For some trans people, voice can be a source of dysphoria. Voice therapy can help those transitioning to find a way of speaking that minimises any discomfort that is triggered by their voice.
However, there is a misconception that in order to access voice therapy you must first be referred to a Gender Identity Clinic. This is not the case: you don’t need a GIC referral, hormones, surgery, or anything else. Your GP can refer you for voice therapy directly.
Despite the increasing demand for access to voice therapy as an important part of transgender healthcare, many GPs don’t realise that they can refer patients directly. They might even assume that they aren’t able to because some other services for trans individuals (like laser hair removal) require a prior GIC referral. Others might not be aware of available services in the area, and so it may not occur to them that this is an option.
For example, in the East Sussex Healthcare Trust there are two speech and language therapists based out of a hospital clinic in Hastings – Karen McInally and Alexa Hollis – who can take direct GP referrals for adult trans therapy. At first local GPs were reluctant to refer patients directly, but once they were given the names of the therapists and told that they accepted direct referrals, without the need for GIC involvement, they were happy to make them. Since then, many trans people in the area have been referred for these services.
Although there are no specific criteria for referral, whether they choose to refer you or not is at your GP’s discretion, and they may ask you questions about why you want this therapy. This is particularly likely if you haven’t spoken to your GP about trans healthcare before. The Nottingham GIC has a great explanation of what voice therapy is and how it works so you can stay informed.
If your GP agrees to refer you and knows who the relevant specialists are then great. If not, you might have to do a little more work. It can be difficult to know where to look for trans specific vocal therapy. Some gender identity clinics, such as London and Nottingham, have in-house speech and language therapists. These may accept GP referrals if you live in the area (although availability may be limited and waiting times could be long). If you don’t, then you might have to do some research.
Most UK hospitals have at least one outpatient speech and language therapist, but not all of them are able to support transgender clients. Look online or call ahead of time to see if this is something they can provide. Some private practitioners may also accept GP referrals (as is the case with most laser hair removal, for instance) but again, this will depend on the individual practitioner.
The Association of Speech and Language Therapists in Independent Practice have a list of UK speech and language therapists with transgender specialisation. Not all of these take NHS referrals, but even if they don’t they might be able to recommend someone who does. For patients based in Wales there’s a list of speech and language therapists who specialise in gender identity, arranged by local health board. There are also free options you can start to work through in the meantime. The Manchester-based LGBT Foundation has made their introduction to voice therapy videos free online, and there are lots of exercises to be found on YouTube.
If you are considering private voice therapy then research your options online. Make sure that your therapist specialises in or has plenty of experience of working with transgender people specifically, and see if you can set up a chat with them beforehand to talk about your needs and your desired outcomes. GenderGP has teamed up with expert speech and language therapist Lori Lynn, who offers private vocal therapy tailored to the individual, and speech language pathologist Jordan Ross Jakomin, who offers workshops on voice and communication.
Speechtools VoiceUp app, working with vocal feminisation expert Christella Antoni, allows users to practice exercises from the comfort of their own home, and their Voice Analyst app can help you accurately measure pitch and volume for voice work over time.
Voice therapy can be a really valuable, affirming part of the transition process. And while it is broadly divided into ‘feminising’ and ‘masculinising’ therapies, that doesn’t mean it’s just for trans women or trans men. Non-binary people who want to work on their voice can benefit just as much from a referral.
While it’s frustrating to have to find this information for your GP, rather than the other way around, making it as easy as possible for them to refer you can really help move things along. By improving awareness we can not only get where we need to go, but pave the way for those who follow.