Benefits of Gender-Affirming Voice and Communication Training for Young People

Abstract

Purpose:

Gender-affirming voice training is an important service for transgender and gender-diverse (TGD) individuals who wish to modify their voice to be more congruent with their gender identity. For decades, the research in this area has focused on adults, yet TGD young people also receive these services regularly. The purpose of this study was to analyze patient-reported outcomes in TGD young people who completed voice training.

Methods:

This study consisted of a retrospective chart review of 118 TGD individuals ages 11 to 23 years old who were seen at a university clinic between 2019 and 2024. We assessed voice outcomes with the Utah Gender Presentation Scale for Communication (U-GPS), the Trans Woman Voice Questionnaire (TWVQ), and acoustic measures. These data were compared before and after voice training.

Results:

Data were available for 68 clients who completed voice training. There were significant improvements in gender congruence by the end of treatment (t = 15.918; p < 0.001) with a median reduction of 32 points on the U-GPS. The trans female clients had significant improvements in voice-related quality of life (t = 12.072; p < 0.001) with a median reduction of 23 points on the TWVQ. Acoustic data show that speaking fundamental frequency (f0) was more aligned with clients’ gender by the end of voice training.

Conclusion:

This article is the first to demonstrate the benefits of voice training for TGD young people. This population warrants special attention in the literature, and further research should evaluate specific treatment protocols and associated outcomes for young people.

Introduction

Gender-affirming voice and communication (GAVC) training is a behavioral intervention for transgender and gender-diverse (TGD) individuals who wish to align their communication with their gender. GAVC training is typically provided by a voice and communication specialist, such as a speech-language pathologist (SLP).¹ The SLP can work with the TGD client to develop customized goals—typically with the aim of enhancing congruence of one’s gender identity with their communication characteristics. Communicative congruence has been shown to be tightly linked to quality of life in the TGD population.^2–4 The literature on GAVC training has largely focused on adults, and there is scarce research on GAVC for young people. In this article, we will refer to young people as individuals between 10 and 24 years of age, as defined by the World Health Organization.⁵

According to a Williams Institute survey in 2022, there were 1,637,200 individuals who identified as TGD in the United States.⁶ Of those individuals, 699,000 were ages 13 to 24. In other words, 42.7% of all TGD people in America were young people. Despite this large percentage, TGD youth are relatively underrepresented in the GAVC literature. To date, there have been a few case reports of transgender teens who completed GAVC training.^7–9 Those reports showed successful outcomes using subjective and objective measures that supported client goals toward voice modification. For TGD adults, there have been numerous studies with stronger levels of evidence for GAVC outcomes, as seen in two recent systematic reviews.^10,11 Given the disparity of representation in the GAVC literature, there have been several calls to action for additional research supporting voice training for young people.^9,12,13

The SLP can play a critical role in the care of TGD young people, as adolescence is an important time for gender identity development as well as voice development. Adolescence can be a confusing and stressful life stage because of ongoing psychosocial and physiological changes.¹⁴ Puberty is also a time of significant growth in vocal tract tissues; vocal folds impacted by androgens have a more dramatic increase in length and mass than those affected by estrogen and progesterone.^15–17 During this time of vocal change, the speaking pitch is expected to lower in both males and females, but most noticeably for individuals assigned male at birth.¹⁸ For TGD individuals, puberty can intensify feelings of gender dysphoria—that is, distress or discomfort related to gender incongruence.¹⁹ If the individual experiences distress regarding voice, they may benefit from a referral to a voice and communication specialist.¹

GAVC training has been shown to greatly increase voice-related self-perceptions in TGD adults.^{2–4,20–26} Voice-related quality of life has been measured through interviews, visual analog scales, and patient-reported outcome measures (PROMs). PROMs assess an individual’s experience from their own perspective without clinician bias.^27,28 TGD voice experiences are unique to each individual, and a PROM can be an effective tool for capturing those experiences. Outcomes in GAVC training are highly dependent on client perspectives; that is, a clinician may support progress with acoustic and perceptual data, but perhaps the most meaningful measure of progress is the client’s self-perception of their voice and voice experiences. Therefore, it is important to consider PROM responses in the assessment of GAVC outcomes.

