Speech and language therapists help trans and non-binary people find their voice

The trans or non-binary population can face many health inequalities when accessing health care and living their daily lives. Our team of speech and language therapists have developed a new service that enables them to live their true authentic lives.

In society, a large proportion of the population expect women and men to dress a certain way and also have a voice that sounds like it aligns to their gender.

When that doesn’t happen, it can draw unwarranted attention to those who look or sound different. Sadly, women can be mocked for having deep voices or men can be mocked for having lighter pitch voices.

This can be a real barrier to the happiness and health of a person affected, but especially those who are non-binary, and those who have transitioned.

Our team of four speech and language therapists have come together with our LGBTQ+ Colleague Network to look at what we could do to help… and that’s how the gender affirming voice therapy service in Somerset began!

The service is run by clinical lead Janet Savva as well as fellow speech and language therapists, Sophie Woodford, Nicola Loraine and Helen Meikle, who are based across the county. They regularly meet with experts from the specialist gender identity clinic in Exeter to develop their skills and access supervision and support, to ensure they offer the best service possible.

When Sophie joined the trust, our gender affirming voice therapy service was already established, but she was asked if she wanted to work in this area. Sophie says she’s proud that her profession has been able to make such a difference to the lives of people who are trans or non-binary.

“Speech and language therapy is a very broad profession, and we support people at all stages of their live, from babies up to end of life,” she says.

“Generally, people think we’re just here to help with stammers or stroke care, but we do so much more, including running unique services, such as gender affirming voice therapy!”

Our speech and language therapy service covers both inpatient and outpatient care, so people can be seen at home or in hospital.

We also support patients who have voice disorders, those with swallowing problems after a stroke or cancer surgery, neuro rehabilitation after a brain injury – a huge variety and essentially, we make sure that people have a way of communicating and getting their needs across; and can eat and drink safely.

One of the lesser-known areas of work that the team does is how colleagues support people who identify as trans or non-binary, and want to alter the way they sound to fit their true selves.

Sophie continues: “Gender affirming voice therapy is a type of therapy that helps people to modify their voice to fit in with their gender – especially if they’ve made a change from the gender they were assigned at birth.

“As part of this, we started thinking about which voice pitches are, stereotypically, either gender neutral, or what’s considered to be feminine or masculine. We work with the person and find out what they’re aspiring to, and we’ll assess how possible it is to achieve this.

“We also look at behaviours that we can use to access different vocal qualities, it might be that a lighter or softer tone is seen as more feminine, so we might talk to them about smiling, as this can help. We can do lots of playful work that helps get them into that pitch of voice, or we may use a more structured approach depending on how the person works best.”

“It’s common for people in the trans and non-binary community to try to modify their own voice, and often without accessing a speech and language therapy service.

“This can put a real strain on the voice, using too much muscle pressure or strain and even lead to them damaging their voice, so doing this work alongside a speech and language therapist is the safest way.

“A lot of people will report that speaking to people face-to-face is easier because they’re giving cues, such as dressing in a certain way, facial hair, make-up, jewellery, hair style and so on, whereas if it’s just a voice on the end of the phone then people get misgendered a lot – and this can be really upsetting.

“Usually, a therapeutic goal could be for the person on the other end of a phone call to be able to assume gender correctly.

“We know there’s a high risk with mental health conditions and even suicide within the trans community due to transphobia, misgendering and deadnaming, and evidence suggests that even something as simple as using someone’s correct pronouns reduces that risk by quite some degree.

“So, if we can help people to feel more confident about expressing themselves more appropriately, and also help to give cues to those communicating with them, then we’re making things safer for all and ultimately improving their quality of life.

“Many of the referrals into our service come through the specialist gender identity clinic in Exeter, with people also able to come through their GP surgeries. A self-referral is a third option, where people can self-refer by simply going on our website and filling out the form.”

Our speech and language therapists are also looking at ways to upskill our wider healthcare teams about how to be more sensitive in checking people’s pronouns and gender, prior to meeting the patient and not making assumptions on appearance or the sound of someone's voice.

“We always ensure to sensitively check for our patients’ pronouns and gender, regardless of who’s coming through the door,” Sophie continues.

“This is why when we first began to shape the service, I joined our LGBTQ+ Colleague Network so I could speak firsthand to many of those with lived experience of trans or non-binary issues. I felt it was vital to hear their thoughts so we could feed it into how the service runs.”

For more information about the service, or to make a self referral, go to Speech and Language Therapy Adult | Somerset NHS Foundation Trust (somersetft.nhs.uk).

Dairin Keating, our LGBTQ+ Colleague Network chair, says: “Speech and language therapy services for the LGBTQ+ community typically focus on providing inclusive and affirming care to individuals who may face unique challenges related to communication, voice, or swallowing.

“Our incredible team of therapists create a safe and supportive environment where our patients can address numerous concerns about their speech, language, communication or swallowing.

“The services offered by Janet and her team often involve tailored interventions to help clients express their gender identity authentically, navigate social situations, and address any speech-related issues they may experience.

“Everyone in our LGBTQ+ Colleague Network is in awe of the great work the team does, and see the team as essential to the wellbeing of all their patients, and especially those within an LGBTQ+ community.”