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 specialising in pediatric transition policy, dissects the New York Times' six-episode Protocol podcast and argues it spent two years investigating youth transition while avoiding every foundational question. His account of an interview with clinical psychologist Laura Edwards-Leeper — in which she acknowledged that gender identity rests on stereotypes — exposes the definitional gap at the heart of medical protocols used internationally, including those influencing Irish clinical practice. For Ireland, where HSE paediatric gender services are still developing, whether the core concept can be scientifically defined is not academic.
Leor Sapir is a fellow at the Manhattan Institute whose research focuses on pediatric transition policy and bioethics. His contribution to this episode centres on a detailed critique of The Protocol, a six-episode investigative podcast produced by the New York Times examining how American clinicians assess and treat young people who present with gender-related distress. The New York Times spent approximately two years producing The Protocol, and Sapir argues that despite its length and apparent thoroughness, it systematically avoided the most fundamental questions the subject demands. Central among these: what, precisely, is gender identity? How is it assessed? And how can a medical protocol be built around a concept that its own practitioners struggle to define in non-circular terms? Rather than grappling with these foundations, Sapir contends, the podcast positioned a particular mode of psychological assessment as a reasonable middle ground without ever interrogating whether the underlying concept it assesses has any coherent scientific basis. A significant moment in the episode involves Laura Edwards-Leeper, a clinical psychologist closely associated with the development of guidelines used in paediatric gender services. In a conversation Sapir recounts from his own interview with her, Edwards-Leeper acknowledged that gender identity, as it is used clinically, is based substantially on stereotypes. This admission matters because gender identity is the conceptual foundation on which referrals, assessments and medical interventions — including puberty blockers and cross-sex hormones — are justified. If the concept rests on stereotypes rather than any observable or measurable biological reality, the clinical protocols built upon it lack the definitional rigour expected in any other branch of medicine. Sapir's sharpest formulation concerns what he describes as circular reasoning. Endocrinologists are treating a condition — gender dysphoria or gender incongruence — that cannot be defined without reference to the very thing it purports to explain. No blood test, no imaging, no genetic marker identifies a patient as a candidate for hormonal intervention. Assessment relies on self-report, on clinician judgement shaped by frameworks developed by bodies such as WPATH, and on a concept of gender identity that, as Edwards-Leeper's admission illustrates, may reduce to a set of social assumptions about masculinity and femininity. The episode also addresses the treatment of detransitioners within The Protocol. Those who have come to regret medical transition, or who have stopped identifying with the gender they previously affirmed, received minimal airtime compared to other voices in the series. Sapir regards this as a structural failure in how the podcast constructed its version of balance, one that reflects broader patterns in mainstream editorial coverage of this area. For anyone following how Ireland's Health Service Executive has approached the development of paediatric gender services, or how Irish clinicians have engaged with international guidelines, the questions Sapir raises are directly relevant. If the clinical frameworks underpinning these services cannot define their central concept without circularity, the basis for expanding or endorsing those services deserves the same scrutiny here as it does in the United States.