The Utah Gender Presentation Scale for Communication (U-GPS) is a PROM that assesses gender incongruence in voice and communication.² It was validated with respondents who identified as trans female, trans male, nonbinary, cis female, and cis male.² The U-GPS asks clients to rate ten parameters of voice and communication on a ten-point masculinity/femininity scale, rating their current and goal status for each item. The total difference score across all items provides an estimate of communicative incongruence. This incongruence score ranges from 0 (no incongruence) to 90 (severe incongruence). The U-GPS items were developed with input from TGD participants who completed GAVC training. The items include pitch, intonation, resonance, loudness, speech smoothness, speech clarity, word choice, facial expression, gesture, and posture. As part of test administration, the clinician is advised to explain these parameters to the client, so that the client feels equipped to make a self-assessment.² As part of the validation for the U-GPS, the authors found excellent longitudinal validity in TGD adults, such that the incongruence score is a valid indicator of progress over time.

The Trans Woman Voice Questionnaire (TWVQ) is a well-validated PROM for use with transgender women only.²⁹ The TWVQ includes 30 Likert-like items about voice-related experiences for trans women, and the total score gives an estimate of the degree to which the patient’s voice impacts their daily living. It includes statements such as “My voice makes me feel less feminine than I would like” and “The pitch of my speaking voice is too low.” Respondents rate each statement on a 4-point scale: never/rarely, sometimes, often, usually/always. The total score ranges from 30 (no impairment) to 120 (severe impairment). The TWVQ also asks two self-rating questions: “Currently, my voice is…” and “My ideal voice would sound…”, and the client selects from very female, somewhat female, gender neutral, somewhat male, and very male.

The TWVQ was validated for TGD adults, but there have been a few case reports that used it with TGD young people. Hancock and Helenius reported a 15-year-old trans female whose score improved significantly from 106 pre-treatment to 53 post-treatment after 15 sessions over 7 months.⁷ Quinn and Swain reported a 17-year-old incarcerated trans female whose score improved from 100 pre-treatment to 81 post-treatment after completing an intensive voice training program that included twice daily sessions across 2 weeks.⁸ Russell and Abrams administered the TWVQ to a 16-year-old trans female, but they did not report outcomes before or after treatment.⁹ These case studies provide precedence for using the TWVQ with young people, but the efficacy has yet to be evaluated in a cohort study. While these three articles provide valuable insights into GAVC, they are based on single cases and may not fully represent the broader population of TGD youth. Overall, TGD adults have been shown to have voice improvements following GAVC training,^3,4 and the aim of this study was to demonstrate that the same is true for TGD young people.

Methods

Study design

The current study is a retrospective chart review of TGD clients who participated in GAVC training at the University of Utah Speech-Language-Hearing Clinic (UUSLHC) located in Salt Lake City, UT. The clinicians at UUSLHC treat a wide range of communication issues, and GAVC training has been offered for over a decade with a positive reputation in the community. UUSLHC is part of the University of Utah Transgender Health Program, which is a collaboration of health care providers working together to ensure TGD clients receive comprehensive, compassionate, and affirming medical care. Most referrals for GAVC training come from other providers at the university, as well as providers in the community and self-referred clients.

The UUSLHC is a university clinic in which graduate students conduct GAVC training under the supervision of certified and licensed SLPs. The current chart review presents data collected over 5 years from August 2019 to August 2024. This study received approval from the University of Utah Institutional Review Board (IRB #00109400) and informed consent was waived.

Data collection

This chart review includes data from individuals who identified as trans female, trans male, and nonbinary, as reported to their clinician through case history discussions. Demographic information was collected including age, gender, number of sessions, and intervention duration. Since 2019, the clinic has followed a standard protocol for collecting data before and after a client’s course of therapy. Data collection includes two patient-reported measures described earlier: U-GPS and TWVQ. These instruments are completed on a clinic iPad or a web browser, and those data are stored in a REDCap (Research Electronic Data Capture) database hosted at the University of Utah.³⁰ REDCap is a secure, web-based software platform designed to support data capture for research studies. Prior to PROM administration, the clinician explains the items on the U-GPS to ensure the client understands what each item means. In this chart review, we report pre-treatment and post-treatment scores on the U-GPS and TWVQ.

