Voice therapy at Mass Eye and Ear provides valuable service for transgender patients

When someone is in the process of affirming one’s gender identity, finding their voice is important. A team of specialists at the Mass Eye and Ear is helping patients during an important part of their gender affirmation journey: finding a voice that matches their gender identity.

Voice therapy is not new to Mass Eye and Ear, but there has been a significant concern for the transgender population that receives these services. A 2015 U.S. Transgender Survey documented widespread disparities between transgender people and others in the U.S. population. Disparities include patterns of mistreatment and discrimination, and they involve basic elements of life, such as finding a job, having a place to live, getting access to quality medical care and simply enjoying the support of family and community.

Those concerns are a big part of the motivation for Mass Eye and Ear to create the Transgender Voice and Communication Modification program, which is staffed by speech-language pathologists with specialized training in voice modification and a board-certified otolaryngologist, a specialist in voice and throat surgery. Created in 2019, the program saw a tripling of patients served from year one to year two.

She relates a conversation with a recent patient who recalled, “You know, my voice doesn’t really bother me specifically. I think I could be OK with my voice except for the fact that I feel unsafe because I feel like my voice doesn’t match the expectations of my outward appearance to the general public.”

Banaszak says, “Many cisgender people have not experienced this feeling of voice incongruence.” (Cisgender definition: someone whose assigned sex at birth is congruent with their personal gender identity.)

“As cisgender people, I think we kind of take advantage of the fact that our voice just fits our gender, and a voice that doesn’t can be extremely dysphoric,” adds Abigail M. Garneau, MA, CCC-SLP, another team member.

Survey respondents also reported high levels of mistreatment when seeking health care, with one-third of those who saw a provider reporting at least one negative experience related to being transgender, whether it was verbal harassment or outright refusal of treatment.

In an effort to address those concerns, the clinic offers a welcoming presence with personal pronoun pins and LGBTQ flags. But beyond those cues and symbols is a thorough evaluation that looks at physical health as well as voice training.

“We thought it was our job to build a program that provides services, especially for people who are just at the beginning of their transition and may not even know what they want yet,” says Matthew Naunheim, MD, who does a complete examination of the neck and larynx. The program “opens the field to a lot more different discussions about the kind of things that you think about when you’re speaking, the kind of voice changes you have when you’re going through hormonal therapy, things like that.”

Banaszak explains that the treatment plan also considers that patients may have issues such as vocal strain or muscle tension stemming from trying out YouTube voice videos. “We are concerned with the efficiency of the voice. That’s part of why patients come to us, to learn how to use their voice, not only in a way that matches their gender and personality, but also in a healthy way. One of the risks if you’re trying on your own is you can really get yourself into inefficient voice patterns that could lead to issues with the voice down the line, outside of gender affirmation.”

Individual training sessions can run 45–50 minutes and require daily practice outside of sessions. Patients are typically seen for many months, and it’s not unheard of for them to be seen for up to a year before they feel confident in their voice.

“It’s a continuing conversation,” says speech pathologist Stefani Kalos, MS, CCC-SLP. “If we are going to make changes, that needs to be continuing and not something that we just do once and expect people to just get right away. It’s a journey. It’s definitely not a ‘we did it and now we’re moving on.’ We have to continuously talk about it.”

The same applies to health care professionals who treat transgender patients, Naunheim points out. “I feel that a lot of folks still don’t feel comfortable talking about it or addressing some of the underlying issues that have bubbled to the surface,” he says.

Banaszak how, “There are still so many patients that we’re not reaching who probably don’t even know we exist.”

“My hope is that it just continues to grow,” adds Banaszak, noting expanding options for patients with financial or insurance barriers through outreach groups or a lower cost alternative. She also envisions an increase in outreach, clinicians, treatment options and research.

This story was featured in Mass General Brigham’s 2021 Check-up on DE&I Report “Equity in a time of crisis.”