Summary

In 2025 a 1,051-page review made for Utah concluded that puberty blockers and hormones are safe and effective for gender-distressed minors. This went against England's NICE, the Cass Review and a US federal review. SEGM, a group that favours a more cautious approach, checks whether it followed standard review rules. It finds the review never rated how strong the evidence was overall, a core step. It also says the review analysed under 40% of the studies it judged eligible, left out the NICE and York reviews and several national guidelines, set aside results such as fertility and detransition, and did not disclose advisors' conflicts of interest. Many points can be checked against the Utah document. But the critique comes from an advocacy group, names no authors, was not checked by outside experts, has some numbers that don't match, and does not review the evidence itself.

Key findings

• SEGM оценява частта от прегледа от Юта, анализираща отделни изследвания, над 90% от неговите 1051 страници, с два стандартни контролни списъка. Тя дава възможно най-ниските оценки и на двата: висок риск от пристрастност и „критично ниско“ доверие.
• Прегледът от Юта проверява качеството на всяко изследване, но никога не оценява колко силни са доказателствата като цяло, така че SEGM твърди, че нито един от анализите му не се брои за подходящ систематичен преглед (структуриран преглед на всички доказателства).
• От 230 изследвания, които екипът от Юта преценява за допустими, са анализирани само около 90 „високоприоритетни“. Плодовитостта, съжалението, детранзицията, сексуалната функция и смъртните случаи не са в този приоритетен списък.
• Прегледът от Юта изключва прегледите на NICE от Англия от 2020 г. и прегледите на Университета в Йорк. Той открива само пет ръководства за лечение и не оценява тяхното качество.
• SEGM посочва проблеми в начина, по който са изтълкувани резултатите. Едно изследване без сравнителна група е оценено с 8 от 9 за качество, а употребата на блокери на пубертета извън одобрението е сравнена с рутинното предписване на антибиотици на деца.
• SEGM казва, че четирима от шестимата съветници са работили с клиниката за пола за младежи на Университета на Юта, а центърът за прегледи се е опирал на работа по договор с щата. Нито едното не е разкрито.
• SEGM казва, че докладът ѝ сам не прави преглед на доказателствата и не дава политически препоръки. Той само проверява дали прегледът от Юта отговаря на стандартните методи.

Abstract

This report provides a methodological analysis of the Utah Review—a set of evidence reviews and recommendations about hormonal interventions for minors with gender dysphoria, published by the Utah Department of Health and Human Services in May 2025. The Utah Review was commissioned by the Utah Legislature in the context of a moratorium on pediatric medical transition (S.B. 16). The analysis was conducted by the University of Utah College of Pharmacy’s Drug Regimen Review Center and was presented as a “systematic review of the medical evidence,” which concluded that puberty blockers and cross-sex hormones are safe and effective treatments for pediatric gender dysphoria and that the hormonal intervention pathway should remain open for adolescents in Utah. Because systematic evidence reviews can substantially influence clinical practice and public policy, adherence to established methodological standards is essential. With more than 90% of the Utah Review comprising analyses of primary clinical studies, we evaluated that component using two standard appraisal tools for systematic reviews of intervention effects—ROBIS and AMSTAR 2. Other components of the Utah Review—including analyses of systematic reviews and clinical guidelines—were also assessed, with a focus on whether the methods were systematic, comprehensive, and reproducible, and whether the conclusions were supported by the evidence presented. We also evaluated the recommendations arising from the evidence review to assess whether the process of moving from evidence review to recommendations followed evidence-based methods. The analytic approaches in the Utah Review do not adhere to the standards for systematic evidence reviews established by the National Academies of Sciences, Cochrane, and other expert bodies. Since the Utah Review does not contain systematic evidence reviews, it cannot serve as a reliable basis for evidence-based decision-making. Numerous conflicts of interest do not appear to have been recognized as such, or appropriately managed.

Conclusion

The analytic approaches in the Utah Review do not adhere to the standards for systematic evidence reviews established by the National Academies of Sciences, Cochrane, and other expert bodies; since it contains no systematic evidence reviews, it cannot serve as a reliable basis for evidence-based decision-making. SEGM concludes that the Utah Review is neither objective nor independent, having been commissioned amid advocacy to overturn Utah's moratorium with unmanaged conflicts of interest; that its main analysis was completed in under four months and set aside over 60% of eligible studies; that over 90% of its 1,051 pages are supplementary tables; and that its conclusions overlooked foundational U.K. reviews, the Swedish and Finnish guidelines, the Cass Review and signals of harm. It argues the field should accept the findings of nearly two dozen systematic reviews that benefits of pediatric transition remain highly uncertain while harms are more certain, and calls for research on the etiology and natural history of youth gender dysphoria, reanalysis of existing patient data, higher-quality primary studies (including of psychotherapy), stronger long-term outcome surveillance, and open debate on the role of adolescent autonomy.