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Feb. 8, 2025 - Epoch Times
22:41
How the Gender Industry Suppressed Evidence of Harm: Leo Sapir
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The UK has now banned puberty blockers.
Probably will ban cross-sex hormones, too, is my prediction in the next few years.
Lear Sapir is a fellow at the Manhattan Institute, where he's been following the massive increase in children identifying as transgender and undergoing what's known as gender-affirming care treatment, from puberty blockers to double mastectomies.
Any way you look at it, WPATH greatly deviated from how responsible, trustworthy medical guidelines are supposed to be developed.
And they suppressed this information and tried to conceal it from the public.
His current area of focus is the pushback to gender interventions for minors, including state bans, lawsuits, and a landmark case now at the Supreme Court.
This case has tremendous consequences for what's going to happen in the 26 states that have banned these interventions in minors.
This is American Thought Leaders, and I'm Jan Jekielek.
Leo Sapir, such a pleasure to have you on American Thought Leaders.
Thanks for having me.
Tennessee has banned what's dubbed gender-affirming care-type treatment for children experiencing gender distress.
This is in front of the Supreme Court right now.
With this new Trump DOJ coming in, they could just walk away from this case and let that Tennessee law stand.
You're arguing against that, though.
Explain that to me, please.
That's right.
So the Trump DOJ could, in theory, let this case, or I should say back away from the case, drop it.
And I argue that they shouldn't do that.
I think the facts of the case and, more importantly, the arguments of the case are heavily on the side of Tennessee, and the court, being a conservative majority court, is likely, some would argue almost certain, to rule in favor of Tennessee.
And this case has tremendous consequences for what's going to happen in the 26 states that have banned these interventions in minors.
Before I get you to talk about the evidence, maybe tell me a little bit how you've come into being, I guess, an expert on this question.
I stumbled into it, frankly.
I wrote a dissertation on Title IX, the federal law that prohibits discrimination on the basis of sex in education.
And I wrote on how the Obama administration and the federal courts had changed the meaning of Title IX to require schools to defer to students according to their gender identity, the way in which they self-defined, self-identified as male or female.
And what I started to notice, actually during my postdoc year, is that the arguments being made by advocacy groups like the ACLU were medical.
These were medical arguments citing medical professionals, medical associations, and medical literature.
And so I started looking at that literature.
And once you look, you can't look away.
Because the reality of the situation is that these interventions, including social transition in school, are said to be based on.
Credible science, credible research over the years, and there just isn't that kind of evidence to support it.
And I found it fascinating that you have this consensus has formed around these types of interventions, psychological as well as physical, in the absence of any credible evidence.
School personnel and advocacy organizations believe, sometimes sincerely, that they are just following the best practices as announced by the medical community.
It can be very difficult for people to believe that the entire medical community, or maybe not the entire, but the decision makers in the medical community have adopted something that you're suggesting actually doesn't have a basis in medical evidence.
That's right.
And that's usually the first hang-up when you talk to people who know maybe a little bit about this topic.
They'll say something like, look, this is the consensus of...
Medical authorities, and by medical authorities, they mean professional medical associations, the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and so on and so forth.
So I think a few things here need to be said.
First of all, if the standard is consensus of medical associations or medical bodies, there is no consensus even by that standard, because...
Numerous European countries, health authorities in several European countries, after conducting systematic reviews of evidence, have backed away from these treatments, recognizing that, in fact, they lack credible evidence of benefits, and they have a real potential to do harm.
So there's no consensus regardless.
Even if you look only at the United States, the medical associations don't...
All march in lockstep on this issue.
For example, last year, the American Society of Plastic Surgeons broke with the consensus and said, we recognize that there's really no good evidence for this in minors.
But the more important point, of course, is that consensus-based medicine is not the same as evidence-based medicine.
That is a very important distinction.
And in fact, the field of evidence-based medicine, which came into its own During the 1990s, was created precisely in order to create this distinction between, you know, what doctors say is good treatment and what the evidence actually supports.
And so you have to recognize, you have to acknowledge that, yes, there is a kind of a pseudo-consensus, and I'll say it in a minute while it's a pseudo-consensus, but that doesn't mean that these are evidence-based treatments.
That just means that medical groups...
Say they are.
