Plentiful Data, No Regret: What the Utah Review on Youth Trans Care Found
A 1,000-page report by the College of Pharmacy at the University of Utah, which found care safe and effective, stands out from others: It’s both independent and an actual review of the evidence.
by Evan Urquhart
A report on youth gender medicine by the Drug Regimen Review Center, a little-known body operating out of the University of Utah, was released late last week by the Utah legislature. The Salt Lake Tribune and a small number of other news outlets have highlighted a few aspects of this report, particularly the finding that youth gender medicine is safe, effective, and comparable to other mainstream medical treatments. They’ve also mentioned its length, over 1,000 pages. But what’s actually in it?
The full pdf for the DRRC’s evidence review is available for download here.
A Comprehensive Review of the Evidence
“Notably, our searches yielded a larger number of primary studies than any of the systematic reviews that underwent data extraction,” the report states proudly on page 117. The authors found a total of 277 studies that included data on over 28,000 young people with gender dysphoria.
The report focuses on 89 studies of puberty blockers or gender-affirming hormone therapy that looked at several “high-priority outcomes” around mental health, psychosocial changes, body changes and body image, and/or key health risks while weeding out case reports and purely descriptive studies. The methods and findings of these 89 were summarized, and each one was evaluated for risk of bias. The report also extracted data from seven previous systematic reviews and four published guidelines.
Here’s an example from one of the many tables that make up much of the report, in this case a table analyzing risk of bias:
The authors found a range of study quality in the data, from lower to higher. The conclusion section (which starts on page 116) strikes a note of seeming bemusement at the conventional wisdom, which has held that the evidence for this care is limited and of poor quality. “The conventional wisdom among non-experts has long been that there are limited data on the use of GAHT in pediatric patients with GD. However, results from our exhaustive literature searches have led us to the opposite conclusion,” the report states.
The report has two parts, with Part I being the main review of the evidence in published literature and Part II being a return to the previously gathered literature with a focus on studies reporting long-term (5+ year) outcomes. The second part found limited data, which is summarized with a note that the literature was not substantial enough to draw any conclusions.
One notable section deals with rates of regret, desistance, and detransition in the literature. A table from pages 109-114 includes 32 studies that reported rates of persistence, desistance, or regret in their findings. While it remains impossible to state a single “detransition rate” the collected studies provide a good way of thinking about the range of possibilities, from stopping treatment and restarting, to stopping/losing care due to insurance issues or an overly great travel distance to the clinic, to patients who stop because they now identify with their birth gender.
Many mainstream media have misreported this data in ways that overstate the prevalence of detransition and misconstrue it as being synonymous with regret and re-identification with birth sex.
Here, the authors state in the conclusion section, “With regards to any misgivings that stakeholders may have about allowing pediatric patients to receive pharmacologic (and frequently surgical) treatments over concerns about future regret, we found (based on the N=32 studies) that there is virtually no regret associated with receiving the treatments, even in the very small percentages of patients who ultimately discontinued them. Reasons for discontinuing GAHT are varied, but changed minds about gender identities is only a very minor proportion overall.”
A Truly Independent Review?
Unlike the highly publicized Cass Review, which was released in the UK in 2024, the Utah review is low on opinion and high on reviewing the evidence. In the places where it does state some of the authors’ conclusions, such as on pages 116-118, it hews closely to what was found in the literature. This stands in contrast with the Cass Review, which opined on a wide variety of topics, from the cause of trans identity to the use of pornography, often departing widely from the evidence base to do so. A recent HHS Review, ordered by the Trump administration, did much the same, but with even less rigor.
This more data-driven approach may be due to the nature of the DRRC and, by extension, the report’s authors. The opposite of high-profile, the Center is described on its website as a longstanding partner of the Utah State Department of Health with a focus on reducing costs associated with prescription drugs for Medicaid patients. The Center has no apparent connection to transgender health care, but it does have more than 20 years of experience evaluating prescription drugs and their evidence base.
Mainstream Media Silence
In contrast to the Cass Report and Trump’s HHS document, no national mainstream media organizations have run stories on the Utah evidence review as of this reporting. Major politicians who sponsored Utah’s ban on youth gender medicine (and commissioned this report) seem inclined to ignore it, according to reporting by the Salt Lake Tribune. As a political document, this review may make few waves due to its inconvenient conclusions, which would seem to go against the grain of popular opinion and conventional wisdom, not to mention mainstream media sentiment.
For those whose primary interest lies in the actual evidence on gender-affirming care and best practices for treating young people with gender dysphoria, however, the comprehensive nature of this review may well make it an essential reference for quickly finding, comparing, and evaluating the many studies on youth gender medicine that were published between 2010 and 2023.
Evan Urquhart is the founder of Assigned Media.