With every administration of the PROMs, clinicians also conduct a perceptual and acoustic analysis of the voice. Clinicians use the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)³¹ to provide a perceptual rating of the client’s voice. A voice recording is collected in which clients produce a series of voice tasks (i.e., sustained phonation, pitch glides, CAPE-V sentences, reading The Rainbow Passage, and a spontaneous speaking prompt). Recordings are made with Praat³² on laptop computers with a microphone-to-mouth distance of 12 inches. Clients are instructed to use a comfortable, conversational speaking voice during the recording.

The acoustic recording is analyzed using a custom Praat script. For the purposes of this chart review, the sustained vowel, reading, and spontaneous speech tasks were manually extracted from each recording. The middle stable section of the sustained vowel was extracted. The second and third sentences of the Rainbow Passage were extracted for the reading task. The spontaneous speech prompt was to explain how to make a peanut butter and jelly sandwich; a 5-sec period of continuous talking was extracted for that task. The Praat script measured fundamental frequency (f0) for each task, using a lower threshold of 75 Hz and an upper threshold of 600 Hz.

Intervention

The UUSLHC schedules 50-min sessions once a week, and the clinic is open 45 weeks in the year, observing short breaks between academic semesters. Clinicians follow a comprehensive approach to voice training that addresses pitch modification, oral resonance, intonation, vocal quality, vocal hygiene, and non-verbal communication techniques.

Clients routinely learn the Vocal Function Exercises (VFEs)^33,34 and the Resonant Voice Therapy protocol (RVT).³⁵ Clients are instructed to practice VFEs twice daily, as they have been shown to be successful in GAVC training.^25,36 Clients simultaneously learn RVT techniques for shaping oral resonance and applying it to a variety of speech tasks.³⁷ During resonance training, clients with feminizing goals explore oral posturing strategies such as lip-spreading and forward tongue carriage or “/i/-ification”,^22,38,39 while clients with masculinizing goals may explore richer/darker tones or “/u/-ification”.^39,40 Principles from semi-occluded vocal tract exercises⁴¹ and conversation training therapy⁴² are also used in treatment. The focus of the intervention can vary depending on the client’s personalized goals for pitch, resonance, intonation, loudness, gesture, posture, etc.

It is important to remember that most evidence demonstrating the benefits of GAVC training has been conducted with TGD adults.²⁰ Our intervention approach is founded on that evidence, and treatment is provided given knowledge about the anatomy and physiology of the client's voice.⁷ In addition to vocal development, the clinician should consider the client’s brain development and provide age-appropriate, engaging, positive, and clear interactions to promote success in GAVC training.¹² In our approach to working with young people, we use largely the same tools that we use with adults, but we dynamically tailor the methods with creativity and adaptability to fit the needs of the individual client—as a clinician would do with any voice client.

Data analysis

Statistical analyses compared the pre-treatment and post-treatment measures of the U-GPS, TWVQ, and acoustic measures. Repeated measures t-tests were used to evaluate differences in U-GPS and TWVQ scores before and after treatment for each gender group separately. A two-way repeated measures analysis of variance (ANOVA) examined the fundamental frequency (f0) in various speech tasks before and after treatment for trans females. A Pearson correlation assessed the relationship between PROMs and acoustic measures. Statistical significance was assumed for p < 0.05 for all tests. All analyses were conducted in R Studio.⁴³