To take that one step further, if you actually look at how these treatments ascended to the level of a consensus among medical associations, first of all, these are professional trade unions.
It's important to recognize that.
They exist to protect doctors and promote the interests of doctors, first and foremost.
But more importantly, in this case, they have...
Oftentimes subcommittees that specialize in a certain area of care.
So the American Academy of Pediatrics, for example, about a decade ago convened a special working subgroup on LGBTQ health and appointed, I think it was, six clinicians to that subgroup who were all kind of ideologically on board with gender transition treatments for kids.
And the rest of the leadership of the AAP deferred to their colleagues in the specialized subcommittee.
On the assumption that they know what they're talking about, they're the experts in the field, and what do we know?
And what you see, Jan, is that in a field as advanced in terms of scientific knowledge as medicine, where there is high levels of complexity and division of labor, you have to have that in order for these types of human endeavors to be possible.
There's a great deal of trust and deference between medical professionals.
And that...
Trust can be exploited and has been exploited.
So that's kind of the backstory to how we got to the pseudo-consensus.
You had the leadership of these medical associations said, look, we're not experts, but these people claim they are, so we're just going to defer to them.
There was a recent lawsuit in Alabama that, you know, in the process of discovery, they basically put into the discovery.
As far as I'm aware, that is the...
The most detailed compendium, up-to-date compendium of evidence that I'm aware of, and maybe you can speak to it.
Sure.
I mean, in a way, it's unfortunate that the case before the Supreme Court is the Tennessee ban, and one of the reasons the Biden administration decided to appeal that ban is precisely because the evidence record in that case is incomplete.
The Alabama case has by far the most complete evidence record.
There's a good reason that the Biden administration decided not to appeal from there.
But look, I've said this before and I continue to believe it.
I think the greatest mistake the gender industry in the United States ever made was to sue the state of Alabama over its ban on youth transition.
What happened is that the Attorney General of the state of Alabama We've secured subpoenas from the judge, in that case Judge Lyle Burke, to have the World Professional Association for Transgender Health, whose standards of care version 8 control the entire medical field in this area in the United States,
to subpoena all their internal emails related to the development of standards of care 8, SOC 8. And what those emails have revealed has been nothing short of shocking.
Those emails contain the smoking gun evidence of medical scandal.
And so here's kind of in a nutshell what they found.
WPATH commissioned systematic evidence reviews as part of the process of developing SOC 8. When it found out that the evidence reviews specifically for minors were unimpressive, did not get them the results that they wanted that would support their medical approach, they suppressed them.
They basically instructed the researchers at Johns Hopkins University who were doing these systematic reviews to not publish them.
And then they also claimed, in SOC 8, they said, systematic review of evidence for minors is not possible, even though they themselves had commissioned one and suppressed it.
More than that, they also spoke to what they called in internal emails a social justice lawyer.
And that lawyer told them, according to these emails, that having these types of systematic reviews would actually be bad for WPATH since it would compromise its ability to win lawsuits.
And it would also place clinicians who provide these treatments at legal risk for malpractice.
So it killed the evidence reviews and claimed that they're not possible.
Beyond that, WPATH also, in a move that surprised a lot of us, a few days after it published SOC 8 in 2022, it issued a correction in the medical journal in which SOC 8 came out, and it said, we're now eliminating all age minimums for medical interventions for kids with the exception of phalloplasty.
So all surgeries, all hormones, puberty blockers, none of that have any age minimums from now on.
And it turns out that they did that not for any clinical reason or because of evidence, but they did that under pressure from Dr. Rachel Levin, who is the Assistant Secretary for Health in the Biden administration.
Who expressed concern that having specified age minimums in SOC 8 would draw political controversy.
And it turns out the American Academy of Pediatrics, which told WPATH, we're not going to endorse this.
In fact, we're going to actively oppose it if you specify age minimums.
So you've got to get rid of them.
And, you know, we have other things that have come out of that discovery that are no less concerning.
For example, the lead author of SOC 8 admitted in a deposition, in this case, that conflicts of interest, both financial and intellectual conflicts of interest, were simply overlooked in the process of recruiting people to work on SOC 8. Having a conflict of interest was deemed to be a prerequisite to being on the SOC 8 committee, which is really shocking.
It violates every tenet of how...
