Abstract
Background: Two systematic reviews published in Archives of Disease in Childhood (2025) examined gender-affirming hormone therapy and puberty blockers for transgender youth, concluding that evidence shows “very low certainty” and “considerable uncertainty.” These reviews have been cited in policy discussions restricting transgender healthcare access. Objective: To evaluate whether these systematic reviews meet established academic standards for research integrity, methodology, and evidence synthesis. Methods: Comprehensive analysis comparing the Miroshnychenko reviews against independent evidence sources, including a government-commissioned 1,051-page University of Utah report, SciSpace analysis of 40 studies, and documentation of funding sources and organisational affiliations. Assessment of methodology against established systematic review standards and GRADE framework applications. Results: Analysis reveals concerning patterns including significant discrepancies in evidence identification that potentially led to systematic exclusion of available evidence, mischaracterisation of GRADE methodology, coordination with advocacy rganisations, and conclusions contradicted by independent academic assessment. The University of Utah report, commissioned by a conservative legislature, identified hundreds of studies and reached substantially different conclusions using transparent methodology. Five authors, including Gordon Guyatt (founder of evidence-based medicine), publicly disavowed their work in August 2025, stating misuse was “unconscionable.” Conclusions: The Miroshnychenko systematic reviews exhibit multiple characteristics inconsistent with rigorous academic standards, including methodological approaches that resulted in evidence bases not representative of the available literature, methodological irregularities, and coordination with ideologically motivated organisations. Independent academic assessment of the same evidence base reaches markedly different conclusions, raising fundamental questions about research integrity in this domain.