Leor Sapir: The Questions the New York Times Refused to Ask (#27)
7 August 2025
With Leor Sapir
North America
Leor Sapir, a Manhattan Institute fellow who has scrutinised the evidentiary foundations of paediatric gender medicine, dissects the New York Times' six-part audio documentary "The Protocol." His analysis reveals that despite two years of reporting, the investigation never defined gender identity, leaving the field's foundational circular reasoning untouched. Sapir's recorded interview with Laura Edwards-Leeper — who acknowledged that gender identity is operationalised through stereotypes — is directly relevant to the systematic reviews now reshaping paediatric gender policy across England, Sweden, Finland and Denmark.
The ability of major media institutions to shape clinical and policy consensus around youth gender medicine is rarely examined directly. Leor Sapir, a fellow at the Manhattan Institute who has tracked paediatric transition policy and its evidentiary foundations for several years, turns that lens on the New York Times and its six-part audio documentary "The Protocol," which spent two years examining the contested practice of medically transitioning minors. His conclusion is that the investigation, despite its length and resources, systematically avoided the questions that would have forced a genuine reckoning with the field's scientific foundations. The central problem Sapir identifies is definitional. Gender identity — the concept at the heart of every assessment, every diagnosis and every treatment decision in paediatric gender medicine — was never defined by the NYT's reporting. Without a working definition, there is no basis for distinguishing a clinical condition from a cultural phenomenon, no possibility of designing a valid diagnostic instrument and no way to evaluate whether any intervention achieves what it claims to achieve. Sapir's formulation is precise: endocrinologists are treating a condition they cannot define except through circular reasoning, and the NYT's investigation left that circularity entirely intact. Sapir draws on his own recorded interview with Laura Edwards-Leeper, a psychologist closely associated with the development of gender-affirming assessment protocols in the United States. In that conversation, Edwards-Leeper acknowledged that gender identity, as operationalised in clinical practice, is grounded in stereotypes. That admission carries considerable weight. Health bodies in England, Sweden, Finland and Denmark have in recent years subjected the evidence base for paediatric gender medicine to rigorous systematic review. Each of those reviews concluded that the evidence was insufficient to support routine medical transition of minors. The question of what gender identity actually measures sits at the heart of those reviews' scepticism, and the Edwards-Leeper admission makes clear that leading practitioners have not resolved it. The episode also examines how the NYT documentary treated voices that complicate the affirmative narrative. Detransitioners — individuals who underwent medical transition and later reversed course — received minimal time across a documentary spanning six episodes and two years of reported work. Jamie Reed, a case manager who raised detailed clinical concerns about practice at a major US gender clinic, was met with hostility rather than substantive engagement. This asymmetry in how testimony was weighed is itself an evidential matter: when journalistic scrutiny applies selectively to critics of a medical protocol, the resulting portrait of the evidence is distorted regardless of which individual facts are accurately reported. Sapir also maps an institutional reckoning now under way in the United States. Medical organisations and individual clinicians face a choice between accepting responsibility for following guidance they had reason to question or seeking distance from the World Professional Association for Transgender Health, whose Standards of Care provided the framework for much of that guidance. That calculation matters beyond the United States. WPATH's Standards of Care have functioned as a reference point, whether explicitly or implicitly, for clinical practice and litigation across European jurisdictions. The credibility of those standards is directly relevant to how European courts, health ministries and national review bodies weigh claims about best practice in this field.
