Whole tool
NICE NG197
Shared decision making (2021). Collaborative process, balanced options, support to ask questions.
About
A patient-centred tool with a clinical spine.
gendr is an independent, non-profit resource. It is built by clinicians and people with lived experience, to NICE shared-decision-making standards, for adults waiting for NHS gender services in the UK.
What gendr does
gendr is a self-paced companion for the period between referral to an NHS adult Gender Identity Clinic and your first appointment. It walks through eight steps, orientation, referral and waiting, assessment, social transition, hormones, fertility, surgery, and lifelong health, and at each step it helps you understand the choices, clarify what matters to you, and prepare your own questions.
It does not assess, diagnose, recommend, or steer.
Who it is for
Adults (18+) in the UK who have been referred to, or are considering referral to, an NHS Gender Identity Clinic. The content also serves partners, family members, and clinicians who want a current, balanced overview of the adult pathway.
It is not for children or young people. Under-18 services follow a separate clinical framework which is out of scope.
Method
Built on a clear shared-decision-making spine.
Three established frameworks operate at three different scales, they don't compete, they nest.
Each step
Three-Talk model
Team talk → option talk → decision talk (Elwyn et al., BMJ 2017). The architecture of every page.
Each decision
BRAN
Benefits, Risks, Alternatives, do Nothing, the portable script for your appointments.
Content development follows the International Patient Decision Aid Standards (IPDAS) and is designed to be assessable against NICE's standards framework for shared-decision-making support tools (ECD8, 2021). See the clinical brief for the conformance checklist.
Principles
What we won't compromise on.
Non-directive and balanced
Every option, including waiting, declining, or stopping, gets equal care and depth. The tool's authors never tell you what to do.
Honest about uncertainty
The adult evidence base is largely observational and rated low-to-moderate certainty. We say so, and we show the ranges, not the headline.
Autonomy with safeguarding
You are the expert on your own life. A crisis-support route is always one tap away. We never delay signposting to wait for a feature.
Identity humility
We don't assume a binary destination, a single narrative, or a single right answer. Non-binary and individualised goals are treated as ordinary.
Plain language
Target reading age 9–11, defined terms, natural frequencies for numbers, no jargon without an explanation in line.
A living document
Every page is dated and versioned. We revise when the NHS England adult specification, RCPsych guidance, or the EHRC guidance changes.
Privacy
Your notes stay on your device.
gendr is designed so your reflections, values, and questions are local to your browser. Nothing is sent to a server by default. You can export a printed copy for your appointment, and you can delete everything with one click on the My notes page.
We treat gender history and health information as the special-category data they are under UK GDPR and the Data Protection Act 2018. We apply data-protection-by-design: a clear lawful basis, data minimisation, transparency, security, and adherence to the Caldicott principles. A Data Protection Impact Assessment is maintained for the tool. If we ever introduce a feature that shares data with a clinical team, it will be opt-in, revocable, and clearly explained at the point of capture.
The site uses no third-party analytics or advertising trackers. The fonts are loaded from Google Fonts; if you would like a version without that dependency, contact us.
Accessibility
Designed to meet WCAG 2.2 AA.
The site is keyboard navigable, supports screen readers, respects "reduce motion" preferences, never conveys information by colour alone, and uses text contrast that meets WCAG 2.2 AA at minimum. The base reading age is around 9–11. Printable, offline-friendly versions of each step are available from the step's footer.
If something isn't working for you, please tell us. We treat accessibility issues as bugs to fix, not feature requests.
Partners and sponsors
How gendr is funded.
gendr is an independent, non-profit project. We accept tasteful, clearly identified sponsorship from organisations whose work is consistent with our principles, trans-inclusive primary, sexual, mental and gender-affirming healthcare; lived-experience advocacy; and academic or NHS partners. Sponsors appear in a single line at the foot of the site and have no editorial influence on the content of the tool.
If your organisation would like to support gendr, or fund a specific module (for example, fertility content or sexual-health resources), please get in touch. We publish a transparency note for every supporter.
A note on what this is not
gendr is not a clinical service and not a substitute for one. It does not diagnose, prescribe, or provide consent for treatment. If you are in crisis or need urgent help, please contact your GP, NHS 111, the Samaritans on 116 123, or 999 in an emergency.