A Paradox of Principles
Unpacking the Anderson-Edwards-Leeper Amicus Brief
This week, the Supreme Court will hear oral arguments in US v. Skrmetti, a pivotal case addressing state restrictions on “gender-affirming care” (GAC) for minors. While the oral arguments will be concise, the amicus briefs submitted carry profound implications for the Court’s decision.
Among the most surprising briefs is one filed by Dr. Erica Anderson and Dr. Laura Edwards-Leeper, two clinicians often associated with critiques of the current affirmation-only model of care. Aligning with the ACLU and the federal government in opposing state restrictions, their stance appears paradoxical given their frequent public critiques of the systemic failures inherent in the existing GAC framework.
Contradictory Commitments
In their brief, Anderson and Edwards-Leeper argue against restrictions on GAC for minors while simultaneously invoking an idealized model of care that, by their own admission elsewhere, does not exist in practice. Both have repeatedly voiced concerns about insufficient psychological assessment, rushed medicalization, and the ethical pitfalls of irreversible treatments for young people. Yet, in their submission to the Court, these systemic failures are conspicuously absent, raising fundamental questions about the coherence of their position.
For instance, their brief fails to mention their awareness of the rising tide of detransitioners—individuals who regret their gender transitions—or their acknowledgement elsewhere of the existence of the phenomenon of Rapid Onset Gender Dysphoria (ROGD) an idea that has been vigorously attacked by the gender affirming care movement. ROGD refers to the aspect of social contagion that has caused an anomalous spike in young people identifying as trans since the early 2010s.
Both are critical issues Anderson and Edwards-Leeper have previously acknowledged. This silence seems particularly troubling given that these phenomena underscore the very risks they have criticized: inadequate safeguards, misdiagnoses, and the failure to account for the fluidity of adolescent identity.
Their defense of “evidence-based, safe, and effective” GAC rings hollow when juxtaposed with their admissions that current standards rarely meet these criteria. How can they oppose legal oversight while admitting the system routinely fails the very youth it purports to protect?
Ideology Versus Reality
One explanation for this paradox lies in their long standing opposition to “gatekeeping” within gender medicine. Anderson and Edwards-Leeper advocate for reduced barriers to access, yet their vision for achieving this without exacerbating harm remains unclear. Without robust diagnostic criteria or reliable methods for determining which minors truly benefit from medical interventions, the risk of inappropriate or harmful treatments looms large.
Their support for the World Professional Association for Transgender Health’s (WPATH) Standards of Care (SOC) in the brief is particularly incongruous. Both Anderson and Edwards-Leeper have publicly criticized WPATH for promoting a hasty, affirmation-only approach to youth transitions. Anderson resigned from USPATH, WPATH’s US affiliate, citing concerns over its suppression of dissent and lack of transparency. Edwards-Leeper has also called for more cautious, evidence-based practices. Their unqualified endorsement of WPATH in this context raises questions about the motivations driving their legal position.
The Global Reassessment
The Anderson-Edwards-Leeper brief arrives at a time when the international landscape of gender medicine is shifting. Countries like Sweden, Finland, and the UK, once leaders in youth gender transition, have moved toward more cautious approaches, emphasizing psychotherapy over medical interventions and significantly restricting the use of puberty blockers and cross-sex hormones. These reversals reflect growing concerns about the long-term safety and efficacy of these treatments, as well as the lack of robust evidence supporting their use in minors.
In contrast, the US medical establishment remains steadfastly aligned with WPATH and its affirmation-only model, even as detransitioners, whistleblowers, and an increasing body of research challenge its premises. The silence of Anderson and Edwards-Leeper on these developments in their brief is striking, particularly given their own critiques of the US approach to gender medicine.
The Business of Affirmation
Edwards-Leeper’s role in pioneering the affirmative model at Boston Children’s Hospital’s GeMS clinic further complicates her position. As one of the architects of this approach, her defense of it may reflect a personal investment in its legacy rather than a dispassionate assessment of its outcomes. This raises broader concerns about the influence of ideology and financial interests in shaping medical guidelines and public policy.
Indeed, the rapid growth of the medical transition industry, fueled by rising demand among adolescents, underscores the stakes of this debate. The tension between meeting this demand and ensuring rigorous, ethical care has created a polarized and often toxic environment, where dissenting voices are marginalized, and critical questions go unanswered.
Toward a Better Future
The paradox at the heart of the Anderson-Edwards-Leeper brief reflects a broader crisis within gender medicine. As clinicians, policymakers, and advocates grapple with the complexities of youth gender dysphoria, the need for a recalibrated approach has never been more urgent.
We must demand a healthcare system that prioritizes evidence over ideology, safeguards over expediency, and the long-term well-being of children over short-term affirmations. The lessons from international reversals, the testimonies of detransitioners, and the warnings from clinicians like Anderson and Edwards-Leeper themselves point to the necessity of reform.
History will judge us by how we respond to this challenge. For the sake of our children, we cannot afford to fail.
Thank you for this. I've just finished reading Eliza Mondegreen's excellent piece on all that's wrong with seeking some kind of middle ground when it comes to "gender ideology" and "gender affirming care". Well worth a read. She concludes:
"A lot of good progressives want to avoid the obvious conclusion here, which is that we really fucked this up. There’s no worthy cause to salvage here."
I wish Drs Anderson and Edwards-Leeper could admit that they'd got it devastatingly wrong.
I would love to know who wrote this. It is beautifully argued and tremendously valuable to help readers understand the problems inherent in the way Anderson and Edwards-Leeper are trying to straddle a fence to the detriment of the children they purport to serve. As Harry Truman once said, “I never sit on a fence. I am always on one side or another.” By filing this brief in support of the US government/ACLU position, Anderson and Edwards-Leeper have taken a side, and they need to be judged accordingly.