Tackling Gender Dysphoria in PLAB 2: A Guide to Compassionate and Competent Adolescent Care

Summary:

This station involves a consultation with an adolescent experiencing gender dysphoria. The scenario primarily tests the candidate’s ability to handle sensitive psychological and social issues, explore the patient’s concerns empathetically, and provide a well-structured, supportive management plan.

Key Points:

Psychosocial Assessment and Data Gathering

• Explore psychosocial aspects thoroughly including school, peer relationships, and support systems.

• Identify any distressing emotions such as anxiety, depression, or suicidal ideation.

• Ask questions to assess the degree of body image concerns and gender dysphoria.

• Clarify if patient is biologically female and explore any past or ongoing gender identity-related issues.

Associated Conditions & Red Flags

• Rule out possible associated conditions such as:

  • PCOS (which can cause androgenic symptoms)

  • Depression or other psychiatric conditions

  • Eating disorders

• Assess for red flags like:

  • Self-harm or suicidal thoughts

  • Abuse or bullying

  • Social withdrawal

Important Considerations:

• Always respect the patient’s expressed gender identity and pronouns.

• Ensure the consultation is inclusive, non-judgmental, and patient-centered.

• Avoid assumptions; allow the patient to express their experiences.

• Ask about menstrual history in biologically female patients to assess for potential endocrine or organic causes.

• Incorporate the patient's own concerns (e.g., issues at school or with friends) into your management plan.

Diagnostic Approach:

1. History Taking:

   • Gender identity and expression

   • Social and emotional wellbeing

   • Family and peer support

   • School performance and relationships

2. Focused Physical Inquiry (if appropriate):

   • Menstrual history

   • Features suggestive of endocrine disorders (e.g., hirsutism, acne)

   • Weight and BMI changes

3. Rule Out Organic Causes:

   • PCOS

   • Thyroid dysfunction

Management:

• Validation and Support:

  • Reassure and validate the patient’s feelings.

  • Acknowledge struggles with identity and social interaction.

• Multidisciplinary Referral:

  • Gender identity development services (e.g., Gender Dysphoria Clinic)

  • CAMHS (Child and Adolescent Mental Health Services)

  • School counselor/social worker if bullying or academic problems present

• Community Resources:

  • LGBTQ+ support groups and foundations (e.g., LGBTQ Foundation)

  • Encourage attending peer support meetings

• Psychological Support:

  • Consider referral to psychological therapy or counseling

  • Safety net for worsening mood or suicidal ideation

• Information and Education:

  • Offer leaflets and discuss what support is available

  • Address concerns about appearance and body image

Communication Skills:

• Maintain a sensitive and empathetic tone throughout.

• Pause and allow the patient to ask questions or express thoughts.

• Reinforce key points from the history during the management discussion.

• Revisit issues the patient raised earlier (e.g., feeling excluded at school) to demonstrate active listening.

• Avoid overly rehearsed phrases; speak naturally and clearly.

Ethical Considerations:

• Ensure confidentiality while being sensitive to the young person's need for support.

• Respect autonomy, even in adolescents—consider Gillick competence if decisions about treatment are involved.

• Avoid making assumptions or stereotyping based on gender presentation.

Additional Resources:

• NHS Gender Identity Development Service (GIDS)

• LGBTQ Foundation UK – Offers mental health and community support

• GMC Good Medical Practice – Domain 2: Patients, Partnership, and Communication​

• PLAB 2 Examiner Tips – Avoid stock phrases, show genuine empathy, prioritize active listening​​