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使用两份标准清单，评判了犹他综述中分析个别研究的部分（占其1,051页的90%以上）。两份清单上都给出了可能的最低评级：高偏倚风险和“极低”可信度。
• 犹他综述检查了每项研究的质量，但从未对证据的总体强度进行评级，因此SEGM认为它的任何分析都不能算作恰当的系统综述（对所有证据的结构化综述）。
• 在犹他团队判定为符合条件的230项研究中，只分析了约90项“高优先级”研究。生育能力、后悔、去过渡、性功能和死亡不在该优先级清单上。
• 犹他综述排除了英格兰NICE 2020年的评估和约克大学的评估。它只找到五份治疗指南，并且没有评判其质量。
• SEGM指出了解读结果的问题。一项没有对照组的研究在质量上被评了9分中的8分，青春期阻断剂的超适应症使用被比作儿童常规抗生素处方。
• SEGM说，六位顾问中有四位在犹他大学的青少年性别诊所工作，而且该综述中心依赖州政府的合同工作。两者都没有披露。
• SEGM说，它的报告本身并不综述证据，也不提出政策建议。它只检查犹他综述是否符合标准方法。

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.