A controversial NHS trial of puberty blockers to youngsters and ask participants whether they see themselves as "two-spirit".
The research project, worth £10.7million and named Pathways, aims to enrol 250 young people between 10 and 15 years old who have received diagnoses of "gender dysphoria".
More than half the participants will receive hormone-suppressing medication that halts their physical development during puberty.
King's College London researchers will conduct the study, which received ethical clearance last week.
The trial is scheduled to start early next year, and will assess the potential advantages and dangers of puberty-blocking treatments for transgender youths.
Young participants will complete a gender identity survey that starts by explaining: "In this measure, gender identity is defined as someone's internal sense of self".
The document asks children to select what "best describes" their gender, offering choices such as "definitely" male or female, "mainly" male or female, "neither a boy or girl", "not sure" and "none of the above".
Participants aged 12 and above face additional questions about "gender identity labels" with options including "two spirit", "agender", "genderqueer" and "other".
PICTURED: Pro-trans protests demonstrate against a 2024 ban on puberty blockers
|GETTY
The term "two spirit" comes from Native Americans, where individuals traditionally embodied both masculine and feminine "spirits" at the same time.
A growing list of medical professionals have raised concerns about the survey's approach to gender identity.
Dr Louise Irvine, a GP and co-chairman of the Clinical Advisory Network on Sex and Gender, said: "It's absolutely ridiculous. It shows that the whole trial is imbued with gender affirmatory ideology.
"What this question will do is reinforce the ideology in the eyes of the children."
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She added: "It will be confusing and most kids won't even know what it means. Questions should also be clear and clearly understood, so the study fails in that respect."
Sue Evans, a psychotherapist who previously worked as a clinical nurse specialist at the former Tavistock children's gender identity service, suggested the inclusion of "two-spirit" indicated that a concept from Native American culture had been "transferred in an ideological way".
The NHS stopped routinely dishing out puberty blockers in March 2024 following a landmark review by paediatrician Dr Hilary Cass, which identified insufficient evidence supporting their effectiveness for treating young people.
Dr Cass was later elevated to the House of Lords for her work.
Dr Hilary Cass was elevated to the House of Lords for her landmark review
| PAPrivate clinics faced an indefinite ban on prescribing these medications from December onwards.
But the Pathways study seeks to address the research gaps in in Dr Cass's evaluation of gender dysphoria treatment for youths.
Researchers will monitor various health impacts of the medications, examining effects on skeletal health, neurological development and psychological wellbeing throughout the trial period.
Legal action against the study remains possible, with opponents warning it exposes minors to unproven treatments that could cause harm.
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