It varies in practice. Most people I see using identify, including many trans people, are well-intentioned and think it's the preferred polite language without thinking too hard on the implications of it.
However there are definitely anti-trans people who will use it pejoratively, which I presume is where that wording originated.
When I was on it I found it helped with distraction, but not task initiation, and the various dosages made no difference. Given that and some of the side effects I ended up going off it.
Guanfacine handled the task initiation for me, but not the distraction.
This is called the "bus rule" around here, you don't sit beside someone if there's a still a set of seats you can have to yourself.
I'd be more worried if they did sit beside you, as that'd be considered a bit creepy.
It's either my alarm clock or 5.1 speakers, both of which would be somewhere over 20 years old.