Results

In this retrospective chart review, we identified TGD clients who enrolled in GAVC training at the UUSLHC. There were 118 TGD clients 11–23 years old seen in the clinic during that time. To be included in this review, clients needed to start therapy before their 24th birthday. The age group breakdown is displayed in Figure 1. Age groups included clients under 15 years old (n = 5), 15–17 years old (n = 19), 18–20 years old (n = 32), and 21–23 years old (n = 62). Of these TGD young people, 93 identified as trans female, 8 identified as trans male, and 17 identified as nonbinary. Of the nonbinary group, 11 were assigned male at birth, and 6 were assigned female at birth. The average age at first visit was 20.96 years old (median = 21.4, range = 13.6–23.9, Standard Deviation [SD] = 2.53 years) for trans female, 17.11 years old (median = 15.6, range = 14.0–23.4, SD = 3.50 years) for trans male, and 19.24 years old (median = 20.4, range = 11.6–23.6, SD = 3.54 years) for nonbinary clients. None of the clients had a prior history of a voice problem (i.e., dysphonia) for which they would need to receive voice treatment.

FIG. 1.

Number of clients (n = 118) grouped by age and gender.

Patient-Reported outcomes

The following analysis includes 68 clients who completed GAVC training. Individuals were excluded from analysis if they did not follow up after evaluation (n = 30), they started but did not finish treatment (n = 10), they were in treatment at the time of this publication (n = 5), or final data were not reported in their chart (n = 5). The final dataset included 59 trans female, 3 trans male, and 6 nonbinary clients. The average course of treatment included 18 sessions (SD = 9.8) over a duration of 6 months (SD = 3.79). One-way ANOVAs revealed no significant difference in the number of sessions (F(133) = 1.839, p = 0.163) or the duration of treatment (F(133) = 1.613, p = 0.203) across genders.

Repeated measures t-tests showed a significant decrease in U-GPS incongruence scores (t(67) = 15.918; p < 0.001) from the start of treatment (Mean [M] = 47.1; SD = 18.1) to the end of treatment (M = 14.7; SD = 13.2). A decrease was observed for trans female (t(58) = 15.184; p < 0.001), trans male (t(2) = 3.524; p = 0.036), and nonbinary clients (t(5) = 3.599; p = 0.008). The median change in incongruence scores was a reduction of 32 points (25th percentile = 21; 75th percentile = 39). There was a large effect size (d = 2.04) of pre- versus post-treatment scores calculated with Cohen’s d. These data are displayed in Figure 2 and Table 1.

FIG. 2.

Utah Gender Presentation Scale for Communication incongruence scores before and after treatment grouped by gender (n = 68). The boxes illustrate the median and interquartile range in the dataset. U-GPS, Utah Gender Presentation Scale for Communication.

Table 1.

Patient-Reported Outcomes for Individuals Who Completed Gender-Affirming Voice and Communication Training

	Trans female	Trans male	Nonbinary
Age	20.7 (2.55)	17.11 (3.50)	19.24 (3.54)
Sessions	18.8 (9.46)	11.0 (6.0)	18.5 (14.6)
U-GPS
Pre: mean (SD)	48.7 (18.0)	27.3 (11.7)	40.8 (15.6)
Post: mean (SD)	15.4 (13.5)	2.33 (0.58)	14.2 (11.0)
Pre: median (IQR)	44 (24.5)	32 (11)	39.5 (25.5)
Post: median (IQR)	12 (21.5)	2 (0.5)	9 (13.5)
TWVQ
Pre: mean (SD)	82.7 (15.0)	NA	NA
Post: mean (SD)	55.6 (16.0)	NA	NA
Pre: median (IQR)	80 (21.5)	NA	NA
Post: median (IQR)	55 (25.5)	NA	NA

Values represent mean and standard deviation (in parentheses), except where median and interquartile range are reported. Variables include age at start of treatment, number of sessions, and pre- and post-treatment scores for the Utah Gender Presentation Scale for Communication and the Trans Woman Voice Questionnaire.

IQR, interquartile range; NA, not applicable; SD, standard deviation; TWVQ, Trans Woman Voice Questionnaire; U-GPS, Utah Gender Presentation Scale for Communication.

