Reviewers see Medusa as a strong open-source, self-hosted alternative to Shopify for teams that want more control. They repeatedly praise its flexibility, customizability, and fit with modern tech stacks, saying it works well for building tailored, scalable ecommerce projects and keeps improving over time. The clearest tradeoff is that it helps to have some coding experience, so it feels more developer-oriented than plug-and-play. One user also flags weaker payment integrations, specifically problems with PayPal, as a notable gap.