Utah Gov. Spencer Cox (R) ratified legislation in January 2023 prohibiting health care providers from providing sex-altering surgeries or drugs to minors.

The law, which enraged gender ideologues and other non-straight activists, also required the Utah Department of Health and Human Services to conduct a "systematic review of the medical evidence regarding hormonal transgender treatments and provide recommendations to the Legislature."

The HHS' statutorily mandated review, which was completed last year then submitted in May 2025 to the legislature, painted the ruinous trans-drugs — which are also used to sterilize sex offenders — in a positive light, characterizing them as "effective."

According to a damning new report from the medical advocacy group Do No Harm, however, the Utah review — which was conducted on behalf of the HHS by the University of Utah College of Pharmacy's Drug Regimen Review Center — "is filled with falsehoods and serves as an aid to push harmful medical interventions as the answer to minors’ confusion, all while blatantly ignoring the associated risks."

'Utah legislators must not rely on a report that clearly undermines the safety and well-being of minors.'

While the executive summary for the review states that the HHS "does not take a position on whether to lift the moratorium" and the authors were not contracted to include a synthesis of the evidence they came across, the over-1,000-page review nevertheless delivers what is effectively an endorsement of sex-altering drugs for minors:

After having spent many months searching for, reading, and evaluating the available literature, it was impossible for us to avoid drawing some high-level conclusions. Namely, the consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of the body changes consistent with the affirmed gender in pediatric GD patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer.

Do No Harm indicated that the Utah review "deviates from established standards for systematic reviews, emphasizes the volume of evidence over its quality, relies uncritically on guidelines from self-proclaimed experts, neglects significant life-altering adverse effects, and includes input from advisers, some of whom demonstrate bias in favor of 'gender-affirming care' for minors."

RELATED: 'Not medicine — it's malpractice': Trump HHS buries child sex-change regime with damning report

Photo by Kevin Dietsch/Getty Images

Do No Harm noted, for instance, that the review glossed over some of the worst, most life-changing effects of gonadotropin-releasing hormone agonists, known as "puberty blockers," and cross-sex hormones — namely infertility, sterility, and sexual dysfunction. While admitting that "infertility is a known risk," the authors of the review didn't bother including it as an outcome of focus in their report. The risk of sexual dysfunction, meanwhile, was apparently not mentioned once.

Extra to leaning heavily on low-quality scientific literature, much of which was observational and not trial-based, the review may have also been ideologically contaminated. After all, among the advisers who consulted on the project were Nikki Mihalopoulos, chief of the division of adolescent medicine for the department of pediatrics at the University of Utah School of Medicine, and Brooks Keeshin, a professor of pediatrics at the university. Both have written positively about "gender-affirming care" for minors in recent years.

Mihalopoulos co-authored a 2021 paper that stated, "Pediatric health care providers can play a critical role in building solutions in policy and advocacy ... to improve the health of transgender/gender diverse youth. Many government entities, especially at the state and local level, actively resist efforts promoting equal rights."

Keeshin wrote in an article published last year that "as states pass adolescent bans on gender-affirming care across the country, Utah offers a potential pathway forward in restrictive states to help maintain or open access to care." Keeshin also suggested that some adolescents could benefit from radical sex-rejecting medical interventions.

Do No Harm concluded on the basis of these and other issues with the review that Utah lawmakers are better off turning to the U.S. Department of Health and Human Services' thorough and peer-reviewed report, which was released last month.

The federal HHS' report underscored that "the harms from sex-rejecting procedures — including puberty blockers, cross-sex hormones, and surgical operations — are significant, long-term, and too often ignored or inadequately tracked."

Michelle Havrilla, Do No Harm's director of programs, said in a statement, "This Utah Report is unreliable, unscientific, and fails to meet the standards of a systematic review."

"The Report’s inaccuracies and bias diminish its credibility and allow left-wing activists to weaponize it for their political machinations. Utah legislators must not rely on a report that clearly undermines the safety and well-being of minors," added Havrilla.

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