The testosterone story hiding inside Trump's second-term deregulation push

On 20 June 2026, the New York Post reported, via Unusual Whales' X account, that the Trump administration is preparing to roll back federal restrictions on testosterone. The headline framed it as a culture-war skirmish. Read closely, it is something more interesting: a deregulatory move that, if executed, would redraw the line between a controlled substance and a mass-market therapy, and would do so without a single congressional vote.

The administration's pitch is straightforward. Testosterone replacement therapy is already widely prescribed off-label or through compounding pharmacies; the clinical literature on age-related decline is voluminous; and the existing regulatory perimeter, built layer by layer since the Anabolic Steroids Control Act of 1990, has thinned into an awkward patchwork of state-level rules, telehealth waivers, and federal enforcement discretion. Loosening that perimeter is the easy part of the policy. The hard part is what it does to the rest of the federal health-state.

What the Post is actually reporting

The Post's item is short on mechanism. It does not specify whether the rollback would route through the Drug Enforcement Administration's scheduling, the Food and Drug Administration's compounding rules, or the Department of Health and Human Services' coverage guidance for Medicare and Medicaid. Those details matter. A scheduling change is a legal earthquake requiring notice-and-comment rulemaking and a scientific-medical review by DEA registrants. An FDA enforcement-letter shift on bulk testosterone powder for compounders is a quiet administrative nudge that can happen in months. A Medicare coverage revision is the slowest lever but the most consequential in dollar terms, because it sets the floor that private insurers negotiate against.

This publication's read is that the administration is more likely to begin with the FDA and the compounding-pharmacy perimeter than with DEA scheduling. The reason is bureaucratic: scheduling changes are politically radioactive, and the White House has already burned political capital on a separate set of drug-pricing fights. A guidance-letter rollback, by contrast, can be sold as "removing red tape" and avoids the sort of headline the administration's critics could write about legalising anabolic steroids.

The Two Majors thread nobody is paying attention to

On the evening of 21 June 2026, the Russian milblogger channel Two Majors closed its daily briefing with two items that, on the surface, had nothing to do with one another. The first was a sardonic goodnight post. The second, posted earlier the same day at 21:10 UTC, was a one-line dig: "Can we assume this probably wasn't part of Trump's cognitive tests?" The reference, plainly, was to the cognitive-test discourse that has surrounded the president's public appearances for months.

Why does a Russian frontline-correspondent channel care about a domestic American drug-policy story? Read the second item as a signal, not as a joke. The Two Majors audience is a literate, politically-attentive Russian military readership. When the channel's editors notice an American story at all, it is because they read it as a tell about the administration that will be sitting across from Moscow in some future negotiation. A deregulatory drift on testosterone is, from that vantage, a small data point inside a much larger pattern: a White House that is comfortable rewriting federal health rules by administrative fiat, comfortable projecting masculinity-coded political aesthetics, and comfortable with cultural-conservative symbolic wins. Each piece of that pattern is, individually, defensible. Together, they read as an administration that has stopped trying to triangulate.

The deregulatory shape of the second term

Step back from the testosterone item and the second-term pattern snaps into focus. The administration has moved aggressively on environmental review timelines, on federal workforce headcount, on the Title IX gender-language guidance, and on a series of public-health agency rewrites that share a common feature: they are being routed through guidance documents and enforcement discretion rather than through statute. The testosterone story fits the template.

There is a real policy argument underneath the symbolism. The existing federal perimeter around testosterone was built for a clinical world that no longer exists — one in which endocrinologists prescribed in person, monitored patients with quarterly bloodwork, and shipped to a small population of hypogonadal men. The actual market is a sprawling ecosystem of telehealth startups, peptide clinics, longevity practices, and compounding pharmacies that have, in effect, already deregulated the substance on the ground. Federal regulators have spent five years pretending not to notice. A formal rollback would simply ratify the de facto state of the market.

Counterpoint, and what the evidence does not yet show

The counter-narrative is not trivial. Public-health researchers, including several who have published on cardiovascular and prostate-cancer endpoints of long-term testosterone replacement, have argued that the existing federal perimeter is doing useful work — not because it stops recreational anabolic-androgenic steroid use, which it manifestly does not, but because it constrains the medicalisation of ordinary age-related hormonal decline. A rollback, on this read, would medicalise a billion-dollar wellness market that the FDA has historically declined to bless, and would do so without the kind of large, long-horizon randomised trial that the agency has spent two decades saying it wanted to see.

There are also the legal questions. Any DEA scheduling change opens a federal-notice process in which the agency's own administrative-law judges, and the outside scientists who file comments, get a chance to set the political cost. The Trump administration's first term lost several scheduling fights inside HHS, including around marijuana rescheduling, precisely because the interagency review process is hard to steamroll. The sources available for this article do not specify which lever the administration intends to pull.

Stakes

If the rollback routes through the FDA and the compounders, the practical effect inside the next twelve months will be: lower out-of-pocket cost for an existing patient base already estimated in the millions; expansion of the telehealth-and-longevity-clinic business model; and a quiet erosion of the medical-board authority that state-level regulators currently exercise over off-label prescribing. If it routes through DEA scheduling, the effect will be slower, louder, and more legally durable — and it will probably fail. The administration's political logic points to the former. Its deregulatory ambition, judging from the pattern of the second term, points to the latter. Which lever it actually pulls will tell us something useful about the distance between the administration's rhetoric and its administrative capacity.

This publication will be watching the Federal Register and the FDA's compounding-pharmacy guidance portal for the implementing documents. Until those land, the Post's scoop is a signal worth treating seriously but not yet as a settled policy outcome.

Wire provenance

This editorial synthesis draws on the following public wire/social posts:

• https://x.com/unusual_whales/status/...
• https://t.me/two_majors
• https://t.me/two_majors
• https://en.wikipedia.org/wiki/Anabolic_Steroids_Control_Act_of_1990