Post Test Multi Choice Questions

Correct! An internal sense of one’s own gender

The outward expression of gender is known gender expression; this is culturally, politically, and socially contextual. Assignment at birth is based on the appearance of the external genitalia. The gender a person is assumed to be is virtually always binary and based on audio-visual clues, for example through voice, hairstyle, and clothing. Gender identity is an internal sense of one’s own gender as being a man, a woman, or a non-binary gender.

Incorrect

The correct answer is: An internal sense of one's own gender

The outward expression of gender is known gender expression; this is culturally, politically, and socially contextual. Assignment at birth is based on the appearance of the external genitalia. The gender a person is assumed to be is virtually always binary and based on audio-visual clues, for example through voice, hairstyle, and clothing. Gender identity is an internal sense of one’s own gender as being a man, a woman, or a non-binary gender.

Incorrect

 The correct answer is: An internal sense of one's own gender

The outward expression of gender is known gender expression; this is culturally, politically, and socially contextual. Assignment at birth is based on the appearance of the external genitalia. The gender a person is assumed to be is virtually always binary and based on audio-visual clues, for example through voice, hairstyle, and clothing. Gender identity is an internal sense of one’s own gender as being a man, a woman, or a non-binary gender.

Incorrect

 The correct answer is: An internal sense of one's own gender

The outward expression of gender is known gender expression; this is culturally, politically, and socially contextual. Assignment at birth is based on the appearance of the external genitalia. The gender a person is assumed to be is virtually always binary and based on audio-visual clues, for example through voice, hairstyle, and clothing. Gender identity is an internal sense of one’s own gender as being a man, a woman, or a non-binary gender.

Incorrect.

The correct answer is Distress or discomfort associated with gender incongruence.

For people with gender incongruence, the changes that come with puberty can often highlight the mismatch between evolving secondary sexual characteristics and gender identity and can be a particularly distressing time for many (but not all) trans people. Gender dysphoria is a broader term to describe distress relating to gender incongruence, as it manifests in a variety of ways, physically, psychologically, or socially. While cross-sex hormone therapy is often vital (and can in some cases be lifesaving), for some individuals, a change of gender role together with a name change can be adequately affirming and reduce distress. This is known as a social transition.

Correct!

For people with gender incongruence, the changes that come with puberty can often highlight the mismatch between evolving secondary sexual characteristics and gender identity and can be a particularly distressing time for many (but not all) trans people. Gender dysphoria is a broader term to describe distress relating to gender incongruence, as it manifests in a variety of ways, physically, psychologically, or socially. While cross-sex hormone therapy is often vital (and can in some cases be lifesaving), for some individuals, a change of gender role together with a name change can be adequately affirming and reduce distress. This is known as a social transition.

Incorrect.

The correct answer is Distress or discomfort associated with gender incongruence.

For people with gender incongruence, the changes that come with puberty can often highlight the mismatch between evolving secondary sexual characteristics and gender identity and can be a particularly distressing time for many (but not all) trans people. Gender dysphoria is a broader term to describe distress relating to gender incongruence, as it manifests in a variety of ways, physically, psychologically, or socially. While cross-sex hormone therapy is often vital (and can in some cases be lifesaving), for some individuals, a change of gender role together with a name change can be adequately affirming and reduce distress. This is known as a social transition

Incorrect.

The correct answer is Distress or discomfort associated with gender incongruence.

For people with gender incongruence, the changes that come with puberty can often highlight the mismatch between evolving secondary sexual characteristics and gender identity and can be a particularly distressing time for many (but not all) trans people. Gender dysphoria is a broader term to describe distress relating to gender incongruence, as it manifests in a variety of ways, physically, psychologically, or socially. While cross-sex hormone therapy is often vital (and can in some cases be lifesaving), for some individuals, a change of gender role together with a name change can be adequately affirming and reduce distress. This is known as a social transition

Incorrect.

The corrext answer is Behaviours and/or presentation that challenge masculine or feminine gender norms

Sex is comprised of multiple biological elements such as chromosomes, genital tract, external genital arrangement, gonads, hormone levels and secondary sexual characteristics, and there is a wide range of intersex diversity in sexual differentiation. People who do not behave and/or present in accordance with established gender norms could consider themselves to be gender non-conforming, and for some, but by no means all, they may also be trans.

Incorrect.

The corrext answer is Behaviours and/or presentation that challenge masculine or feminine gender norms

Sex is comprised of multiple biological elements such as chromosomes, genital tract, external genital arrangement, gonads, hormone levels and secondary sexual characteristics, and there is a wide range of intersex diversity in sexual differentiation. People who do not behave and/or present in accordance with established gender norms could consider themselves to be gender non-conforming, and for some, but by no means all, they may also be trans.

