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 bedömde den del av Utah-översikten som analyserade enskilda studier, mer än 90 % av dess 1 051 sidor, med två standardiserade checklistor. Den gav lägsta möjliga betyg på båda: hög risk för bias och ‘kritiskt låg’ tillit.
• Utah-översikten kontrollerade kvaliteten på varje studie men bedömde aldrig hur stark evidensen var totalt, så SEGM hävdar att ingen av dess analyser räknas som en riktig systematisk översikt (en strukturerad granskning av all evidens).
• Av 230 studier som Utah-gruppen bedömde som lämpliga analyserades bara cirka 90 ‘högprioriterade’ studier. Fertilitet, ånger, detransition, sexuell funktion och dödsfall fanns inte på den prioritetslistan.
• Utah-översikten utelämnade Englands NICE-granskningar från 2020 och University of Yorks granskningar. Den fann bara fem behandlingsriktlinjer och bedömde inte deras kvalitet.
• SEGM pekar på problem i hur resultaten lästes. En studie utan jämförelsegrupp fick 8 av 9 i kvalitet, och användning av pubertetsblockerare utanför godkänd indikation jämfördes med rutinmässig förskrivning av antibiotika till barn.
• SEGM säger att fyra av sex rådgivare arbetade med University of Utahs könsklinik för unga, och att granskningscentret byggde på uppdrag från delstaten. Inget av detta redovisades.
• SEGM säger att dess rapport inte själv granskar evidensen eller ger politiska rekommendationer. Den kontrollerar bara om Utah-översikten uppfyllde standardmetoder.

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.