Finding a Voice: A Guide to Gender Affirming Voice and Communication Training

May 18, 2020 

The way people communicate with others can affect how they see themselves and how they are perceived by others. For some transgender individuals, the sound of their voice can be an issue of discomfort if it does not align with their gender identity and gender expression.

Speech language pathologists (SLPs) specializing in gender affirming voice and communication training can help these individuals find their voice by addressing factors such as pitch and communication style. Additionally, by utilizing the help of a professional, transgender individuals can maintain their vocal health and avoid injury as they develop their vocal and communication skills.

Glossary of Terms

Dysphonia

A voice quality that leads an individual to sound strained, tremorous, weak or rough.

Gender Affirmation

The process through which a person’s gender identity and gender expression are recognized and supported.

Gender Dysphoria

A diagnosis for individuals who experience significant distress or problems functioning due to an incongruence between their gender assigned at birth and their gender identity.

Gender Expression

The external presentation of someone’s gender. Signifiers of gender expression can include clothing, hairstyle, pronouns, voice, behaviors and other factors.

Gender Identity

A person’s internal sense of their true gender.

Gender Nonconforming

A person whose gender expression is not confined to the typical expectations of masculine or feminine. Someone who is gender nonconforming is not necessarily transgender, and the term is only applied to people who self-identify as such.

Non-Binary

When gender identity or expression do not fit entirely into the categories of man or woman. This term only applies to people who self-identify with it.

Non-Verbal Communication Skills

Cues that do not involve speech, such as eye contact, hand gestures and body language.

Transgender

Individuals whose gender identity or gender expression do not align with what is typically associated with the sex they were assigned at birth.

Transgender Man

Someone whose gender identity is male but who was assigned female at birth.

Transgender Woman

Someone whose gender identity is female but who was assigned male at birth.

Transition

The process of aligning one’s gender expression with their gender identity. This can include changing one’s name and pronouns, dressing differently, hormone therapy and surgery.

Verbal Communication Skills

The use of sounds and words to express one’s self, which can include aspects such as language choice and communication patterns.

Voice Feminization

Training to help transgender women adapt their voices and communication patterns.

Voice Masculinization

Training to help transgender men adapt their voices and communication patterns.

Sources:

What Is Gender Affirming Voice Training?

The way a person speaks can play an important role in how they express themselves. Voice and communication training can be helpful when aspects of a person’s voice and the way they speak do not match their gender identity or gender expression, according to the American Speech-Language-Hearing Association’s (ASHA) resource on voice and communication services for transgender and gender diverse populations.

This can include individuals who identify as transgender, non-binary, gender nonconforming or other gender identities.

Among transgender people, transgender women are more likely to seek gender affirming voice and communication training. According to The Report of the 2015 U.S. Transgender Survey (PDF, 2.2 MB), voice treatment is the second most common intervention for transgender individuals assigned male at birth.

Cynthia Simonetti, MA, CCC-SLP, a speech language pathologist based in Santa Fe, New Mexico, explained that this is because transgender men who undergo hormone therapy experience a thickening of their vocal folds over time, resulting in a deeper pitch. Conversely, transgender women do not experience a change in their voice when undergoing hormone therapy. However, pitch is not the only factor in how a person’s communication style is perceived.

“Transgender men can still benefit from voice training because it’s not all about pitch,” Simonetti explained. “There are other components that help someone’s voice and communication style be more consistent with their gender identity.”

Gender affirming voice and communication training can play an important role in a person’s transition process. According to a study on the perception of voice in transgender individuals, a voice that is incongruent with gender identity can negatively affect quality of life, in addition to attracting unwanted attention and threatening safety.

Speech language pathologists (SLPs) with training in gender affirming voice and communication training can help patients safely modify their voice and communication behaviors. This can include verbal and nonverbal communication, such as vocal pitch, intonation, voice quality, resonance, fluency, articulation, pragmatics and vocalization (e.g., laughing), according to ASHA’s resource on voice and communication services for transgender and gender diverse populations.

According to Simonetti, gender affirming voice and communication training allows an individual to choose which aspects of their voice and communication skills they want to alter to align with their identity.

“The world isn’t always so welcoming, and when I ask [transgender clients] what they want [to work on], sometimes they don’t know. They have to be able to ‘try it on’ in a safe place.”

