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Conducting Gender-Affirming Hormone Evaluations for Adults Using the Informed Consent Model

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1.  Which of the following are NOT WPATH SOC 8 guidelines for establishing readiness for gender-affirming hormone therapy?
  1. explore impact on reproduction and reproductive options
  2. diagnose gender incongruence
  3. establish capacity for consent
  4. ensure all comorbid mental health concerns are being concurrently treated
2.  Which of the following is an irreversible effect of testosterone therapy
  1. body fat redistribution
  2. deepening voice
  3. increased muscle mass
  4. skin oiliness and acne
3.  What is a substance use concern for individuals who want to start estrogen therapy?
  1. cigarettes
  2. alcohol
  3. cannabis edibles
  4. psilocybin
4.  How would you go about using the informed consent model to evaluate readiness for testosterone therapy in a patient who has psychosis?
  1. Distinguish gender incongruence from other mental health diagnoses; once the patient is diagnosed with gender incongruence, go ahead and approve readiness for testosterone therapy.
  2. Distinguish gender incongruence from other mental health diagnoses, establish capacity to consent, and ensure that the patient first is engaged in treatment for psychosis prior to approving testosterone therapy.
  3. Patients with active psychosis should not be taking testosterone therapy as psychosis is a contraindication for testosterone therapy.
  4. Distinguish gender incongruence from other mental health diagnoses, establish capacity to consent, and discuss any negative impacts that testosterone might have on the patient’s mental health.
5.  How would you go about discussing reproduction with a patient starting estrogen and testosterone blockers?
  1. Discuss the possible irreversible impact of hormones on fertility and explore reproductive options such as fertility preservation.
  2. Explain that hormones nearly always cause infertility and explore reproductive options such as fertility preservation.
  3. Discuss the possible irreversible impact of hormones on fertility, explain that hormones can be used as an effective method of birth control, and explore reproductive options such as fertility preservation.
  4. Discuss the irreversible impact of hormones and fertility and explain that the best practice is to wait to start hormones after having children.
6.  Which of the following criteria of gender incongruence must be met before recommending hormone therapy?
  1. The experience of gender incongruence must begin prior to 18 years of age.
  2. The experience of gender incongruence must be accompanied by disclosure of one’s transgender or gender diverse identity.
  3. The experience of gender incongruence must be marked and sustained.
  4. The experience of gender incongruence must be accompanied by severe levels of distress.
7.  What is the best course of action when evaluating a patient with cardiovascular disease who wants to begin estrogen therapy?
  1. Ensure that the patient’s cardiovascular disease is being managed by a medical provider prior to initiating the hormone readiness evaluation.
  2. Discuss risks and benefits of hormone therapy with the patient; once consent is provided, approve the hormone therapy from a mental health perspective and refer to the endocrinologist for further assessment.
  3. Explain to the patient that estrogen therapy is contraindicated for individuals with cardiovascular problems and explore alternate methods of gender transition.
  4. Diagnose gender incongruence, establish capacity consent, and do not discuss the medical implications of hormone therapy with the patient as this is beyond psychologists’ scope of practice.
8.  When a diagnosis is required for access to care, what is the recommended diagnosis to use per WPATH SOC 8?
  1. DSM-V, Gender Incongruence
  2. DSM-V, Gender Dysphoria
  3. ICD-10, Gender Dysphoria
  4. ICD-11, Gender Incongruence
9.  In which of the following scenarios might a psychologist want to discuss the role of social transition with a patient prior to initiation of hormone therapy?
  1. A patient wants to start testosterone therapy and does not plan on telling their partner.
  2. A non-binary patient wants to start feminizing hormones but does not want to change their name, pronouns, or gender expression.
  3. A patient wants to pursue top surgery but is not interested in hormone therapy.
  4. A patient is starting testosterone therapy and has come out to their family.
10.  According to WPATH SOC 8, who can recommend a patient for hormone therapy and how many recommendations are needed?
  1. Two recommendations are needed from any professionals who have competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.
  2. Two recommendations are needed, one from a medical professional and one from a mental health professional who have competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.
  3. One recommendation is needed from any healthcare professional who has competencies in the assessment of transgender and gender diverse people wishing gender related medical and surgical treatment.
  4. One recommendation is needed from a mental health professional who has competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.

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