Gender-Affirming Voice

  • Sarah L. PenzellEmail author


The field of transgender healthcare is rapidly expanding and evolving in many parts of the world. Medical practitioners and other providers working in transgender and gender-diverse services attempt to keep pace with the needs of those communities. For speech-language pathologists (SLPs), our role is critical in helping individuals align their voices and communication with their gender identity. The increasing demand for voice and communication services obligates our profession to increase the population of SLPs that are comfortable, competent, and prepared to provide services in this burgeoning practice area. This chapter on gender-affirming voice serves as an introduction to a variety of concepts for transgender and gender-expansive voice and communication services and how they may apply to pediatric/adolescent patients.


Gender-affirming voice Transgender healthcare Speech-language and gender-affirming voice Gender terminology The World Professional Association for Transgender Health 


  1. 1.
    Trans101 Gender Diversity Crash Course: website and pamphlet [Internet]. Trans101 gender diversity crash course. Available from:
  2. 2.
    Human Rights Campaign, Glossary of Terms [Internet]. Human rights campaign. Available from:
  3. 3.
    Fisk N. Editorial: gender dysphoria syndrome – the conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen. West J Med. 1974;120(5):386–91.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Knudson G, De Cuypere G, Bockting W. Recommendations for revision of the DSM diagnoses of gender identity disorders: consensus statement of the World Professional Association for Transgender Health. Int J Transgenderism. 2010;12(2):115–8.CrossRefGoogle Scholar
  5. 5.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232. Available from: Scholar
  6. 6.
    Clifford A. Gender identity map, the IMPACT program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University [Internet]. 2014. Available from:
  7. 7.
    Children’s Hospital of Philadelphia. Support for your physical health as transgender youth. [Internet]. 2018. Available from:
  8. 8.
    Bhasin S, Safer J, Tangpricha V. Patient guide to the endocrine treatment of transsexual persons. J Clin Endocrinol Metab. 2009;94(9):0–0. Available from: Scholar
  9. 9.
    Hancock A, Helenius L. Adolescent male-to-female transgender voice and communication therapy. J Commun Disord. 2012;45(5):313–24. Available from: Scholar
  10. 10.
    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ, Spack NP, et al. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54. Available from: Scholar
  11. 11.
    Adler RK, Hirsch S, Mordaunt M. Voice and communication therapy for the transgender/transsexual client: a comprehensive clinical guide. San Diego: Plural Publishing; 2006.Google Scholar
  12. 12.
    Davies S, Goldberg JM. Clinical aspects of transgender speech feminization and masculinization. Int J Transgenderism. 2006;9(3–4):167–96. Available from: Scholar
  13. 13.
    Cohen-Kettenis PT, Pfäfflin F. Transgenderism and intersexuality in childhood and adolescence: making choices. 1st ed. Thousand Oaks: Sage Publications, Inc.; 2003. (Developmental Clinical Psychology and Psychiatry; vol. 46).Google Scholar
  14. 14.
    Hsieh S, Leininger J. Resource list: clinical care programs for gender-nonconforming children and adolescents. Pediatr Ann. 2014;43(6):238–44. Available from: Scholar
  15. 15.
    Davies S, Papp VG, Antoni C. Voice and communication change for gender nonconforming individuals: giving voice to the person inside. Int J Transgenderism. 2015;16(3):117–59. Available from: Scholar
  16. 16.
    Davies S. The evidence behind the practice: a review of WPATH suggested guidelines in transgender voice and communication. Perspect ASHA Spec Interes Groups. 2017;2(10):64. Available from: Scholar
  17. 17.
    Wolfe VI, Ratusnik DL, Smith FH, Northrop G. Intonation and fundamental frequency in male-to-female transsexuals. J Speech Hear Disord. 1990;55(1):43. Available from: Scholar
  18. 18.
    Perez K. Exceptional voice, transgender resources [Internet]. Exceptional voice. Available from:
  19. 19.
    Oates JM, Dacakis G. Speech pathology considerations in the management of transsexualism—a review. Br J Disord Commun. 1983;18(3):139–51.CrossRefGoogle Scholar
  20. 20.
    Owen K, Hancock AB. The role of self- and listener perceptions of femininity in voice therapy. Int J Transgenderism. 2010;12(4):272–84. Available from: Scholar
  21. 21.
    Gorham-Rowan M, Morris R. Aerodynamic analysis of male-to-female transgender voice. J Voice. 2006;20(2):251–62. Available from: Scholar
  22. 22.
    Hancock AB, Garabedian LM. Transgender voice and communication treatment: a retrospective chart review of 25 cases: transgender chart review. Int J Lang Commun Disord. 2013;48(1):54–65. Available from: Scholar
  23. 23.
    Carew L, Dacakis G, Oates J. The effectiveness of oral resonance therapy on the perception of femininity of voice in male-to-female transsexuals. J Voice. 2007;21(5):591–603. Available from: Scholar
  24. 24.
    Gelfer MP, Mikos VA. The relative contributions of speaking fundamental frequency and formant frequencies to gender identification based on isolated vowels. J Voice. 2005;19(4):544–54. Available from: Scholar
  25. 25.
    Hillenbrand JM, Clark MJ. The role of f 0 and formant frequencies in distinguishing the voices of men and women. Atten Percept Psychophys. 2009;71(5):1150–66. Available from: Scholar
  26. 26.
    Hancock A, Colton L, Douglas F. Intonation and gender perception: applications for transgender speakers. J Voice. 2014;28(2):203–9. Available from: Scholar
  27. 27.
    Adler RK, Hirsch S, Mordaunt M. Voice and communication therapy for the transgender/transsexual client: a comprehensive clinical guide. 2nd ed. San Diego: Plural Publishing, Inc.Google Scholar
  28. 28.
    Voice Disorders [Internet]. American Speech-Language-Hearing Association (ASHA). Available from:
  29. 29.
    Dacakis G, Davies S, Oates JM, Douglas JM, Johnston JR. Development and preliminary evaluation of the transsexual voice questionnaire for male-to-female transsexuals. J Voice. 2013;27(3):312–20. Available from: Scholar
  30. 30.
    Andrews ML, Schmidt CP. Gender presentation: perceptual and acoustical analyses of voice. J Voice. 11(3):307–13. Available from: Scholar
  31. 31.
    Kaye J, Bortz MA, Tuomi SK. Evaluation of the effectiveness of voice therapy with a male-to-female transsexual subject. Scand J Logop Phoniatr. 1993;18(2–3):105–9. Available from: Scholar
  32. 32.
    King JB, Jensen DELM, Law M. Transgendered voice: considerations in case history management. Logoped Phoniatr Vocol. 1999;24(1):14–8. Available from:
  33. 33.
    Waller WN, Penzell SL. Be heard for who you are: a seven-week voice/communication program for transgender pediatric clients. Annual meeting of the American Speech, Language, and Hearing Association (ASHA): Philadelphia; 2016.Google Scholar
  34. 34.
    Providing Transgender Voice Services [Internet]. American Speech-Language-Hearing Association (ASHA). Available from:
  35. 35.
    ASHA Code of Ethics [Internet]. American Speech-Language-Hearing Association (ASHA). Available from:

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Center for Audiology, Speech, Language, and Learning, Roxelyn and Richard Pepper Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonUSA

Personalised recommendations