top of page

Transforming Voice and Communication with Transgender and Gender-Diverse People: An Evidence-Based Process
by Adrienne Hancock and Linda Siegfriedt

Cultural awareness for SLP service providers

Trans 101.  There are 4 videos in this series (each about 4 minutes). Start here:

“They/them pronouns”

“A Guide for being Inclusive of Transgender”

Trans-Inclusive Environments

“Making Primary Care Trans-Friendly” (The Atlantic, 2017)

“LGBTQ Inclusive Curriculum and Classroom Climate” Center for Ethics Education at Fordham Univ (a Jesuit, Catholic university)

“It’s Pronounced Metrosexual” is a comedy show and online resource about snap judgments, identity, and oppression. It’s a site where advocates of social justice can find helpful articles, fun graphics, and other resources designed to be shared in an effort to advance social equity. The show is performed by Sam Killermann, who is the Director of Creativity for hues.”

Clinical information for SLP service providers

Evidence-Based Practice (EBP) standards are improving each year. There are several peer-reviewed publications; the most comprehensive and recent summary of them all is:

Davies, S., Papp, V., & Antoni, C. (online 2015). Voice and communication change for gender nonconforming individuals: Giving voice to the person inside. International Journal of Transgenderism, 16(3), 117-159.

available online here:

FAQs about Transgender Voice Modification and Training

What is a speech-language pathologist?

A speech-language pathologist (SLP) is a licensed, certified professional with expertise in speech, language, social communication, cognitive-communication, voice, and swallowing function in children and adults.

What is transgender voice training/therapy?

Transgender voice therapy (sometimes called “training” to de-pathologize, sometimes called “therapy” to qualify for insurance coverage and be recognized by populations at large) involves a series of exercises typically aimed at making the voice more feminine- or more masculine-sounding, depending on the needs and desires of the individual. One important factor that distinguishes a typical cisgender female voice from a typical cisgender male voice is pitch, which is how high or low the voice sounds. Voice therapy can help change a person’s pitch without damaging their voice. Breath support, resonance and intonation are also important areas of focus in voice therapy. Resonance is the “buzz” or vibrations in the mouth as we speak. Voices perceived as feminine typically vibrate more toward the front of the mouth than voices perceived as masculine, even though a healthy voice for any person will have some “buzz” feeling in the front area. Intonation and volume contribute to the “melody” of the voice, and influence the unique sound of each person’s communication. The culturally and clinically competent SLP guides the individual to modify and habituate new speech in everyday communication.

What can I expect from therapy sessions?

The SLP begins the first session by getting to know the individual and their specific goals related to voice and communication. The SLP will assess the voice abilities of the client and how the client feels about their voice. Then the SLP will guide the client through a series of exercises involving breath support, relaxation, pitch, resonance, and intonation to work toward the desired-sounding voice. Many of these exercises can be done for practice between sessions. The amount of time voice change will take depends on a number of factors, such as how often you use your new voice, the pitch and quality of your starting voice, and how often you come to therapy.

Can I just change my voice on my own?

It is not recommended that individuals attempt to change their voice without at least an evaluation or consultation by a speech-language pathologist. Without proper guidance, permanent damage to the voice could result. As with any physical change or exercise, starting with a healthy system and having professional guidance can prevent injury and optimize success.

What if I don’t identify as masculine or feminine?

Voice therapy services are available to the full spectrum of gender identification, including queer, non-binary, and gender nonconforming.

Why are most voice therapy clients transwomen?

Most voice therapy clients tend to be transwomen because hormone therapy (testosterone) usually deepens transmen’s voices, but hormone therapy for transwomen (estrogen) does not affect the voice very much. Therefore, transwomen find voice therapy helpful in achieving their desired more feminine-sounding voice. However, voice therapy is available to transmen who want a more masculine voice than the one achieved through testosterone alone. There is growing evidence that the effects of testosterone vary and voice changes are not totally unproblematic for transmen.

Can I get surgery to change my voice?

Some people choose to have surgery to change the pitch of their voice. There are a few types of surgeries that can do this, and they are performed by laryngologists. Research shows these surgeries to be particularly effective when combined with voice therapy.

*Special thanks to Kristen Davis, Alyssa Giegerich, and Sara Griffiths for assistance composing these answers

bottom of page