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

• SEGM은 유타 검토의 1,051쪽 중 90% 넘게를 차지하는 개별 연구를 분석한 부분을 두 가지 표준 점검표로 판단했습니다. 두 곳 모두에서 가능한 가장 낮은 평가, 즉 높은 편향 위험과 ‘매우 낮은’ 신뢰도를 주었습니다.
• 유타 검토는 각 연구의 질을 점검했지만 근거의 전반적 강도는 평가한 적이 없으므로, SEGM은 어떤 분석도 제대로 된 체계적 검토(모든 근거에 대한 구조화된 검토)로 볼 수 없다고 주장합니다.
• 유타 팀이 자격이 있다고 판단한 연구 230건 중 약 90건의 ‘우선순위 높은’ 연구만 분석되었습니다. 생식 능력, 후회, 디트랜지션, 성기능, 사망은 그 우선순위 목록에 없었습니다.
• 유타 검토는 잉글랜드 NICE의 2020년 검토와 요크대학교의 검토를 제외했습니다. 치료 지침을 다섯 개만 찾았고 그 질을 판단하지 않았습니다.
• SEGM은 결과를 읽는 방식의 문제를 지적합니다. 비교 집단이 없는 한 연구가 질 평가 9점 만점에 8점을 받았고, 사춘기 차단제의 허가 외 사용이 아동에 대한 일상적인 항생제 처방에 비유되었습니다.
• SEGM은 여섯 명의 자문위원 중 네 명이 유타대학교의 청소년 성별 클리닉과 함께 일했고, 검토 센터는 주 계약 업무에 의존했다고 말합니다. 어느 쪽도 공개되지 않았습니다.
• SEGM은 자신의 보고서가 근거를 직접 검토하거나 정책을 권고하지 않는다고 말합니다. 유타 검토가 표준 방법을 충족했는지만 확인합니다.

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.