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 使用兩份標準檢核表，評判猶他審查中分析個別研究的部分（占其 1,051 頁的 90% 以上）。兩者都給了可能的最低評等：高偏誤風險和「極低」信心。
• 猶他審查檢查了每項研究的品質，但從未評估證據整體的強度，因此 SEGM 主張它的任何分析都不算是適當的系統性回顧（對所有證據的結構化審查）。
• 在猶他團隊判定合格的 230 項研究中，只分析了約 90 項「高優先」研究。生育能力、後悔、去過渡、性功能和死亡不在該優先清單上。
• 猶他審查排除了英格蘭 NICE 2020 年的審查和約克大學的審查。它只找到五份治療指引，且沒有評判其品質。
• SEGM 指出解讀結果方式上的問題。一項沒有對照組的研究在品質上得到 9 分中的 8 分，而青春期阻斷劑的標示外使用，被拿來與兒童例行開立抗生素相比。
• SEGM 表示，六位顧問中有四位曾在猶他大學的青少年性別門診工作，審查中心則依賴州政府的合約工作。這兩點都沒有揭露。
• SEGM 表示，它的報告本身並不審查證據，也不提出政策建議。它只檢查猶他審查是否符合標準方法。

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.