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Introduction

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  • A trans person is an individual who identifies and lives in a role that was not assigned at birth. It is not a mental health condition to be trans. The significant distress caused by gender dysphoria (a deep feeling of unease or unhappiness with someone’s birth-assigned gender and the mismatch felt between one’s internal sense of self and one’s physiological characteristic) lead people to explore and seek treatment at a gender specialist centre. Gender care pathway involves hormonal, psychotherapeutic, psychosocial and surgical interventions to ease their distress and discomfort
  • Speech and language therapists (SLTs) have a key role to play in trans health care. Trans people do not have a voice disorder but may seek help to explore or make changes to their voice and communication congruent with their sense of self. The SLT working with trans and gender-diverse people delivers voice and communication therapy
  • Clinicians (SLTs, psychologists, GPs, psychiatrists, surgeons, nurses, endocrinologists, etc) working in trans health care embrace a trans-affirmative culture, where correct pronouns, styles or address and titles are used, and there is a matter-of-fact ease with encountering gender variance and gender questioning individuals.

Helpful definitions

  • Gender identity is a person’s internally felt, personally verifiable experience of their own gender. It is “an individual’s personal sense, and subjective experience, of their own gender” (NHS England, 2016).
  • A person is said to be ‘gender questioning’ when they experience an incongruence between their birth assigned sex and gender role and their gender identity. When this incongruence causes significant distress, the individual attracts a diagnosis of ‘gender dysphoria’ and they may seek hormonal, psychotherapeutic, psychosocial and surgical treatments to ease their distress and discomfort (Barrett, 2007)
  • Trans is the community-preferred and ‘safe’ term for transgender. A ‘trans man’ (assigned female birth) identifies and lives in a male social gender role; a ‘trans woman’ (assigned male at birth male) identifies and live in female social gender role. When a person’s trans status is not relevant, trans women are simply women, and trans men are simply men (Richards & Barker, 2013).
  • A person who does not identify with the female-male gender dichotomy is non-binary, gender-diverse or genderqueer
  • A person is cisgender when their personal sense of gender identity corresponds with their birth assigned sex and gender role.
  • A person may transition or make a social gender role change as part of their treatment for gender dysphoria. In the 50 years since NHS healthcare records started in this field, 130,000 people have made a social gender role change. Since 1966, when the first Gender Identity Clinic opened in London, referral rates have risen by 20% in each subsequent year, and by 30% in 2018 (Barrett, 2017).
  • A Gender Identity Clinic (GIC) is a specialist multidisciplinary centre of excellence with the remit to provide treatment for the safe and sustainable alleviation of gender dysphoria, and exploration of gender identity.
  • The Gender Identity Development Service (GIDS) is the paediatric and young person’s clinic (up to 18 years of age) and offers a holistic and systemic exploration of the young person’s needs, and those of their family network.
  • For both the general public and clinicians working in this field, awareness of potential unconscious bias and  heterocisnormative stereotyping will contribute to a trans-affirming culture. Using client preferred pronouns and will reduce misgendering and experiences of shame and stigma felt by trans and non-binary people (Bouman & Arcelus, 2017; Lewis et al., 2017).
  • Voice and communication therapy, also known as voice modification therapy, is delivered by speech and language therapists in order to assist trans and gender-diverse people in creating and sustaining their authentic voice and communication, congruent with their sense of self (Mills & Stoneham, 2017)

Role of speech and language therapy

Speech and Language Therapists (SLTs) have a key role in ensuring the best possible outcomes for trans and gender-diverse people related to voice and communication. It is recommended that SLTs work within a gender specialist MDT in delivery of the biopsychosocial (endocrine, surgical, psychological, psychosocial) care pathway for gender dysphoria. SLTs working in local services will liaise with the client’s responsible gender specialist clinician, and/or relevant gender specialist team, and seek appropriate guidance from MDT colleagues (Royal College of Psychiatrists, 2013).

SLTs deliver voice and communication which involves voice coaching and changing vocal parameters such as pitch, resonance and voice quality, and exploration of non-verbal communication. SLTs will also be appropriately trained in a number of psychological approaches to support this voice change process, self efficacy, confidence and the transfer of skills into social situations (Adler, Hirsch & Mordaunt, 2012; Davies, Papp & Antoni, 2015; Mills & Stoneham, 2017).

Resources

RCSLT trans and gender diverse voice and communication therapy Competency Framework

This document aims to

  • support the delivery of services with a more equitable provision for trans and gender diverse clients nationally
  • support individual SLTs working with trans and gender diverse people in developing the necessary competencies to operate safely and effectively in this specialist field, and make the case for access to appropriate supervision and support
  • provide a tool which can be used by supervisors and managers to identify areas of professional development
  • support the development of the speech and language therapy workforce in this field
  • guide service specification of speech and language therapy services for trans and gender diverse clients in the delivery of Voice and Communication Therapy.

See Mills, Stoneham, Kurji-Smith, Gorb and Elias (2018) for a discussion of the profession-wide response to increased service demand and development of the Competency Framework.

Dr Sean Pert – Working with trans and non-binary people: Voice and communication webinar presentation

Key organisations

References

Adler, R.K., Hirsch, S., & Mordaunt, M. (2012) Voice and communication for the transgender/transsexual client: A comprehensive clinical guide (2 nd Ed). San Diego, CA: Plural.

Barrett, J. (2017). Gender Dysphoria: Assessment and management for non-specialists. BMJ 2017; 357:j2866.

Barrett, J. (2007). Transsexual and other disorders of gender identity. Oxford: Radcliffe Publishing.

Bouman, W.P., & Arcelus, J. (Eds). (2017) The transgender handbook. New York: Nova Science Publishers.

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

Lewis, E., Vincent, B., Brett, A., Gibson, S., & Walsh, R. (2017). ‘I am your trans patient.’ BMJ 2017; 357:2963.

Mills, M. & Stoneham, G. (2017). The voice book for trans and non-binary people: A practical guide to creating and sustaining authentic voice and communication. London: Jessica Kingsley Publishers.

NHS England (2016). C05. Gender Identity Services (Adults).

Richards, C. & Barker, M. (2013). Sexuality and gender. London: Sage.

Royal College of Psychiatrists (2013). Good practice guidelines for the assessment and treatment of adults with gender dysphoria. [Online].

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