Podcast Summary

Podcast: American Thought Leaders
Host: Jan Jekielek, The Epoch Times
Episode: A New Approach to Alzheimer’s? | Lou Reese (Note: Actual discussion centered on pediatric gender medicine, not Alzheimer’s; Guest: Leor Sapir)
Date: January 23, 2026
Guest: Leor Sapir, Senior Fellow, Manhattan Institute, co-author of the 2024 HHS review of pediatric gender medicine

Episode Overview

This episode features an in-depth interview with Leor Sapir, a leading researcher in the debate over pediatric gender medicine. The discussion focuses on the findings of a recent, comprehensive U.S. Department of Health and Human Services (HHS) report reviewing evidence and best practices in “pediatric medical transition.” Sapir details the report’s methodology, core findings, ethical analysis, and addresses criticisms from major medical organizations. He also highlights systemic problems within the field and explains both scientific and cultural dynamics impacting clinical practices in the U.S. and abroad.

Key Discussion Points and Insights

1. Defining the Language of Gender Medicine

• Contested Terminology:
  Sapir critiques the terms commonly used in this field. For example, "gender-affirming care" is described as a euphemism or marketing term that disguises the intent behind the treatments ([01:16]).

  • Notable quote:

  "Gender affirming care is a euphemism and it is essentially a marketing term."
  (Sapir, 01:16)

• Alternative Terms:
  The HHS report uses "pediatric medical transition" (PMT) instead of “sex rejecting procedures" or "gender affirming care," aiming to maintain a neutral, fact-based tone (04:53).

• Unscientific Language:
  Terms such as “sex assigned at birth” and “gender identity” are criticized as misleading and lacking scientific precision ([13:08], [31:00]).

2. The HHS Report: Goals, Methodology, and Key Findings

• Origin and Scope:
  Initiated by an executive order from President Trump, the review was completed in just under nine weeks—a sharp contrast to the four years taken for the comparable UK Cass Review ([02:14]).

  • Notable quote:

    "We were working under a very, very tight deadline. But luckily I was able to recruit very, very good experts, medical doctors, bioethicists, researchers... we were able to produce this report."
    (Sapir, 02:14)

• Methodology:
  The report is an "umbrella review"—that is, a review of systematic reviews, sitting at the apex of the evidence hierarchy ([06:26]).

• Summary Finding:
  Across all systematic reviews worldwide (Finland, Sweden, UK), evidence for the benefits of puberty blockers, cross-sex hormones, and surgeries in minors is of very low quality. The evidence for harms is stronger ([08:58]), e.g., bone density loss, cognitive and cardiovascular risks.

3. Systemic Bias and Research Limitations

• Design and Publication Biases:
  Most studies are conducted by advocates of medical transition, leading to methodological flaws, short-term studies, cherry-picked outcomes, and suppression of negative results ([08:58], [11:43]).
  • Example: A major, NIH-funded study whose lead investigator withheld publication because the results did not show meaningful benefit ([08:58]).
  • Notable quote:

    “She chose not to publish the results because they were unimpressive... This is fairly characteristic of the field.”
    (Sapir, 08:58)

• Misleading Outcome Measures:
  Studies often use superficial outcome tools (e.g., satisfaction with chest appearance post-mastectomy) that can't measure long-term well-being or regret ([11:43]).

4. Misleading Parents and Patients

• Misrepresentation of Science:
  The field's foundational concepts are said to be consistently misrepresented in clinical practice, leading parents and children to misunderstand the risks and realities ([13:08]).
  • Notable quote:

    “Sex is not assigned at birth... To tell patients... that the sex you thought your daughter or son is, is not their true sex is fundamentally unscientific and misleading.”
    (Sapir, 13:08)

5. Institutional Behavior: Suppression and Circularity

• Suppression of Evidence:
  WPATH, the World Professional Association for Transgender Health, is described as having suppressed its own systematic reviews when results didn’t support their desired conclusion ([16:16]).

  • Notable quote:

    “You see the clinicians admitting that they are suppressing evidence... eliminating age minimums for hormones and surgeries due to political pressure.”
    (Sapir, 16:16)

• Circular Endorsements:
  Major societies (AAP, Endocrine Society) are said to cite each other's guidelines as evidence—creating the appearance of consensus without robust empirical foundation ([18:49]).