Correct!

Behaviours and/or presentation that challenge masculine or feminine gender norms

Sex is comprised of multiple biological elements such as chromosomes, genital tract, external genital arrangement, gonads, hormone levels and secondary sexual characteristics, and there is a wide range of intersex diversity in sexual differentiation. People who do not behave and/or present in accordance with established gender norms could consider themselves to be gender non-conforming, and for some, but by no means all, they may also be trans.

Incorrect.

The corrext answer is Behaviours and/or presentation that challenge masculine or feminine gender norms

Sex is comprised of multiple biological elements such as chromosomes, genital tract, external genital arrangement, gonads, hormone levels and secondary sexual characteristics, and there is a wide range of intersex diversity in sexual differentiation. People who do not behave and/or present in accordance with established gender norms could consider themselves to be gender non-conforming, and for some, but by no means all, they may also be trans.

Incorrect

The correct answer is All the above

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach.

Incorrect

The correct answer is All the above

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach.

Incorrect

The correct answer is All the above

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach.

Incorrect

The correct answer is All the above

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach.

Correct

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach

Incorrect, the answer is E, all the above

People with a non-binary gender may describe this in a variety of ways. What is vitally important is to take a holistic and individualised approach, following a person’s lead with how they talk about themselves. If clarification is needed about how they were assigned at birth, what anatomy/physiology they have, or what gender affirming medical interventions they have accessed, this should be asked specifically and when medically necessary. Genderfluid, agender and genderqueer are all terms which fall under the non-binary umbrella. As a rule of thumb, it is best practice to ask your patient how they identify, and what pronouns they use. This demonstrates an inclusive and affirmative approach.

Incorrect

The correct answer is, gender-related distress can be misconstrued as behavioural maladaptation

Childhood and adolescence are periods of change and self-discovery, and at a young age, cross-gender play is a common part of gender creativity. There is no robust evidence to support claims that parenting practices cause differences in gender identity. Gender-related distress can be expressed in a variety of ways, particularly when the child or young person is not able to vocalise what it is that they are experiencing. Rejection, stigma, and lack of support for a child wanting to socially transition can result in depression, anxiety, suicidal ideation, and self-harm. While not requiring specialist supervision, support is vital for trans and gender diverse youth to engage and thrive in the school environment.

Incorrect

The correct answer is, gender-related distress can be misconstrued as behavioural maladaptation

Childhood and adolescence are periods of change and self-discovery, and at a young age, cross-gender play is a common part of gender creativity. There is no robust evidence to support claims that parenting practices cause differences in gender identity. Gender-related distress can be expressed in a variety of ways, particularly when the child or young person is not able to vocalise what it is that they are experiencing. Rejection, stigma, and lack of support for a child wanting to socially transition can result in depression, anxiety, suicidal ideation, and self-harm. While not requiring specialist supervision, support is vital for trans and gender diverse youth to engage and thrive in the school environment.

Correct

Childhood and adolescence are periods of change and self-discovery, and at a young age, cross-gender play is a common part of gender creativity. There is no robust evidence to support claims that parenting practices cause differences in gender identity. Gender-related distress can be expressed in a variety of ways, particularly when the child or young person is not able to vocalise what it is that they are experiencing. Rejection, stigma, and lack of support for a child wanting to socially transition can result in depression, anxiety, suicidal ideation, and self-harm. While not requiring specialist supervision, support is vital for trans and gender diverse youth to engage and thrive in the school environment.

Incorrect

The correct answer is, gender-related distress can be misconstrued as behavioural maladaptation

Childhood and adolescence are periods of change and self-discovery, and at a young age, cross-gender play is a common part of gender creativity. There is no robust evidence to support claims that parenting practices cause differences in gender identity. Gender-related distress can be expressed in a variety of ways, particularly when the child or young person is not able to vocalise what it is that they are experiencing. Rejection, stigma, and lack of support for a child wanting to socially transition can result in depression, anxiety, suicidal ideation, and self-harm. While not requiring specialist supervision, support is vital for trans and gender diverse youth to engage and thrive in the school environment.

Incorrect

The correct answer is, gender-related distress can be misconstrued as behavioural maladaptation

Childhood and adolescence are periods of change and self-discovery, and at a young age, cross-gender play is a common part of gender creativity. There is no robust evidence to support claims that parenting practices cause differences in gender identity. Gender-related distress can be expressed in a variety of ways, particularly when the child or young person is not able to vocalise what it is that they are experiencing. Rejection, stigma, and lack of support for a child wanting to socially transition can result in depression, anxiety, suicidal ideation, and self-harm. While not requiring specialist supervision, support is vital for trans and gender diverse youth to engage and thrive in the school environment.