Responsible guidelines should be developed.
Just clarify that for me.
It didn't say having a conflict of interest was a prerequisite.
What do you mean exactly?
Right.
So what happened was this came out of the deposition of Eli Coleman, who's the lead author of SOC 8, and also of Marcy Bowers, who was then the president of WPATH and also a co-author on SOC 8. Coleman was asked explicitly, were you aware that most of the people on the SOC 8 Development Committee had conflicts of interest, and he said yes.
He was aware.
And yet, if you look at the disclosure section, it says no conflicts of interest.
Marcy Bowers said that being a proponent of the medical gender-affirming approach was a prerequisite to being invited to participate on the committee.
So the WPATH leadership...
What do I mean by financial and intellectual conflicts of interest?
A few of the developers of SOC 8 were expert witnesses in cases in which what SOC 8 would have said would determine whether their side in the lawsuit ends up winning.
So they stand to gain financially from SOC 8 saying certain things and not others.
Marcy Bowers, the president of WPATH. Set in a deposition, admitted to making over a million dollars in 2023 from performing gender surgeries.
Most of the other clinicians on the SOC 8 development team also made money, had professional appointments, gained professional reputations from performing these procedures or at least endorsing them.
And those are considered financial conflicts of interest.
And of course, intellectual conflicts of interest, if you become a public advocate, if you write in favor of a certain position, you're less likely to evaluate impartially the evidence base for a treatment.
So the key thing here is that the US Institute of Medicine in 2011 announced standards for the development of what they called trustworthy medical guidelines.
And WPATH claimed that they were following these standards.
In fact, Eli Coleman himself claimed that those standards were controlling.
But if you look at those standards, they clearly...
You cannot have people with conflicts of interest dominating the process of developing a medical guideline.
Any way you look at it, WPATH greatly deviated from how responsible, trustworthy medical guidelines are supposed to be developed and they suppressed this information and tried to conceal it from the public.
WPATH basically is the standard that a lot of these professional organizations have followed.
Right.
But WPATH isn't per se a medical organization as I understand it.
So how did WPATH rise to prominence?
You know, I mean, it's a situation, again, in which you have a specialized group of clinicians and activists.
And it's true that WPATH is, even though it calls itself the Professional Association for Transgender Health, it's an activist group made up of lots of, you know, disparate elements.
Not all of them are doctors.
Not all of them are mental health professionals.
Some of them are journalists, run-of-the-mill activists.
Some of them are social workers.
But they have positioned themselves as the experts.
And, you know, nobody really questions that in the medical field, although now they do.
And certainly in Europe, European countries completely reject WPATH. I think the director of Belgium's Center for Evidence-Based Medicine said he would throw WPATH's guidelines in the dustbin.
So there are no fans of WPATH there.
But here in the United States, they are de facto the authorities in the field.
In the absence of other organizations issuing guidelines, and there's one exception, the Endocrine Society did issue a guideline.
But in the absence of other organizations saying, no, we're going to issue our own guideline and take a different approach, WPATH has emerged as the de facto leader in the field.
WPATH did not immediately respond to a request for comment.
Lear, just one quick sec.
We're going to take a quick break.
Sure.
And we'll be right back.
And we're back with Manhattan Institute Fellow, Lear Sapir.
So, and how is it that Europe has taken, you know, writ large, right, has taken, you know, really looked more systematically at the evidence?
How do you explain that exactly?
You know, it's a great question.
It's one that concerns me a lot.
So first of all, just so listeners are aware, the UK has now banned puberty blockers.
Probably will ban cross-sex hormones, too, is my prediction in the next few years.
Surgeries are almost never performed outside the United States.
Extremely rare.
Lior, before you continue, maybe just lay out to me what this, as quickly as possible, what this gender-affirming care approach is.
Because you mentioned a few elements of it, but I'd just like to offer a picture.
So according to kind of the standard protocol as developed in the Netherlands, as soon as a kid reaches Tanner stage two of puberty, which is kind of the early development of puberty, the first stage is puberty blockers, which, as the name implies, block puberty from going into effect.
Initially these drugs were intended to kind of provide a window of time for kids to figure out whether to continue with transition.
Now we know based on research, based on the expertise of clinicians involved in the field, that that is simply not the case.
