gendr

For clinicians and commissioners

The clinical brief.

gendr is a patient decision-support tool for adults referred to NHS Gender Identity Clinics. It is designed to be methodologically defensible, clinically conservative, and useful in clinic, not a workaround for it.

Purpose

gendr serves adults (18+) in the period between referral to an NHS Gender Identity Clinic and first specialist appointment. Its aims are to reduce decisional conflict, improve preparation, support autonomy, and create a structured "waiting well" experience without substituting for clinical assessment, diagnosis, or prescribing.

It is non-directive: every realistic option, including the option to wait, defer, or decline, is presented with equal care.

Out of scope

  • Children and young people's services
  • Clinical assessment, diagnosis, or treatment recommendations
  • Prescribing, monitoring, or care coordination
  • Mental-health crisis triage (routed directly to NHS / Samaritans / 999)

Methodology

The spine.

Three established frameworks at three scales, they don't compete, they nest.

Whole tool

NICE NG197 (2021)

Shared decision making. The collaborative process, balanced options, support to ask questions, and explicit reference to BRAN as a patient-facing structure.

Each step

Three-Talk model

Elwyn et al. (BMJ 2017). Team talk → option talk → decision talk. The architecture of every page in the tool.

Each decision

BRAN

Benefits, Risks, Alternatives, Nothing. A portable script the patient takes from the tool into clinic.

Conformance

How gendr maps to IPDAS and NICE ECD8.

The tool has been designed against the International Patient Decision Aid Standards (IPDAS) qualifying criteria and against NICE's standards framework for shared-decision-making support tools (ECD8, 2021). A summary follows; a full conformance log is maintained as part of the development documentation.

IPDAS qualifying criteria

  • Describes the health condition or problem in plain language ✓
  • Explicitly states the decision under consideration ✓
  • Describes options available, including doing nothing ✓
  • Describes positive and negative features of options with equal detail ✓
  • Shows positive and negative features in equal weight and format ✓
  • Uses methods to clarify and express patients' values ✓
  • Information is up to date, with revision dates and review intervals ✓
  • Author / funder disclosure ✓

NICE ECD8 essentials

  • Suitable for use in a healthcare context, with clinician partnership ✓
  • Transparent about evidence base and uncertainty ✓
  • Supports, does not replace, the consultation ✓
  • Designed for patient autonomy, including option to defer or decline ✓
  • Accessible language and accessible technical implementation (WCAG 2.2 AA) ✓
  • Defined governance, review and revision schedule ✓
  • Defined safeguarding routes for crisis and risk ✓

Content development

How the content was built, in five layers.

  1. Research dossier. A structured review covering: NHS England adult service specification and the Levy Review (2025); UK College guidance (RCPsych PS02/18, GMC); WPATH SOC-8 (international comparison); current evidence on adult outcomes; the UK legal framework (Equality Act 2010 post-2025 Supreme Court ruling on the meaning of sex, Gender Recognition Act 2004, Mental Capacity Act 2005, UK GDPR / DPA 2018).
  2. Methodological spine. NICE NG197 + Three-Talk + BRAN, with eight design principles, IPDAS qualifying-criteria mapping, NICE ECD8 conformance checklist, risk-communication rules (natural frequencies, both numerators), a reusable values-clarification component, defined safeguarding routes, and a review-triggers schedule.
  3. Eight-step pathway. Each step is built to a consistent template: purpose, three-talk position, learning objectives, option talk (balanced, four options including "wait"), BRAN, values clarification, reflection, captured/shared outputs, safeguarding, signposting.
  4. Patient-facing build. A self-paced static site (the present implementation), with local-only progress storage, summary export, and accessible design.
  5. Review and iteration. Content is dated and versioned. Triggers for review include: changes to NHS England service specifications; new RCPsych or NICE guidance; significant published reviews; and lived-experience feedback.

Honesty about evidence

What we say where the evidence is uncertain.

Most of the evidence base on adult gender-affirming care is observational. Systematic reviews suggest meaningful improvements in dysphoria, depression, and quality of life for many adults, with no substantive long-term harms identified in the published literature, but the certainty of the evidence is rated low to moderate. gendr does not paper over this. Where ranges exist, we give them. Where a number is contested, we say it is.

This stance follows GMC Good Medical Practice on truthful information-sharing, NICE NG197 on representing uncertainty honestly, and the principle of informed consent.

Governance

Independence, transparency, and review.

Independence

gendr is independent and not affiliated with the NHS. Funders and sponsors have no editorial influence on content.

Conflicts of interest

Editorial team conflicts are declared on a per-page basis where relevant. Sponsor relationships are disclosed in the footer and on the Partners page.

Data protection

No personal data is collected by default. Progress data is stored locally in the user's browser. A DPIA is maintained.

Review schedule

Content reviewed every six months, or sooner on a trigger (new NHS specification, new RCPsych/NICE guidance, major published review).

Get in touch, clinicians and commissioners

If you'd like the full development documentation (research dossier, spine and pathway specification, conformance log), to propose a clinical-collaboration arrangement, or to raise a content concern, please contact us. We respond to clinical correspondence within five working days.