it announced an expansion into mental health services, following overwhelming pandemic-induced demand. In April 2023, with 540,000 users registered with the platform, the company received another $18 million; this past October, $53 million, from a handful of funders.

While Felix appears to be the most successful among Canadian for-profit online pharmacies, the North American field as a whole is flourishing, especially in men’s health, where startup founders and venture capitalists seem to have found opportunity at the intersection of men’s reluctance to see a doctor and their willingness to pay for a quick fix to uncomfortable lifestyle concerns. The market is awash in digital startups with masculine-sounding names like myRocky, a Mississauga-based company formed by a trio of thirtysomethings with backgrounds in medicine and pharmacy, who wanted to “create a brand that guys would be proud of,” CEO Aba Anton told The Local.  

If you’ve taken the subway in the past few years, or used social media, or watched a sports game, you’ve spotted the near-ubiquitous advertisements for erectile dysfunction solutions—visual metaphors involving wilting cacti, or winking taglines like popular virtual men’s health pharmacy Phoenix’s “rise again.” That company was inspired by the “direct-to-consumer healthcare model gaining momentum in the UK and Australia,” co-founder Kevin Bache wrote in a statement to The Local. “The model proved to be successful in those countries, and we saw an exciting opportunity to bring it to Canada, a country needing greater access to care.”

In Instagram ads, the company juxtaposes old interview or movie clips of the likes of Matthew McConaughey, John Cena, and Brad Pitt with marketing for their own services, implying the company can offer you the immovable, glossy hairline of an A-lister. (When reached for comment, a representative for McConaughey said the star was not affiliated with the brand, calling the ad “a scam.” A Phoenix representative told The Local the company “does not claim that any celebrity featured in such content is affiliated with or endorses our products or services.”) Last spring, after having previously raised $5 million in funding, Phoenix received $50 million in capital investment.

While no overall market forecast for the Canadian sector appears to exist, a report on the U.S. pharmaceutical industry by the management consulting firm McKinsey and Company estimated online direct-to-consumer pharmacies have received $3 billion in venture capital funding since the 2010s. Various market analysts predict the online pharmaceuticals industry more broadly will be worth hundreds of billions in the next decade.

How this all works is that online direct-to-consumer lifestyle pharmacies vertically integrate every facet of the health care process under one roof. Their scope is narrower than, for example, Maple, which is advertised as Canada’s “virtual walk-in clinic” and offers to treat a more general range of health concerns. With direct-to-consumer pharmacies, users go to the service with one of a limited list of ailments—crucially, ones that aren’t medically urgent or complex—and message with a doctor or nurse practitioner. Sometimes, they do blood work or send some images, and at the end, they receive a prescription that can be shipped to their front door. Drug sales are one of a few primary ways these companies make money, alongside billing for certain services: Felix bills $40 for most practitioner consultations, for instance, and myRocky charges up to $99 for an initial consultation on certain health programs while others are free.

It’s a health care model for the modern age, presented online in sleek digital packaging with ad copy about wellness, optimization, and longevity.

In theory, this model may not seem much different than a hospital or doctor’s office that houses a pharmacy. But “these companies have a different obligation than…health care providers or hospitals,” says Sheryl Spithoff, doctor, researcher, and director of the Health Tech and Society lab at Women’s College Hospital. “They’re in the private sector, they’re for-profit. They often have an obligation to their shareholders.”

When you go to a family doctor—or for the 2.5 million Ontarians without one, a walk-in clinic—most health care practitioners aren’t employed by venture capitalists or other investors answerable to shareholders. At many of Canada’s biggest direct-to-consumer pharmacies, they are. If a company makes money off prescriptions, then “the more prescriptions that are dispensed, the more money the company makes,” Spithoff explains. “There is a theoretical incentive, at least, to encourage the clinicians who work there to prescribe more medications, so that they get more engagement from patients who are then coming back to the platform for ongoing prescribing.”

In 2024, Spithoff co-authored a study on the use and sale of patient data at direct-to-consumer virtual care platforms—another means by which some of these companies turn a  profit. The study included interviews with North American industry members, including executives and employees. Since participants in the study are anonymized, there is no way to confirm whether any of the virtual pharmacies mentioned in this story were included in the study. Representatives of Phoenix, myRocky, and Felix told The Local they do not sell patient data. “We do use deidentified patient data internally,” said Bache of Phoenix, “to better understand who our patients are and what they are coming to our platform for in order to provide a better user experience.”

Essential Clinic said by email that, “We are in the business of making care accessible to patients, not mining any data. Patient data is confidential and regulated by privacy laws.”

One consultant in Spithoff’s study said there is a belief in the virtual care industry that “the future is data,” which sparked a “gold rush” that brought in investors and entrepreneurs. “What we found is [user data] was seen often as a revenue stream, something that was incredibly valuable,” Spithoff says. Users’ browsing data, IP addresses, personal contact details, and anonymized health data, all adjusted to align with Canadian privacy laws and pharmaceutical regulations, are for sale, her research finds.

In some cases, virtual care platforms have relationships with pharmaceutical companies to promote particular drugs to users, either broadly or based on their health particulars. One respondent in the study, an employee of a virtual care company, shared that his platform was paid by a pharmaceutical company to promote a drug; unbeknownst to their clients, the platform would conduct A/B testing and send out communications about the drug, then report back to the manufacturer on what methods best promoted uptake. Users were, Spithoff found, unknowingly having their treatment plans influenced by their virtual clinic or pharmacy’s relationship with a pharmaceutical company. Some employees were concerned by this. But by and large, respondents said it was normal, acceptable, or even beneficial.

