Return to Scenario ListShow Learning Points most relevant to Phase 1:

Trans- and Gender Diverse Health

Clinical Discipline(s)/Organ System(s)
Endocrinology, General Practice, Paediatrics, Reproduction & Development
Progress Test Topic(s)
A mother presents to the family doctor with her 14 year old adolescent. They have come out to the whanau as being transgender and has asked to be known by a different name. Mother reports they are really struggling with menstruation and her teenager wants to start testosterone.  The adolescent was assigned female at birth). Mother reports they have dressed as a boy since very young, wearing their hair short and has often told their family they really are a boy. The family have been happy for their child to express themselves in a masculine way at home but they are known as a girl at their co-educational school.


The young adult and their mother want advice and direction.

Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Fetal medicine and anatomy of development of reproductive organs
   - Endocrinology of puberty
   - Cognitive changes associated with puberty
Clinical and Communication Skills 
   - Taking a history from caregiver and from young person (HEADSS assessment)
   - Seeing young person alone as a healthcare professional
   - Understand and recognise distress that arises from incongruence between a person’s gender identity and their sex assigned at birth (gender dysphoria).
   - Use of appropriate terminology in talking with and about trans-children, young people and adults
   - Use of respectful and affirming language
   - Starting pathway of supportive exploration of the child’s gender identity over time including assessment of family support, dynamics and functioning.
   - Developmental assessment including obtaining educational history and social functioning (HEADSS assessment).
   - Assessment/detection of any co-existing mental health difficulties
   - Knowing the clinically relevant education and referral pathways including to secondary and tertiary services for child with gender dysphoria to a paediatrician or paediatric endocrinologist experienced in the care of trans and gender diverse adolescents for medical assessment (ideally prior to the onset of puberty).
   - Inquiring about preferred name and pronoun during consultations
Personal and Professional Skills 
   - Understanding own bias
Hauora Māori 
   - Understand the difficulties in accessing trans and gender diverse healthcare can be more vulnerable in culturally and linguistically diverse groups including Māori
Population Health 
   - Understand frequency (NZ Youth health survey 2012 estimated that approximately 1.2% of adolescents identify as transgender)
   - Associated health risks for marginalised group (mental health, sexual violence, discrimination and difficulty accessing health care)
Conditions to be considered relating to this scenario
Resources (Guidelines for gender affirming health care for gender diverse children , young people, and adults in Aotearoa New Zealand OLIPHANT j et al)

Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents ( RCH Melbourne clinical guidelines)