Clinician and Consumer Perspectives on Gender-Affirming Voice Services



      A significant portion of the transgender, nonbinary, and gender-expansive community experiences gender-related voice issues. However, barriers exist to accessing gender-affirming voice care, and most existing voice research does not include the gender-nonbinary population. Our study aimed to examine transgender, nonbinary, and gender-expansive consumer/potential consumer (hereafter referred to as consumer) engagement and compare/contrast consumer and speech-language pathologist perspectives on gender-affirming voice services. A secondary aim was to assess possible voice impairments in transgender, nonbinary, and gender-expansive individuals.


      Two surveys were distributed via listservs for SLPs and flyers and social media posts for consumers. Surveys included items regarding experience with and accessibility of gender-affirming voice services and clinician competence. Consumers and clinicians answered the same questions from their respective positions. Consumers additionally completed the Voice Handicap Index-10 (VHI-10).


      Forty-eight consumer and 54 clinician responses were collected. Twenty (41.7%) consumers were trans women, 15 (31.2%) were trans men, 12 (25%) were gender-nonbinary, and one (2.1%) was gender fluid. VHI-10 responses were in the abnormal range for 61.4% of consumers, and 68.8% indicated desire to receive gender-affirming voice services, including 58.3% of gender-nonbinary respondents. However, only 6.25% of consumers considered themselves as having a voice disorder and 29.2% reported that their voice impairs communication. In contrast, 24.1% of clinicians felt consumers seeking gender-affirming voice services have a voice disorder and 51.2% felt they have an impaired communication ability. Consumers indicated positive perceptions of voice services/providers but reported a variety of barriers to access. SLPs indicated mixed confidence in accessibility of services. Both groups perceived an affordability barrier.


      This study demonstrates the desire and need for gender-affirming voice services and is the first to our knowledge to explicitly include gender-nonbinary individuals’ perspectives on them. Understanding how consumer and clinician perspectives differ can help focus provider efforts in improving experiences with, access to, and visibility of gender-affirming voice services.

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      Glossary of Terms (in order of appearance, adapted from the PFLAG National Glossary of Terms)

      Often shortened to trans, from the Latin prefix for “on a different side as.” A term describing a person's gender identity that does not necessarily match their assigned sex at birth. Trans is often considered more inclusive than transgender because it includes transgender, transsexual, transmasc, transfem, and those who simply use the word trans.
      Refers to people who do not subscribe to the gender binary. They might exist between or beyond the man-woman binary. Some use the term exclusively, while others may use it interchangeably with terms like genderqueer, genderfluid, gender nonconforming, gender diverse, or gender expansive.
      An umbrella term sometimes used to describe people who expand notions of gender expression and identity beyond perceived or expected societal gender norms.
      Describes a person who does not consistently adhere to one fixed gender and who may move among genders.
      A term for those who do not follow gender stereotypes. Often an umbrella for nonbinary genders. Though fairly uncommon, some people view the term as derogatory, so they may use other terms including gender expansive, differently gendered, gender creative, gender variant, genderqueer, nonbinary, agender, genderfluid, gender neutral, bigender, androgynous, or gender diverse.
      Gender binary
      The disproven concept that there are only two genders, male and female, and that everyone must be one or the other. Also often misused to assert that gender is biologically determined.