Because almost 100% of kids who go on puberty blockers end up going on to cross-sex hormones.
So blockers very likely lock in the gender distress that would otherwise, in most cases, evaporate.
So a kid shows up, has gender distress, not sure whether they're male, female, or something else.
And then the next step is...
Well, I mean, according to the traditional protocol, they had to be quite sure that they are, in fact, the opposite sex.
And so they would be given puberty blockers to figure out, time to figure it out.
And almost all of them would, of course, figure out that, in fact, they're trans, they want to proceed.
And so the next step is cross-sex hormones.
So testosterone if you're a girl, estrogen if you're a boy, whereas puberty blockers...
To prevent the body from developing through its endogenous puberty process, cross-sex hormones are meant to induce the appearance of sex characteristics that mimic the opposite sex.
So, you know, in girls who take testosterone, for example, their voice will get lowered, and that could actually be irreversible.
And then the final stage, in the United States at least, surgeries.
And for boys, this is much, much more rare, but for boys, it could involve a vaginoplasty, a surgical inversion of the penis, or if they went on puberty blockers and their penile tissue didn't develop.
The surgeon will borrow tissue from the colon and create a kind of a semblance of a vagina with the colon tissue.
In Europe, these surgeries are usually only offered after age 18, but in the United States, they are offered to minors as well.
So that's the full protocol.
Now, you know, there's deviations from it.
Some kids only want...
In the United States, gender affirming care is typically more a la carte.
It's whatever the kid wants, right?
So if they want just the cross-sex hormones, that's what they get.
If they want just the surgery, that's what they get.
And now also within the last five, six years, we've seen the rise of so-called non-binary procedures, which unlike the Dutch protocol, the non-binary procedures are really just meant to allow kids to pursue whatever, as the clinicians call it, embodiment goals they want.
So if they want a little bit of body hair and to also have breasts and all that kind of stuff, they can kind of mix and match their drugs and surgeries to produce idiosyncratic body types that are not found in nature.
If you had kind of a wish list for what you would like to see this incoming administration do with respect to this issue?
Yeah, I mean, there's more things that I could possibly list now, but maybe some highlights would be HHS needs to deprogram itself from gender ideologies.
It needs to get rid of all the ideological language, all the directives.
The NIH, for example, needs to stop Pumping money, you know, hundreds of millions of taxpayer dollars into research whose only purpose is to promote these interventions.
I actually think that instead of shutting off the valve, NIH should reorient itself and devote money to studying the harms, which are not studied.
Nobody's studying harms because the gender clinicians doing the research don't want to know.
They're only studying benefits and then they're spinning the results of their studies.
We need evidence on detransition and regret, which are real and growing phenomena.
I would also like to see the agencies within NIH responsible for evidence reviews step it up.
Do the evidence reviews if you need to, or at least acknowledge the evidence reviews performed by other countries.
It would be nice to see the Surgeon General issue a warning about off-label use of puberty blockers.
At the Department of Justice, I would like to see an immediate stop to the persecution of whistleblowers, specifically Dr. Eitan Haim from Texas, who blew the whistle on Texas Children's Hospital.
He's been subject to a ruthless political persecution by the Biden administration to try to shut him up and deter other whistleblowers.
That has to stop.
There's a lot of things that an incoming Trump administration can do on the executive side alone to say nothing of what Congress can do through its powers of investigation, of appropriations, even legislation, although that's going to be very difficult.
There's a lot that can be done over the next four years.
So what about on the executive side?
So, you know, the Biden administration on day one in office issued executive orders on trans issues and has issued others, too.
A good first step would be for President Trump to just rescind the executive orders of the Biden administration on this particular issue.
That's easy to do, right?
Stroke of a pen, you can do it.
Stroke of a pen, you can undo it.
So I'm not sure there's a whole lot else to be done through executive orders, simply because executive orders can be undone by the next incoming Democratic president and will be undone by the next incoming Democratic president.
We need to We need the federal government to use its powers to investigate how the American medical profession went off track here and what can be done to restore us to a place of evidence-based ethical medicine.
Well, Lear Sapir, it's such a pleasure to have had you on.
Thanks so much, Ian.
Thanks for having me.
Thank you all for joining Lear Sapir and me on this episode of American Thought Leaders.
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