The Role of Speech-Language Pathologists in Transgender Voice Modification Therapy

Few of us really think about it, but our voice is an important part of who we are and what we reveal about ourselves to the world. It is not only the medium by which we communicate, but it is also something that is fundamental to how we express ourselves and establish our identities with others.

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But for the transgender community, a voice that doesn’t correspond with gender expression and identity can be greatly distressing.

However, awareness of transgender rights and the need for proper support for the transgender community has led to a growing number of speech-language services aimed at what is now commonly referred to as voice modification therapy.

Opportunities for Speech-Language Pathologists Specializing in Transgender Voice Modification Therapy

Transgender voice modification therapy dates back to the early 1980s but has garnered significantly more attention in recent years, thanks to public recognition and support for the transgender community. A June 2016 analysis by the UCLA School of Law’s Williams Institute estimates that about 1.4 million adults in the U.S. identify as transgender.

Unfortunately, specialization in transgender voice modification is still largely underrepresented among speech language pathologists (SLPs).

A 2015 study published by the American Journal of Speech-Language Pathology found that just 47 percent of SLPs had completed graduate coursework that addresses transgender communication and voice therapy and just 51 percent of the SLPs surveyed could describe any of the practice components of transgender voice modification therapy.

Another study released by the International Journal of Transgenderism in 2014 revealed that of the 228 SLPs surveyed, just 5 percent had ever worked with a transgender client and a mere 23 percent felt comfortable enough in their knowledge to provide therapies that specifically address voice modification for transgender clients.

Recognizing this competency gap in the professional community, SLPs who might be interested in specializing in this area of practice would be well-positioned to fill an important and growing niche by providing therapies to this underserved group.

Particularly in areas where there are few, if any, clinics that offer specialized transgender voice modification therapy services, SLPs that specialize in this area of practice often offer their services via telepractice.

Balancing the Psychological and Physical Implications of Gender Transition

With many aspects of vocalization and communication being highly relevant to gender identity, many transgender individuals find themselves struggling with the chasm between how they identify and how they sound when interacting with the world. This makes speech-language therapy just as important as hormone therapy and other interventions when making the transition from man to woman or woman to man.

A 2006 International Journal of Transgenderism study found that altering the aspects of voice and communication related to gender can improve mental health and quality of life for those making a transition. SLPs consider the whole person, bringing a unique level of understanding of both the psychological and physiological implications of gender transition, and can provide therapy at any point during transition, or even in the years following.

There is the potential for transgender clients to cause damage to their vocal folds if they try to push out sounds that their voices can’t make, so the work of SLPs in this field also includes identifying any underlying vocal pathologies, educating clients on proper vocal care, and overseeing the process of making gradual and subtle voice changes over time.

Transgender Voice Modification Therapy: Focus Areas, Assessment and Treatment

SLPs examine several aspects of communication when providing voice and communication therapy to transgender clients.

Areas of focus of voice modification therapy include:

  • Articulation
  • Volume and intensity
  • Pitch
  • Intonation and stress patterns
  • Breath support
  • Resonance
  • Speaking rate
  • Language
  • Pragmatics
  • Vocal health

In addition to providing voice therapy services (verbal communication), SLPs working with transgender individuals also often work on the nonverbal aspects of communication, which can include everything from eye contact to facial expressions to physical posturing.

The work of SLPs in transgender voice modification includes:


Before providing services to their transgender clients, SLPs perform an assessment, which involves collecting a case history and medical history and assessing the client’s current voice, language and communication. It is also important for SLPs to recognize if their clients are currently trying to change their voice’s pitch and intensity so they can work to change the behavior to ensure clients avoid damaging their vocal folds.


Treatment of transgender clients is always patient-specific and dependent upon the outcome of the assessment. The voice and communication therapies and techniques provided by SLPs are often provided alongside medical/surgical interventions and hormone therapy.

Voice Feminization – The components of voice production in voice feminization include:

  • Pitch
  • Resonance
  • Intonation

Two common voice therapy techniques in voice feminization include flow phonation, which targets the exertion of airflow during voice production, and resonant voice therapy, which focuses on attaining comfortable phonation while experiencing a vibration of sound in the mouth.

Voice Masculinization – Far fewer transgender males seek voice and communication therapy than transgender females, likely because the desired change in pitch is often achieved through hormone therapy.

Flow phonation and resonant voice therapy are used in voice masculinization therapy. Flow phonation focuses on the balanced exhalation of airflow during talking to achieve a stronger voice, while resonant voice therapy focuses attaining easy phonation while experiencing a vibration of sound in the mouth.

Speech-Language Pathology Practices Specializing in Transgender Voice Modification Therapy

Just some of the many SLP practices in the US that have made transgender voice modification therapy an important part of the specialized services they offer include:

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