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Background: While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not currently known how alcohol treatment research accounts for sex characteristics and/or gender identities and modalities. This methodological systematic review documents and assesses how sex characteristics, gender identities, and gender modalities are operationalized in alcohol treatment intervention research involving youth. Methods and findings: We searched MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, PsycINFO, CINAHL, LGBT Life, Google Scholar, Web of Science, and grey literature from 2008 to 2023. We included articles that reported genders and/or sexes of participants 30 years of age and under and screened participants using AUDIT, AUDIT-C, or a structured interview using DSM-IV criteria. We limited the inclusion to studies that enrolled participants in alcohol treatment interventions and used a quantitative study design. We provide a narrative overview of the findings. Of 8,019 studies screened for inclusion, 86 articles were included in the review. None of the studies defined, measured, and reported both sex and gender variables accurately. Only 2 studies reported including trans participants. Most of the studies used gender or sex measures as a covariate to control for the effects of sex or gender on the intervention but did not discuss the rationale for or implications of this procedure. Conclusions: Our findings identify that the majority of alcohol treatment intervention research with youth conflate sex and gender factors, including terminologically, conceptually, and methodologically. Based on these findings, we recommend future research in this area define and account for a spectrum of gender modalities, identities, and/or sex characteristics throughout the research life cycle, including during study design, data collection, data analysis, and reporting. It is also imperative that sex and gender variables are used expansively to ensure that intersex and trans youth are meaningfully integrated. Trial registration: Registration: PROSPERO, registration number: CRD42019119408 A.J. Lowik systematically review the consideration and reporting of sex and gender variables in studies of alcohol treatment interventions involving young people. Author summary: Why was this study done?: Both sex and gender are important factors for intervention design, implementation, and evaluation, including with regards to alcohol treatment interventions for young people. However, little is known about how alcohol treatment research accounts for sex and gender factors. What did the researchers do and find?: We systematically searched the peer-reviewed literature to identify alcohol treatment intervention studies that reported genders and/or sexes of participants 30 years of age or younger. Of the 86 articles included in our review, we found that none of them defined, measured, and reported both sex and gender variables accurately. Approximately 37% (n = 32) of the studies defined, measured, and reported either sex or gender accurately. Only 2 studies reported including trans participants. Most of the studies (n = 54) used sex or gender measures to control for their effects on the intervention but did not discuss the implications of this procedure. What do these findings mean?: Our findings identify how the vast majority of alcohol treatment intervention research with youth conflates sex and gender factors, including terminologically, conceptually, and methodologically. To advance sex and gender science in alcohol treatment intervention research, it is essential that researchers clearly articulate why they are choosing to include measures related to sex, gender or both, and to advance study designs and procedures that can account for sex and gender. It is also imperative that sex and gender variables are used in a way that ensures that intersex and trans people are meaningfully integrated so that both research and intervention can address their alcohol-related needs. [ABSTRACT FROM AUTHOR]