In 2017 Zachariah "Z" Reitano pitched his startup Roman to New York City-based venture capital firm General Catalyst. The concept was straightforward: For $15, Roman pairs men with doctors online to help diagnose and treat hard-to-discuss ailments such as hair loss, cold sores, and erectile dysfunction.

Reitano was inspired to start Roman after having experienced erectile dysfunction in his late teens and early 20s--and feeling alone, confused, embarrassed, and ignorant about it.

The investors were sold, not just on Reitano and his personal connection to the problem he wanted to solve, but also on the company's bigger potential. Twenty-seven-year-old Reitano envisioned using Roman to test out his new telemedicine model, and once it proved scalable, launch other verticals until he had simplified and digitized a large segment of health care.

By early 2019, the company had made headway, by launching two additional verticals in just two years. Under a parent company that goes by Ro and has raised $90 million in funding, it offers services in three areas: Roman is strictly for men's health issues; Zero, launched in September, focuses on smoking cessation; and in March, Rory launched to cater to women suffering from menopause symptoms. Ro has more than 50 physicians on its platform, and 10 pharmacists on call around the clock. Over the past two years, it has facilitated more than a million patient-physician interactions.

"It's still early innings for their big ambitions," says Peter Boyce, a General Catalyst partner who led early funding for Ro.

Going after an unobvious market

For its most recent expansion into women's health care, Ro tapped Rachel Blank, who had been a summer associate at General Catalyst when Reitano first made his pitch. "All the things that Z talked about regarding health conditions you don't feel comfortable talking about really resonated [with] me," says Blank. At 22, she dealt with her own health issue--a diagnosis of polycystic ovary syndrome--which left her feeling isolated and undereducated despite her access to care and information. She joined Reitano and his co-founders Rob Schutz and Saman Rahmanian in 2018.

She was hired with the aim of building out Ro's next vertical--one for women. It would need its own name, its own brand design, and its own specific angle on women's health.

Other competing telemedicine companies had already ventured into prescription birth control and skin care for women. Blank didn't go for those obvious markets. Instead, she decided to dig into the medical issues that are both common and invoke the same feelings she and Reitano had felt as patients: confusion, stigma, and isolation.

"There are over 40 million women experiencing or about to experience menopause symptoms," Blank says. "When we went to talk with some of them, we heard exactly that: I'm alone, I'm confused." A significant portion of the women she did focus groups with had experienced symptoms but sought no treatment.

The women's vertical, Rory, launched this March offering a non-prescription treatment for hot flashes (black cohosh and vitamin E), personal lubricants, a sleep aid (melatonin), two anti-depressants (paroxetine HCL and venlafaxine HCL), and Latisse (a medication to treat hair-thinning, which can be associated with menopause). While Rory had the benefit of the robust back-end and website that Ro had built to fuel its previous two verticals, it also came with its own unique marketing and educational challenges.

"These conversations are not happening: People are uncomfortable talking about vaginas. They are not talking about vaginal dryness," Blank says. "Part of what we need to do is let women know it's OK to talk about these things, especially with your doctor."

Part of Ro's strategy is offering patients short digital quizzes, whether about vaginal dryness or erectile dysfunction, which may yield more honest answers about symptoms than an awkward conversation with a doctor. Ro's medical professionals also can engage with patients over text, which further removes some of the squeamishness involved in talking about these health issues.

Boom days for telemedicine

Given that Reitano started Roman when he was just 25, it may be surprising that 89 percent of its customers are over the age of 30--and the majority are older than 50. He and Blank expect that a similar demographic will be drawn to the womens' products and Rory experience.

Cornering that market is a smart move: The online telemedicine industry is booming, with hundreds of millions of dollars in venture-capital funding having infused it with growth since 2017. San Francisco-based Doctor on Demand pairs users with physicians for urgent care, behavioral issues, and a wide range of health concerns, and it has raised $160 million. Maven Clinic in New York has raised $42 million for fertility, maternity, and postpartum care. Hims and Keeps provide men hair-loss treatments, and Hers (part of Hims) prescribes skin medication, birth control, an anti-anxiety drug, and even a libido booster.

But what to some is a revolution in telemedicine, in which venture-backed unicorns are turning prescription medication into a service, to others is allowing patients to self-diagnose and "shop" for medications off of a digital menu, with minimal review by or contact with physicians. While one might suspect these sites and their affiliated doctors would be subject to copious federal and state regulation, they exist in a gray area. There is "no single federal or state agency in charge of overseeing online prescription drug services," according to The New York Times.

Reitano says that Ro's doctors review every patients' account and prescribe appropriate medication, with appropriate consutation. He claims his company is not trying to minimize physician-patient interaction; rather, he says, it is trying to deepen the ability of physicians to diagnose and treat the underlying conditions behind erectile dysfunction and other symptoms.

To prep for that task, Ro is growing fast. The startup went from seven employees at the end of 2017 to 110 at the turn of 2019, and is now at 140. It expects to continue the hiring spree, and be close to 300 employees in a year. In mid-April, Ro confirmed it had raised even more cash: A $85 million Series B round of venture funding, bringing its total funding to $176.1 million. The company is hoping to add many products, prescriptions, and offerings to its verticals in 2019 as well--and hopes to fight a perception problem that's been lingering.

"The biggest challenge that I see is that people see us from the outside as a one-condition service," Reitano said. "It'll be on us to show the world and our patients and our members that we are here for all their health needs."