Incorrect

The correct answer is, on the autistic spectrum

Trans people are likely to have the same variety of sexual orientations as cis people, but data pertaining to this is scarce. The same can be said for the prevalence of intersex differences among trans people. Although the evidence base is somewhat limited, clinical impressions suggest that among trans people there is a higher prevalence of autistic spectrum traits. Consider how you might adjust your consultation style to best accommodate your patient’s particular communication needs.

Correct

Trans people are likely to have the same variety of sexual orientations as cis people, but data pertaining to this is scarce. The same can be said for the prevalence of intersex differences among trans people. Although the evidence base is somewhat limited, clinical impressions suggest that among trans people there is a higher prevalence of autistic spectrum traits. Consider how you might adjust your consultation style to best accommodate your patient’s particular communication needs.

Incorrect

The correct answer is, on the autistic spectrum

Trans people are likely to have the same variety of sexual orientations as cis people, but data pertaining to this is scarce. The same can be said for the prevalence of intersex differences among trans people. Although the evidence base is somewhat limited, clinical impressions suggest that among trans people there is a higher prevalence of autistic spectrum traits. Consider how you might adjust your consultation style to best accommodate your patient’s particular communication needs.

Incorrect

The correct answer is, on the autistic spectrum

Trans people are likely to have the same variety of sexual orientations as cis people, but data pertaining to this is scarce. The same can be said for the prevalence of intersex differences among trans people. Although the evidence base is somewhat limited, clinical impressions suggest that among trans people there is a higher prevalence of autistic spectrum traits. Consider how you might adjust your consultation style to best accommodate your patient’s particular communication needs.

Incorrect

The correct answer is, on the autistic spectrum

Trans people are likely to have the same variety of sexual orientations as cis people, but data pertaining to this is scarce. The same can be said for the prevalence of intersex differences among trans people. Although the evidence base is somewhat limited, clinical impressions suggest that among trans people there is a higher prevalence of autistic spectrum traits. Consider how you might adjust your consultation style to best accommodate your patient’s particular communication needs.

Incorrect

The correct answer is, offer referral to the Gender Identity Clinic (GIC) as part the consultation

In this case, as for any distressed patient, it is important to evaluate mental state and identify psychosocial needs. However, in a capacious individual without clinical signs of severe mental illness this should not delay referral to Gender Identity Services.²⁰ Equally, the assertion of a trans identity (or feelings of gender distress or uncertainty) is not indicative of psychosis or impaired capacity. Input from a local psychologist or counsellor can help some people wishing to explore or better understand their gender identity, but this should be directed by the patient, and where desirable a referral could be made in parallel. It is good practice to ask your patient how they would like to be referred to, including what their pronouns are, and whether they would like any notes made on the medical record. Experience of gender incongruence is not limited to childhood. Concealment or denial of a trans identity with delay in request for support is common for several reasons including lack of information, cultural or religious beliefs and practices, risk of financial or social isolation, disapproval of family members (spouse, children, parents, etc), and internalised shame.

Correct

In this case, as for any distressed patient, it is important to evaluate mental state and identify psychosocial needs. However, in a capacious individual without clinical signs of severe mental illness this should not delay referral to Gender Identity Services.²⁰ Equally, the assertion of a trans identity (or feelings of gender distress or uncertainty) is not indicative of psychosis or impaired capacity. Input from a local psychologist or counsellor can help some people wishing to explore or better understand their gender identity, but this should be directed by the patient, and where desirable a referral could be made in parallel. It is good practice to ask your patient how they would like to be referred to, including what their pronouns are, and whether they would like any notes made on the medical record. Experience of gender incongruence is not limited to childhood. Concealment or denial of a trans identity with delay in request for support is common for several reasons including lack of information, cultural or religious beliefs and practices, risk of financial or social isolation, disapproval of family members (spouse, children, parents, etc), and internalised shame.

Incorrect

The correct answer is, offer referral to the Gender Identity Clinic (GIC) as part the consultation

In this case, as for any distressed patient, it is important to evaluate mental state and identify psychosocial needs. However, in a capacious individual without clinical signs of severe mental illness this should not delay referral to Gender Identity Services.²⁰ Equally, the assertion of a trans identity (or feelings of gender distress or uncertainty) is not indicative of psychosis or impaired capacity. Input from a local psychologist or counsellor can help some people wishing to explore or better understand their gender identity, but this should be directed by the patient, and where desirable a referral could be made in parallel. It is good practice to ask your patient how they would like to be referred to, including what their pronouns are, and whether they would like any notes made on the medical record. Experience of gender incongruence is not limited to childhood. Concealment or denial of a trans identity with delay in request for support is common for several reasons including lack of information, cultural or religious beliefs and practices, risk of financial or social isolation, disapproval of family members (spouse, children, parents, etc), and internalised shame.

