Gender Affirming Voice Treatment (GAVT)

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What is gender-affirming voice therapy?

Transgender voice therapy, also called gender-affirming voice therapy (GAVT), aims to align a transgender individual's voice with their gender identity. The Mayo Clinic describes it as treatments focusing on altering vocal characteristics and nonverbal communication patterns. These therapies can feminize, neutralize, or masculinize a person's voice and speech through various techniques, including adjusting pitch, prosody, resonance, quality, articulation, rate, and nonverbal cues. Speech-language pathologists (SLPs) typically administer this therapy, as they specialize in treating speech, language, social communication, cognitive-communication, and swallowing disorders in both children and adults, according to the American Speech-Language-Hearing Association (ASHA).

Gender Affirmation Process

Gender-affirming voice therapy (GAVT) is a crucial aspect of gender affirmation, which encompasses three main domains: social, medical, and legal. These domains have a significant impact on the mental health of transgender and nonbinary individuals. The social domain, as defined by King & Gamarel (2021), involves institutions or individuals validating a trans person's identity through the correct use of names and pronouns.

Social Domain

The social domain, as defined by King & Gamarel (2021), involves institutions or individuals validating a trans person's identity through the correct use of names and pronouns. The social domain of gender affirmation significantly affects mental health, particularly in relation to parental support and the ability to express one's true gender identity. Research suggests that when parents use their child's true name, individuals experience less anxiety and fewer depression symptoms. Additionally, youth who are unable to express their gender identity consistently exhibit more depression symptoms compared to those who can express their true gender identity at least part of the time.

Medical Domain

The medical domain of gender affirmation involves hormonal treatment, surgery, and other medical procedures to align a transgender person's body with their gender identity, as defined by King & Gamarel (2021). Research suggests that individuals who have undergone hormonal or surgical treatments experience fewer symptoms of anxiety and depression compared to those who have not undergone such treatments (Fontanari et al., 2020).

Barriers

Accessing the domains of gender affirmation can be hindered by various barriers. Legal gender affirmation lacks federal standards, with states having different requirements such as court orders or public announcements for name changes. Some jurisdictions mandate proof of medical gender affirmation for legal name changes. Accessing medical gender affirmation faces additional hurdles including high costs, limited insurance coverage, geographic inaccessibility, stigma in healthcare settings, medical contradictions, and age restrictions, as highlighted by King & Gamarel (2021) and Restar et al. (2020).

Voice Therapy Terms

Articulation: how clearly the person creates distinct sounds and words
Intonation: refers to the rise and fall of pitch in spoken language, which helps convey meaning, emotion, and emphasis.
Larynx: aka the voice box; part of the throat located at the top of the windpipe. Contains vocal cords and is crucial for producing sound during speech and singing.
Nonverbal cues: gestures and mannerisms of the head and hands
Pharynx: a muscular tube located behind the mouth and nasal cavity and in front of the esophagus and larynx. It serves as a passageway for air and food, playing a crucial role in swallowing and vocalization.
Pitch: how high or low the person’s voice is
Resonance: how space in the nose, mouth, and throat affect the sound of the voice and impart traits often perceived by the listener as masculine or feminine
Speech language pathologist: Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults
Vocal folds: aka vocal cords; two small bands of muscle tissue located in the larynx. They vibrate when air passes through, producing sound. They are essential for speech, singing, and other vocalizations.Consumer glossary, Transgender and Gender-Diverse Voice Care. (2023). John Hopkins Medicine.

Insurance Terms

Beneficiary: the individual who receives the benefits or healthcare coverage.
Benefits: total expenditures for health care services paid to or on behalf of a member
Calendar year deductible: the amount you must pay in health insurance each year before the insurance starts covering more costs
Coinsurance: a percentage of each claim that the insured will bear.
Conditions: rules in the insurance contract that the insured must follow to get paid back for losses
Copay: In group insurance plans, the insured pays a set amount of medical expenses, and the insurer covers the rest.
Deductible: portion of the insured loss (in dollars) paid by the policy holder
Group health coverage: health insurance given to employers, groups, or associations for their members and their families, with a certificate showing coverage.
Insurance: a way to move risk from a person to a company, making uncertain events less worrisome by grouping them together.
Lapse: end of a policy due to failure to pay the renewal premium
Monthly premium: a fixed amount that you pay each month or with each paycheck for your health plan.
Out-of-network provider: those that do not participate in the health plan’s network
Out-of-pocket maximum: the most you pay during a plan period before your health plan pays all of the costs for covered services
Pre-existing conditions: health issues for which you received advice, daignosis, care, or treatment within the 12 months before your coverage started
Premium: the money you pay for insurance coverage, based on the likelihood of lossess happening
Provider network: list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members
Rider: an added change to a policy agreement
Usual, reasonable and customary: the typical amount paid for a medical service in an area, based on what providers usually charge for similar servicesGlossary of Insurance Terms, Consumer Glossary. (2024). National Association of Insurance Commissioners.