Speech and language therapy

This is also known as Voice and communication therapy. Every patient attending the GIC and currently accessing treatment can be referred for our specialist Voice and Communication Therapy by any of the clinicians.

Patients are advised to make a full-time social gender role change or at least have the intention of doing so, prior to accessing speech and language therapy because voice change takes consistent practice to acquire. It may be that patients are close to making a social role change and speech and language therapy can help move individuals nearer to this point.

Effects of hormones on the voice

Oestrogen hormone therapy does not affect the size or function of the voice box and vocal folds and pitch is unaltered. Instead, voice change is achieved through exercises and training within the therapy, together with regular outside practice from the patient.

Testosterone hormone therapy promotes growth of the vocal folds over several months which produces a lower pitch of voice.

Therapy model

Voice and communication therapy is individualised according to each patient’s needs and goals, as discussed at the initial appointment. Patients are seen in one-to-one sessions, followed by group sessions.

Initial assessment appointment

This is an information gathering appointment for both patient and therapist, and an opportunity for patients to discuss their concerns and hopes about their voice and communication and what they would like to achieve. As part of this appointment, we will:

  • Take a case history related to your communication goals
  • Listen carefully to your voice to ensure it is working healthily
  • Take a baseline recording of pitch
  • Explain how the voice works, the process of voice change and what is possible
  • Provide initial exercises and advice about home practice
  • Make a plan for how many follow-up sessions are required

Follow-up appointments

Individuals will be offered up to five follow-up therapy appointments of fifty minutes in duration at monthly intervals to assist the process of voice practice and change.

For those seeking to feminise their voice, help will be offered to:

  • raise pitch to a comfortable degree without strain
  • achieve a brighter resonance or vocal colour
  • explore intonation patterns
  • use a feminine voice on the phone
  • project voice over background noise
  • cough at pitch
  • explore and develop your singing potential

For those seeking to masculinise their voice, help will be offered to:

  • understand the effect of testosterone on the voice by measuring pitch and tracking the changes over time
  • develop a stronger breath support needed for larger vocal folds created by testosterone therapy
  • access increased chest resonance
  • explore intonation patterns
  • increase social confidence through assertiveness training
  • explore and develop your singing potential

For those identifying as non-binary individuals, therapy goals will be individualised according to what you are hoping to achieve in your gender expression through:

  • work on pitch, resonance and intonation
  • communicative power and personal presence
  • developing your singing potential

Voice Groups

After individual one-to-one sessions where vocal skills are taught, a voice group programme is offered, according to numbers of patients who need this. Groups consist of no more than 10 members and enable individuals to develop their vocal skills in a wider communicative context and through conversation, sharing and peer support. We offer workshops activities on voice projection, presentation skills, assertiveness training, speaking on the telephone to help individuals generalise their voice and communication skills so that they are able to use them easily in everyday life.

Following voice group sessions, individuals are discharged from speech and language therapy.

Important points to consider

Voice and communication change is a process. It takes time to achieve and consists of small changes which add up to a significant difference. We aim to help you achieve a voice which feels congruent for you. Your commitment to practice the exercises given is an essential part of the process. It is designed to be a supportive, collaborative, enjoyable and confidence-building process.

Some patients seek information about a surgical option to raise the pitch of the voice. The most common procedure used by Ear Nose & Throat (ENT) surgeons in the UK is the Cricothyroid Approximation (CTAS). Currently funding is not routinely available for this procedure on the NHS. It is also important to remember that pitch is only one aspect of voice and other vocal features need to be developed with a speech and language therapist.

Some individuals seek reduction in the laryngeal prominence (Adam’s apple). This procedure is known as Thyroid Chondroplasty. Reduction in the thyroid prominence does not have any effect on the sound of the voice, and individuals will need to discuss potential referral for this procedure with their main clinicians, although funding is currently not available on the NHS.

 

To be referred for speech therapy:

Ask the clinician at your first assessment, or later clinic appointments