Incorrect

The correct answer is, offer referral to the Gender Identity Clinic (GIC) as part the consultation

In this case, as for any distressed patient, it is important to evaluate mental state and identify psychosocial needs. However, in a capacious individual without clinical signs of severe mental illness this should not delay referral to Gender Identity Services.²⁰ Equally, the assertion of a trans identity (or feelings of gender distress or uncertainty) is not indicative of psychosis or impaired capacity. Input from a local psychologist or counsellor can help some people wishing to explore or better understand their gender identity, but this should be directed by the patient, and where desirable a referral could be made in parallel. It is good practice to ask your patient how they would like to be referred to, including what their pronouns are, and whether they would like any notes made on the medical record. Experience of gender incongruence is not limited to childhood. Concealment or denial of a trans identity with delay in request for support is common for several reasons including lack of information, cultural or religious beliefs and practices, risk of financial or social isolation, disapproval of family members (spouse, children, parents, etc), and internalised shame.

Incorrect

The correct answer is, propose she provide a deed poll or statutory declaration, and if not feasible put her request into writing

A patient can change the name, title, and gender marker on their medical record without first having attended a GIC (Gender Identity Clinic) or acquiring a GRC (Gender Recognition Certificate). It is a relatively straightforward process for the patient of proving either a signed letter, Deed Poll or Statutory Declaration.

Incorrect

The correct answer is, propose she provide a deed poll or statutory declaration, and if not feasible put her request into writing

A patient can change the name, title, and gender marker on their medical record without first having attended a GIC (Gender Identity Clinic) or acquiring a GRC (Gender Recognition Certificate). It is a relatively straightforward process for the patient of proving either a signed letter, Deed Poll or Statutory Declaration.

Correct

A patient can change the name, title, and gender marker on their medical record without first having attended a GIC (Gender Identity Clinic) or acquiring a GRC (Gender Recognition Certificate). It is a relatively straightforward process for the patient of proving either a signed letter, Deed Poll or Statutory Declaration.

Incorrect

The correct answer is, propose she provide a deed poll or statutory declaration, and if not feasible put her request into writing

A patient can change the name, title, and gender marker on their medical record without first having attended a GIC (Gender Identity Clinic) or acquiring a GRC (Gender Recognition Certificate). It is a relatively straightforward process for the patient of proving either a signed letter, Deed Poll or Statutory Declaration.

Incorrect

The correct answer is, False

A significant number of trans people transition socially and not via hormonal or surgical routes, thereby not attracting a medical diagnosis. Diagnostic labels of this kind are considered by many in the trans community to be pathologizing, and if consent has not been given could contravene the GRA 2004 in disclosing a patient’s gender history to the phlebotomist, laboratory staff, et cetera. If it is clinically relevant to mention any aspect of the physiology, anatomy, or assignment made at birth of your patient, first seek their permission to do so, explain your rationale for doing so, and ask how they might wish this to be conveyed, for example “HRT monitoring” if reviewing hormone therapy. Applying the correct sex reference range to interpretating results requires consideration of your patient’s unique biological system.

Correct

A significant number of trans people transition socially and not via hormonal or surgical routes, thereby not attracting a medical diagnosis. Diagnostic labels of this kind are considered by many in the trans community to be pathologizing, and if consent has not been given could contravene the GRA 2004 in disclosing a patient’s gender history to the phlebotomist, laboratory staff, et cetera. If it is clinically relevant to mention any aspect of the physiology, anatomy, or assignment made at birth of your patient, first seek their permission to do so, explain your rationale for doing so, and ask how they might wish this to be conveyed, for example “HRT monitoring” if reviewing hormone therapy. Applying the correct sex reference range to interpretating results requires consideration of your patient’s unique biological system.

Incorrect

The correct answer is, all the above

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.

Incorrect

The correct answer is, all the above

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.

Incorrect

The correct answer is, all the above

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.

Incorrect

The correct answer is, all the above

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.

Correct

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.

Incorrect

The correct answer is, all the above

There are no medical grounds for requesting a patient produce a GRC (Gender Recognition Certificate). Exemptions for a disclosure by health professionals and for medical purposes are found under Section 5 of the Gender Recognition Act 2004 and are based on clinical relevance. If a disclosure was found to be in breach of these regulations, it could amount to a criminal prosecution and fine. A GRC is the only mechanism by which a person can change their birth certificate to reflect their acquired gender.