– Cynthia Simonetti, Speech Language Pathologist

In addition to receiving this guidance and support from an SLP, individuals can benefit from learning safe and healthy ways to alter elements of their voice.

According to an article on voice and communication change for transgender individuals (PDF, 586 KB), “modifying habitual pitch, adopting unfamiliar articulatory postures or producing the voice in nonhabitual ways can be fatiguing and potentially damaging.”

The authors explain that straining the voice by using unhealthy techniques can lead to problems such as vocal fatigue and dysphonia — an impairment of the voice that causes difficulty when speaking.

“As a speech pathologist, I will not help somebody adopt an unhealthy or potentially dangerous vocal behavior if I feel like it could do them harm,” Simonetti said.

What to Expect From Your First Transgender Voice Therapy Visit

When setting up a first session with an SLP for gender affirming voice and communication training, individuals can expect to first go through a comprehensive case history to guide treatment, according to Simonetti.

Step by Step: Voice and Communication Training Assessment

As an SLP with expertise in gender affirming voice and communication training, Simonetti explained the steps she takes with clients during a first visit:

Step 1: Oral-Motor Examination

This exam informs the SLP of how the muscles of the face, mouth and throat are working and if there is any weakness or decreased coordination of those muscles. “Ninety-nine percent of our clients have no issues, but [an SLP will] want to make sure of that,” Simonetti said.  

Step 2: Voice Evaluation

The next step is to look at the current state of a person’s voice by evaluating factors that include respiration, or the power behind a person’s voice, as well as habitual pitch and pitch range, resonance, vocal quality, articulation, intonation and intensity.

Step 3: Assess Communication Skills

The SLP will look at current verbal and non-verbal behaviors the client exhibits during conversation. This allows the SLP to help the client identify which aspects they would like to change. 

Step 4: Identify Goals

The final step is to discuss what success looks like for the client in regard to voice and communication training. This conversation helps the SLP create a plan for future sessions that is personalized to the needs of the client.

How to Access Transgender Voice Training

When looking for an SLP for voice coaching and communication training, Simonetti emphasized the importance of finding a professional who has experience working with transgender clients and related vocal exercises. There are a number of resources and directories for finding an SLP.

Voice and Speech Trainers Association (VASTA): Provider Index

VASTA provides an index of its members organized by location. After choosing your state of residence, the index will provide a list of voice coaches and professionals that includes their areas of specialty.

World Professional Association for Transgender Health (WPATH) Provider Directory

WPATH’s online directory includes professionals across all areas of transgender health. The website allows you to search by location and specialty to find potential providers in your area. 

ASHA: Find a Speech Language Pathologist 

ASHA’s ProFind tool allows you to search for speech therapists based on a variety of filters, including type of provider, state/region, ages treated, areas of expertise and languages spoken.

When seeking gender affirming voice and communication training, it is also important to research whether an insurance provider will cover such services.

According to the National Center for Transgender Equality, federal and state laws prohibit most private and public health insurance providers from refusing to cover care related to transition-related care. However, Simonetti still advises individuals to seek information on what requirements are needed to qualify for coverage.

In many cases, services such as voice and communication training may be covered if the individual has been formally diagnosed with gender dysphoria, according to an ASHA resource on insurance for transgender individuals.

Transgender Voice Therapy Resources for Further Reading

Health Coverage Guide — National Center for Transgender Equality

NCTE provides a comprehensive guide on how to seek health care coverage for transgender people. This resource can help individuals learn their rights and advocate for access to care across all areas of health.

Voice and Communication Services for Transgender and Gender Diverse Populations — ASHA

This resource from ASHA provides an overview of gender affirming voice and communication training services, including the roles and responsibilities of a speech language pathologist, what voice training services cover and other helpful information for anyone who is new to the topic. 

Resources for Transgender People — GLAAD

This resource list from GLAAD includes a variety of tools for transgender and gender nonconforming individuals, as well as their families, friends and allies. The list also includes other organizations that provide support to the transgender population.

Gender Affirmation Nonsurgical Services — John Hopkins Medicine

The transition process looks different for every individual. This information page from John Hopkins Medicine highlights nonsurgical services, rather than transgender voice surgery, related to gender affirmation as part of its holistic approach to transgender health care. 

Legal Disclaimer: Please note that this article is for informational purposes only. Individuals should consult their health care provider before following any of the information.