Inclusion & Diversity Patient Care

Gender-affirming voice therapy improves quality of life

photo of Jess MacKimm with patient
Speech-language pathologist Jess MacKimm explains vocal cord function during a patient voice training session.

Washington University offers gender-affirming voice therapy to help transgender and other gender-diverse patients seeking to more closely align their voice with their gender identity.

Many of these patients suffer distress related to the perceived mismatch between their gender identity and biological sex, a condition known as gender dysphoria.

Tailored to meet the needs of the individual patient, treatment for gender dysphoria is offered through the Department of Otolaryngology’s Voice and Airway Center. The multidisciplinary approach can include voice training and surgery, leading to improved mental health and quality of life.

Voice and gender are tightly linked in social identity

Voice and communication are essential components of daily life for all humans and are highly related to gender and culture. Verbal communication in particular is an integral part of personal identity.

head shot of Jess MacKimm
Voice-specialized speech-language pathologist Jess MacKimm

When sex assigned at birth is incorrectly equated with gender identity, individuals may experience incongruence between their socialized voice and speech patterns and their personal identity.

According to WashU voice-specialized speech-language pathologist Jess MacKimm, this incongruence between voice and gender identity may lead to:

  • misalignment between a person’s gender identity and gender presentation
  • safety concerns due to others’ misperception of an individual’s gender identity
  • the distress known as gender dysphoria

“Voice quality and speech patterns are socialized from birth and intersectional in nature, based on an individual’s sex assigned at birth, languages used, and culture.”

Speech-language pathologist Jess MacKimm

MacKimm also says professional voice therapy can alleviate other concerns patients have when attempting to achieve voice training on their own, including:

  • fear of causing vocal injury
  • limited opportunities to explore voice capabilities and receive constructive feedback
  • access to reliable and sustainable voice resources
  • vocal fatigue, strain, or discomfort with voice use

Multidisciplinary voice therapy at WashU

MacKimm conducts voice training exercises with a patient.

Voice therapy in the Voice and Airway Center utilizes a multidisciplinary approach. Services include voice health screening, consultation, voice training, and surgical treatments.

A non-invasive stroboscopic imaging tool called videostroboscopy is commonly used during the initial consultation to produce a slow-motion video of vocal cord vibrations. This technique allows trained clinicians to evaluate tissues for injury and overall health. Any health issues should be addressed prior to starting voice therapy.

One-on-one voice training sessions are conducted with a voice-specialized and LGBTQIA+ affirming speech pathologist. Importantly, care and training are client-centered with a focus on achieving individual goals and finding the voice that uniquely matches the patient’s identity. Voice training can be used to successfully adjust a number of voice qualities:

  • pitch
  • intonation
  • resonance
  • rhythm, rate and volume of speech
  • choice of language
  • vegetative sounds like cough, throat clearing and laugh
  • nonverbal communication such as body language and facial expression
WashU laryngologist Randal C. Paniello, MD, PhD

When indicated, voice surgery can be performed with two common goals in mind: 1) to alter vocal pitch to provide a better match with gender identity; and 2) to alter the prominence of the thyroid cartilage or Adam’s apple to better match gender identity.

According to Washington University laryngologist Randal Paniello, MD, PhD, multi-disciplinary treatment that utilizes a combination of evaluation, training and surgery, when indicated, is vital to providing patients with the best care possible.

“While surgery can adjust the pitch of the voice, the perception of our voice by others is more than just this,” says Paniello. “By working together as a team, and tailoring care to each patient, our clinic is able to provide the best outcomes.”

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