The realm of women's health has never been under a brighter spotlight than in 2023. Enter Clue, a HealthTech company that has been transforming the way people approach reproductive and menstrual health. As early investors in the company, we at Molten had the opportunity to speak with the dynamic duo at its helm: Co-CEOs Audrey Tsang and Carrie Walter. In this week's Long Read, they shared their experiences, insights, and perspectives on leading a company focused on women's health, the unique leadership model, and the role of HealthTech in the ever-changing landscape of health data privacy.

As I prepared for my Zoom call with Clue's Co-leaders Audrey and Carrie last November, I anticipated a fascinating discussion. Just eight months prior, they had captivated the audience at our Investor Day with their shared vision, collaborative spirit, and ambitious goals for the Clue brand. Much had transpired since then; significant market trauma affected most technology companies including Clue, who – like many others – were compelled to make difficult decisions.

Yet, I sensed that this company possessed an innate resilience, rooted in its mission to address inequities and driven by an unwavering belief in the value of its product. The passion of its Co-CEOs is palpable; their commitment to the company purpose of changing the paradigm of women's healthcare evident in their vigour and eloquence.

Carrie and Audrey are disarmingly honest. During our conversation, they openly ponder whether their co-CEO model reflects a "characteristically female" attitude. Whether or not there’s merit in that observation, I was nonetheless drawn to the extensive benefits to corporate culture if the model was more pervasive. Imagine how many better businesses could be built when leaders embraced a culture of open dialogue and collaboration at the highest level, where diverse perspectives were not only acknowledged but actively sought out. The combination of visionary thinking and pragmatic execution could create a potent formula for success, fostering innovation and driving meaningful change across industries.

As I listened to Audrey and Carrie recount their experiences and aspirations for Clue, it would have taken a more cynical mind than mine not to feel inspired. Their unique leadership model, which transcends traditional hierarchies and emphasises partnership, seemed to be the ideal catalyst for both personal and professional growth. It was clear that their journey together had not only enriched their understanding of the HealthTech landscape but had also emboldened them to challenge the status quo and advocate for a brighter future in women's health.

Indeed, the joint leadership structure adopted by Audrey and Carrie may not be a "typically female" endeavour, but it does offer a valuable lesson in the power of collaboration and the potential for achieving great things when diverse minds come together in pursuit of a common goal. In a world where businesses are increasingly challenged to adapt, innovate, and thrive, perhaps more organisations should consider embracing this spirit of partnership and mutual respect at the top.

Audrey Tsang: Tech Visionary Meets Women's Health Advocate

"I'm originally from San Francisco, born and raised," Audrey begins. Having spent her career in Silicon Valley, she led product teams at well-known companies like Pinterest, HotelTonight, and Yelp. 

Audrey desired to apply her experience in technology to areas that would make a meaningful difference in people's daily lives, such as health and education. Her search led her to Clue, a company focusing on women's health—an area she found "infuriatingly inequitable".

Upon joining Clue, to lead their product team, Audrey's focus was on monetising the business. Clue had millions of monthly active users, most of whom were using the app for free. The second part of her role involved leading a company that was both a consumer app and a medical device, navigating the challenges and making crucial decisions to have a positive impact while building a strong business.

Carrie Walter: The Regulatory Mastermind

"I'm a lawyer by training, very different from Audrey," Carrie introduces herself. Born in Germany to American parents, she moved to the UK for 15 years before returning to Berlin. Unlike Audrey's consumer tech background, Carrie is "the regulatory medical device part" of the leadership brain.

Carrie has worked in heavily regulated industries such as nuclear energy, oil and gas, automotive, and med tech. She spent almost a decade at Freshfields in London and Berlin, helping companies navigate new market entries, geographic expansions, and litigation. This diverse intellectual background is a key strength of their working relationship. Audrey brings an evidence-based approach typical of consumer tech, while Carrie contributes a more principles-driven and strategic perspective from her regulatory experience.

“It’s not lonely at this top”

The pair’s complementary skillsets led to their co-leadership. Tsang explained that they represent two sides of the business, with Walter adding, "Audrey is the science part of the brain, and I'm the humanities part. We get the best of both worlds, being agile and engaging as a consumer app, but also careful and strategic when it comes to making sure we’re medical-grade and compliant."

The Co-CEO model emerged in February 2021 when the company received FDA clearance as a medical device, making it the world’s first FDA-cleared all-digital fertility awareness-based method of contraception in the USA. Clue's co-founder, Ida Tin, recognised that the company would need to scale as a consumer medical device and sought leaders with the right skills. Tin proposed the idea of a dual leadership position to Tsang and Walter, and they readily accepted the challenge.

“We often get asked, ‘Don't you need one person who decides?’ Carrie tells me. “We've resolved that many decisions can be made by one of us, but the important ones require dialogue. These decisions are better and more robust. I think the superpower of being a Co-CEO duo is that when there is too much to handle, you can divide tasks and use your strengths to accomplish them. And when there’s a really important decision to make, you explore more of the opportunity space when it’s two genuinely different perspectives, and not just you debating with yourself.