None of this matters if users have resigned themselves to the realities of 21st century data trading. This is, perhaps, another archetypical trait of the patient-consumer. Isaac, six-years loyal to his routine with Essential Clinic, works in software engineering. It made him a nihilist to data protection. “You drive yourself crazy,” he says. So many websites already have his browsing and purchase history. “I guess I don’t see it any differently from any other internet activity. What information can they get from that, that they don’t get from how long I spend on a video on Instagram, or [from] my private messages?”

The relationship between pharmaceutical companies, doctors, and pharmacists is well known and documented. But the difference between brick and mortar and virtual providers, Spithoff points out, is that the former is still largely run by doctors and nurse practitioners running independent practices. The virtual care world, meanwhile, is ruled by corporations answerable to investors.

“We understand the concern that physician ownership in healthcare businesses can raise questions about conflicts of interest,” Phoenix’s Gavin Thompson said in an email. “That’s why it’s our policy that no prescribing physicians are shareholders in our business.”

“Felix maintains rigorous clinical standards in order to support evidence-based care for our patients,” a company representative said in a statement to The Local, adding that their employees “are never incentivized to prescribe medications.”

“I don’t necessarily think that, in any case, whether you’re [venture-capital] backed or not, that any company in this space is operating outside of those medical frameworks,” said Aba Anton of myRocky. “I think that they all value and prioritize patient safety at all costs.”

“Venture capital makes companies prioritize investors over customers,” Essential Clinic’s Al-Shurafa wrote in an email to The Local. “For this reason, we have decided not to raise venture capital.”

In early 2025, there were three things Aishwarya knew: she wanted Ozempic, she suspected it might not be medically necessary, and she didn’t want to experience the shame or judgement of talking to her family doctor about it. “Diet and exercise, right?” she says. “No shit, Sherlock.”

When Aishwarya, a 39-year-old Scarborough resident who is using a pseudonym for privacy, googled her options, Felix was right there. “It’s like catching an Uber,” she says, showing me the sleek, user-friendly app interface.

With a quick questionnaire, some messages exchanged with a nurse practitioner, and a bit of requisitioned blood work, Aishwarya says she received an Ozempic prescription. She wasn’t at any point in the process dissuaded from taking weight loss drugs, she says, or given advice on lifestyle changes.

There’s no way to tell whether Aishwarya’s family doctor would have prescribed Ozempic or a similar weight loss drug if asked.

Being a platform incentivized to sell lifestyle drugs means developing a reputation, at least among some consumers, as the easy route to a coveted prescription. Online, on Reddit forums about accessing weight loss drugs in Canada, commenters often encourage each other to go the online route, saying it’s easier to get prescriptions through direct-to-consumer virtual pharmacies than through a family doctor. Felix has leaned into this messaging: in the same subreddits, their brand account has responded to user questions about accessing Ozempic and Mounjaro with messages like, “You can talk to your family doctor, or if you’d prefer something quicker, there are online options too. With Felix, for example, you can complete an online medical assessment that’s reviewed by a licensed Canadian practitioner. No more awkward conversations with your doctor or pharmacist.”

“Am I going bald?…Am I fat? Am I anxious? Do I feel depressed? The idea is that you don’t really need to see a doctor to get the diagnosis.”

What telehealth companies are built on, or capitalizing on, isn’t just demand among a consumer base: it’s a desire for agency in one’s own medical treatment. Today, health care consumers feel more informed than they’ve ever really been before. The internet has made it possible for every patient to do their own research. This does not, of course, mean that patients know as much about treatments as their doctors do—and it doesn’t mean they always know what’s good for them. But it’s a response to a system that has traditionally left patients—especially women—feeling disempowered.

“What I appreciated is that with Felix, or I think any of the other [telehealth] companies, what I want is what happens,” Aishwarya says. When she needed to switch from Ozempic, to Wegovy, and then to Zepbound, after not seeing any change $4,000 into the process, all she had to do was talk to her nurse practitioner—the same one every time, which not all companies can boast. (She is as unworried about what happens to her health data as Isaac. “We pay by apps, we use apps to buy food, to buy clothes, to Amazon shop, to stream services,” she says. Trading in sensitive information is an inevitable part of modern life.)

The day I met Aishwarya, she had just gone to see her family doctor. “I didn’t tell her anything about Felix,” she says. Aishwarya is bubbly, seems younger than her age, but speaks with an air of certainty about what she wants. And what she wanted was not to talk to her doctor about her weight, and certainly not to hear about the importance of natural weight loss methods.

The inevitable consequence of this path, however, is that Aishwarya is now experiencing what doctors and health advocates call a discontinuity of care: she is, in tandem, and in this case by choice, being treated by two different medical practitioners who aren’t communicating with one another. The College of Family Physicians of Canada has warned against this effect of for-profit virtual health care, saying it creates a sub-standard level of care for patients, who resultantly tend to see their family doctor less.

Patients, especially men, are already less likely to speak to their doctors about stigmatized health concerns. The virtual pharmacy model says it can solve that problem, but really perpetuates it—the business model is predicated on clients never having to go to their primary care provider for the issues that bring them the most shame. Marketing that emphasizes discretion, and tongue-in-cheek ads where patients announce to no one in particular that their ED medication delivery is, in fact, a pack of golf balls, only further stigmatizes the condition. For Aishwarya, and the potential hundreds of thousands of patients who are using virtual pharmacies and family doctors in tandem, the risk of being prescribed conflicting or incompatible medication is serious. It is likely that many of these patients will never disclose their lifestyle drug prescriptions to their primary care doctors. But Aishwarya feels confident that her virtual nurse practitioner, just a DM away, could tell her what she needs to know about potential conflicts and prescription side effects.