HBI Deals+Insights / Interviews

Interview: Audrey Tsang, Co-CEO, Clue

Women’s health offers a huge opportunity for investors, with conditions like endometriosis underserved. What business models can help support this? Audrey Tsang is co-CEO at women’s health app company Clue. She talks to HBI about how she thinks the gender health gap might be closed.

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Tsang highlights the problem female patients often face: “Women’s health is held back by taboo and because of that it’s under researched, underfunded and underserved. We hear from our users quite a bit that they feel nobody is taking them seriously. Women are diagnosed later than men for the same conditions, are more likely to have adverse drug reactions as clinical trials didn’t include them, get given pain treatment later or get pain misdiagnosed as a mental health issue.

“Menopause happens to every woman, endometriosis to more than 1-in-10 and polycystic ovarian syndrome is quite common too. All of these have a big impact on fertility – and quality of life. These are what people often think about as women’s health conditions, but you even see it with heart diseases. Women with chest pain wait 29% longer for heart attack evaluation. Part of that is this pain displays differently in women than men – it’s chest or jaw pain rather than pain in the arm – and that misunderstanding leads to disparity.”

This lack of understanding means research is required, which would mean operators could find it more expensive to enter this market. However Tsang says women make 80% of healthcare decisions and spend twice as much on healthcare as men. Despite this, only 2% of biopharma R&D funding goes to women’s health issues. Tsang sees women’s health as “an easy win for investors”.

The possibility of integrating fertility with other women’s health issues was one of the topics discussed at our HBI 2023 conference (read more on that here). There are indeed obvious wins for this – such as the move away from a hyperfocus on fertility and the ability to build trust and rapport with female patients. However there may also be limits – for example is it appropriate/too controversial to have fertility and abortion services in the same clinics? How would you separate patients getting ultrasounds from those being diagnosed with infertility.

This is one of the big challenges, and Tsang explains: “This is how we approach things at Clue. We respect everyone’s experiences, choices, health goals, whatever they may be. That’s their life and the best thing anyone can do is to respect and arm them with trustworthy information and tools which work and from there recognise everyone is different and to create the space – and the empathy – to honestly process their own experience.”

She insists there’s an opportunity in folding these services together: “I think they should be and the reason for that is they all are interconnected. Polycystic ovary syndrome (PCOS) affects fertility for example. I don’t think we even know how linked earlier life experiences in menstrual health are to other conditions.”

So how does Clue (a period and fertility tracking app) try and fill this demand? Tsang tells HBI that Clue produces software which is sold on a subscription model. The aim is to build “something so valuable our users are willing to pay for it”. In doing this Clue builds a premium model not reliant on targeted advertising. This helps maintain the trust of  the patient, which is particularly important in women’s health. Tsang says: “I don’t want to be an advertising target. I want something to help me.”

There are of course occasions when the data is useful on a wider scale, but Tsang says there are certain parameters Clue wants to operate in when doing this: “On an aggregate data level, we do share unidentified data with accredited research institutions such as Harvard and Oxford – we can do that and we believe in furthering what we know in women’s health for that. We can also look at this data within our own algorithms and use it to better predict things like ovulation windows.

“We always ask consent for sharing de-identified data with research institutions – the other great thing is most of our user community actually does want to contribute but in a way which respects their data privacy.”

This makes sense – HBI has heard previously that cancer and cardiology patients are more willing to share data as it’s clear what the data is needed for. In an area which requires a certain level of non-mainstream patient awareness,  it is plausible patients would be more willing to share data to further research.

There is also a wealth of content marketing on the Clue website. This is not so much linked to the product itself, but gives general information about women’s health. For example in this article on ovulation, the emphasis is on the science behind ovulation. Within the body of the text, Clue is mentioned only once (although there are occasional banner ads directing potential customers to the app store). Tsang says all the content is written by health experts and fact-checked by others.

This is an interesting strategy which feeds patients to the app while also educating them. Tsang says: “We see our content as a way to educate and increase awareness, and our products are a way to help people once they are aware. We believe a part of this should be accessible to all, but certain parts are part of our premium product and have more value and cost to us.”

Within the app itself patients track not only periods but factors such as mood and energy. HBI mentions this seemed a little subjective. Tsang agrees.

“It’s self-reported data by design. There’s no better way to capture what you’re thinking than by reporting it. It can still reveal patterns as you’re the one reporting it. The power of tracking what’s going on with your body is you can objectively observe what’s happening, understand what your own patterns are, understand, for example, you’ll experience cramps. You can anticipate that in the same way you can anticipate your period. That’s empowering. It’s a matter of thinking about what insights you might want from the data. In other cases, more objective data might be more helpful.

“But also say you’re in the position where you have a health condition, it’s really useful to know what’s changed from usual. Are you experiencing more pain than usual, energy levels are different, etc. You’d want to figure out why that is, or go to a healthcare provider and be able to bring that data in to show the health provider what’s changed. History is 70% of the diagnosis. It can give you signs of what’s happening.”

Clue can also track ovulation cycles, with an obvious benefit for patients hoping to conceive.

The app has over 2two million reviews on app stores, and claims to have over 10m users across 190 countries in 20 languages – though the definition of “user” is unclear. With so many countries, HBI pointed out it must have presence in countries not known for their women’s rights.

Tsang agrees: “We do localise and translate for each of our major markets, and we may have some users in markets where we haven’t localised. But fundamentally people have always been tracking their periods. There are artefacts showing 28 notches on a stick for example, or with pen and paper.”

We would welcome your thoughts on this story. Email your views to Joe Quiruga or call 0207 183 3779.