6. Response to Criticisms and Peer Review Process

• Initial Criticism:
  The report faced immediate criticisms from organizations like the American Academy of Pediatrics (AAP), but Sapir points out that this occurred before critics could reasonably have reviewed 400+ pages of material ([21:19]).
• Peer Review:
  Some organizations declined to peer review, while others reviewed only partially or superficially. The supplement to the HHS report includes point-by-point responses to critics' claims ([21:19]-[25:00]).
  • Notable quote:

    "So again, I encourage people to read the supplement and really see for themselves what were the criticisms made of the report and do those criticisms hold up."
    (Sapir, 25:00)

7. Why Medical Societies Aren’t Changing Directions

• Organizational Inertia:
  Groups are reluctant to reverse positions due to sunk costs, inertia, and fear of admitting error regarding irreversible interventions ([27:06]).
• “Capture by Committee”:
  Small, highly motivated activist groups within larger societies shape policy while most members defer.
• Broken Chain of Trust:
  Medical professionals rely on presumed experts, reinforcing flawed consensus when oversight or substantive expertise is lacking ([30:44]).

8. Historical Parallels in Medicine

• Persistence of unsupported medical practices is common, even after strong evidence demonstrates inefficacy (e.g., knee surgery for arthritis, peanut allergy recommendations) ([33:57]).

9. The Ethics Chapter: An Innovation in the Field

• Why Focus on Ethics?
  Despite the debate's “intuitive obviousness” as an ethical issue, Sapir notes his team’s chapter was the first rigorous English-language analysis of medical ethics in pediatric gender transition ([34:17]).

• Ethical Principles Applied:

  • Beneficence, Non-maleficence, Autonomy, Justice ([34:17]):
    • Risk-benefit ratio is unfavorable.
    • “Autonomy” has been reinterpreted wrongly as a blank check for patients/parents to demand interventions ([36:00]).
    • Justice: Disproportionate harm may befall “proto-gay” youth.
    • "Regret" is relevant, but not central to the ethical analysis.
  • Notable quote:

    “The correct standard…is best interests. Parents have to make decisions in the best interests of their children, not based on the supposed Autonomy of a 12 year old who doesn't even understand what it means to give up their future fertility…”
    (Sapir, 41:40)

• Research Ethics:
  Proposes extreme caution for clinical trials given ethical uncertainties.

10. The Shift in Medical and Political Climate

• Recent Reform Movements:
  Since the current administration, there’s been a “dramatic shift” including more scrutiny, investigation of insurance fraud, and a growing willingness from both liberal and conservative professionals to question the field’s standards ([45:37]).
• Sapir’s Call to Action:
  Encourages professionals to self-educate, read the report (or at least executive summary and ethics chapter), and contribute to a more open and scientific discussion ([47:26]).

Notable Quotes & Memorable Moments

• On the consequences of misleading terminology:

  “Sex is not assigned at birth...to tell patients...is fundamentally unscientific and misleading.”
  (Sapir, 13:08)

• On institutional suppression:

  “You see the clinicians admitting that they are suppressing evidence...eliminating age minimums...due to political pressure.”
  (Sapir, 16:16)

• On the ethics of pediatric autonomy:

  “What 12 year old can possibly understand what it means to never be able to have children in the future?”
  (Sapir, 41:40)

• On study design and manipulation:

  “You can design a study to show you something that you in advance want it to show.”
  (Sapir, 12:51)

• On the field’s response to critique:

  “The bottom line is nobody was able to identify any significant errors in the report.”
  (Sapir, 25:00)

Timestamps for Key Segments

• Defining Language & Concepts
  • [01:16]–[04:53]: Critique of “gender-affirming care”; report’s terminology
• Report Scope & Methods
  • [02:14]–[06:16]: Goals, umbrella review explanation
  • [06:26]–[08:58]: “Hierarchy of evidence” and why benefits are unproven
• Systemic Bias in Studies
  • [08:58]–[12:51]: Biases, missing publication of negative or null results
• Evidence Misrepresentation & Parental Deception
  • [13:08]–[16:16]: Clinical misrepresentations; WPATH’s role
• Circular Endorsement & Suppression Dynamics
  • [18:49]–[20:57]: How organizations collude (wittingly or otherwise)
• Peer Review and Handling Critics
  • [21:19]–[26:12]: Critique from AAP, handling of peer review, supplement responses
• Medical Society Inertia & 'Broken Trust'
  • [27:06]–[33:57]: Organizational issues, medical precedent parallels
• Ethics and the Ethics Chapter
  • [34:17]–[41:40]: Key ethical principles and their misapplication; “autonomy” reconsidered
• Implementation and Next Steps
  • [45:37]–[47:26]: Policy impacts, spreading awareness, call to action

Final Thoughts

The interview provides a comprehensive, critical look at the current state of pediatric gender medicine in the U.S. Sapir’s analysis is rooted in systematic evidence evaluation, detailed ethical argument, and a focus on language and narrative in medicine. The episode will be especially valuable to listeners seeking an accessible yet rigorous summary of the HHS report, the debates around it, and the underlying institutional and ethical challenges shaping this highly contested field.

Recommended Reading:

• HHS Report Executive Summary
• Ethics Chapter (Chapter 13)
• Supplement with responses to critics
  (All available on the HHS website as referenced in the episode.)