“There are many reasons why people become co-CEOs, and for us, it was born out of the transition of what the company was becoming and what it would take to go after the opportunity of the white space between medtech and consumer tech. Med tech is perceived as unlovable, inhuman, and undesirable, while consumer tech does not adhere to healthcare standards. The emerging category of consumer med tech needs leadership that can do both”.

As investors, we try to combat the loneliness at the top that many of our leaders and founders experience. I ask Carrie and Audrey if their leadership model is a tonic to that oft-cited ill. “Put simply: it's not lonely at the top for the two of us.”

Under their leadership, Clue has continued to grow and evolve. One of their most significant accomplishments is the development of Clue Conceive, a fertility awareness-based aid to conception that uses a digital algorithm rather than biomarkers such as blood and hormone testing. "We released Clue Conceive last September, as a kind of timed intercourse support, with more bells and whistles and more science behind it," says Audrey. "In addition to the science, the product also takes lessons from user insights and from trying to understand how best to help people and support them in their journey."

Indeed, Audrey and Carrie possess a particular clarity on the importance of user feedback in driving their mission. "We know far less about our bodies than we think,” notes Audrey. “It's shocking to me how little we know about what it takes to get pregnant for example—I thought I took Sex-Ed way back when! Did you know your cervical mucus has to be welcoming? Or that you can't predict when you ovulate? We don't know as much as we should to live our healthiest, fullest, and happiest lives. Knowledge is power; we see people thanking us all the time because of what they learned and tracked and were able to then talk to their doctor about." But Carrie does acknowledge a culture shift, with younger people becoming more comfortable discussing their bodies openly. Both expressed hope that future generations would be more at ease with these conversations.

The Role of HealthTech in Data Privacy

As a HealthTech company, Clue is at the forefront of the intersection between technology and health data privacy. "One thing that sets Clue apart is its commitment to data privacy," Audrey shares. "The team has always been transparent about what we do with users' data and how we protect it. It's not just a legal requirement, it's part of our DNA."

Clue steadfastly committed to keeping data secure and private. “Our business model is not, and never has been to sell data, but to build things that people use and love so much that they pay for them," continues Audrey. "Data is key to getting personalised insights about our individual health. And we are very thoughtful about how we handle that data in service of health. And when we work with academic or research institutions to leverage data to increase what we know about female health, we always de-identify it."

“Clue recognised how intimate health data is," adds Carrie. “It’s a key feature of femtech, or what some might refer to as taboo tech. To succeed in this area, you need to be understanding and empathetic of how vulnerable people feel around data. While modern data processing is complex, you have to try and help people understand what is happening to their data, and not be too legalistic about it.”

As the landscape of health data privacy changes, both are dedicated to ensuring that Clue remains a trusted and reliable platform for users. As Carrie explains, “Our original commitment to protecting people's data and treating it with the same care we would want for our own data is only strengthened by widespread fear of reproductive surveillance in some jurisdictions. We are based in the EU and legally comply with GDPR, but also believe health data should never be used against you. It would be a tragedy if a lack of reproductive rights and data privacy leads to self-censorship and the enormous promise of increasingly personalised health being denied to women."

Audrey and Carrie on Leadership and Women's HealthTech

Both Audrey and Carrie have strong views on women's health and the role technology can play in creating positive change. Audrey points out that women's health has been "historically underfunded and understudied," resulting in a lack of resources and information for women seeking to understand their bodies. She is determined to use Clue's platform to help fill this gap.

Carrie, on the other hand, is particularly passionate about the regulatory aspects of offering digital services in women's health. She acknowledges that the field is "very much in its infancy, most apps out there operate in a regulatory grey zone or make regulated claims without actually complying with the evidence and quality requirements of med tech." But she believes this will change will be driven by consumers, who will ultimately demand that their health apps are held to the same standard as other health products.

When asked about the future of Clue and women's health technology, both Audrey and Carrie express optimism. Audrey envisions Clue becoming "the go-to place for women who want to understand their bodies, whether they're trying to conceive, avoid pregnancy, or simply want to know more about their cycle." Carrie adds that she sees Clue playing a key role in the maturation of the whole industry, ahead of regulatory changes that she believes are only a matter of time.

“There is a big desire and demand among younger cohorts to work with their natural cycles, rather than change them. We can help them do this with trustworthy, science-based information. People are getting smarter about using trustworthy apps to handle their most intimate data. Gone are the Wild West days where there was no discrimination or understanding as to which apps were higher quality and reliable.”

What should Clue be known for?

Audrey and Carrie are trailblazers in the field of women's HealthTech. Both are uniquely dedicated to improving the lives of millions of women around the world with a platform that empowers them to better understand their reproductive health and make informed decisions. By leveraging technology and innovative leadership, Audrey and Carrie are working towards a future where all women have access to the resources and information they need to take control of their reproductive health.

We’re clocking out so I ask one last question: what do they want Clue to be known for?

Carrie: “trustworthy, empowering, and enabling HealthTech at scale.”
Audrey: “I think mine would be health equity.”
Carrie: “That’s better. See? That’s why you ask Audrey.”