Trans females (n = 59) showed a significant decrease in TWVQ total scores (t(58) = 12.072; p < 0.001) from the start of treatment (M = 82.7; SD = 15.0) to the end of treatment (M = 55.6; SD = 16.0). The median change in TWVQ scores was a reduction of 23 points (25th percentile = 16.25; 75th percentile = 38). There was a large effect size (d = 1.72) of pre- versus post-treatment scores calculated with Cohen’s d. The TWVQ self-ratings included current and goal voice ratings (1 = “Very female,” 2 = “Somewhat female,” 3 = “Gender neutral,” 4 = “Somewhat male,” and 5 = “Very male”) before and after treatment. A paired Wilcoxon signed-rank test found a significant decrease (W = 4656; p < 0.001) from the start of treatment (M = 2.660; SD = 0.863) to the end of treatment (M = 0.831; SD = 0.791). This difference had a large effect size (r = 0.844). The TWVQ data are shown in Figure 3 and Table 1.

FIG. 3.

A. Trans Woman Voice Questionnaire scores before and after treatment for trans female clients (n = 59). B. TWVQ self-ratings for current and goal voice rated before and after treatment. The boxes illustrate the median and interquartile range in the dataset. TWVQ, Trans Woman Voice Questionnaire.

Acoustic outcomes

Acoustic measurements of the voice were captured before and after GAVC training for the 68 clients reported above. For the 64 clients with feminizing goals, a two-way repeated measures ANOVA showed that f0 increased at the end of voice training with significant main effects of treatment (F(63) = 172.22, p < 0.001), recording task (F(103.95) = 12.93, p < 0.001), and their interaction (F(102.29) = 21.92, p < 0.001). Post hoc pairwise comparisons with a Bonferroni adjustment showed that tasks varied as follows: the sustained vowel showed the largest increase in f0 (t(63) = 13.7, p < 0.001), followed by reading (t(63) = 9.32, p < 0.001) and spontaneous speech (t(63) = 9.16, p < 0.001). For the 4 clients with masculinizing goals, the data did not reach enough power for statistical analysis. The f0 results for both groups are displayed in Figure 4 and Table 2.

FIG. 4.

Plot of fundamental frequency before and after treatment across three voice tasks: sustained vowel, reading the Rainbow Passage, and spontaneous speech. The left panel shows data for clients whose goal was to raise their pitch, and the right panel shows data for clients whose goal was to lower their pitch. The boxes illustrate the median and interquartile range in the dataset.

Table 2.

Acoustic Values Before and After Treatment

	Goal: Raise pitch	Goal: Lower pitch
Vowel
Pre-treatment	150 (46)	222 (39.9)
Post-treatment	221 (39.5)	174 (45.5)
Reading
Pre-treatment	159 (40.9)	222 (78.8)
Post-treatment	206 (46.3)	201 (49.3)
Speech
Pre-treatment	144 (35.1)	218 (69)
Post-treatment	188 (43.3)	211 (49.4)

Fundamental frequency (Hertz) before and after treatment for each task: sustained vowel, reading passage, and spontaneous speech. Values represent median and interquartile range (in parentheses).

A Pearson correlation tested the relationship of the acoustic data with incongruence scores on the U-GPS for the 64 clients with feminizing goals. The f0 value in spontaneous speech was negatively correlated with incongruence (r = −0.476; p < 0.001); that is, as clients raised their speaking pitch, they reported an increased degree of vocal congruence. For the 59 trans female clients, the f0 value in spontaneous speech was negatively correlated with TWVQ total score (r = −0.467; p < 0.001); that is, a higher speaking pitch was associated with improved voice-related quality of life. These correlations are plotted in Figure 5.

FIG. 5.

Scatter plots of fundamental frequency in the spontaneous speech task plotted against the Utah Gender Presentation Scale for Communication incongruence score (left) and the Trans Woman Voice Questionnaire total score (right) before and after treatment. The Utah Gender Presentation Scale for Communication plot includes 64 clients with feminizing goals, and the Trans Woman Voice Questionnaire plot includes 59 clients who identified as trans female.

Discussion

This retrospective chart review analyzed patient-reported and acoustic measures for TGD young people seen in a speech-language pathology clinic across a five-year period. This is the first article in the literature sharing clinical outcomes of GAVC training for a cohort of young people. The results demonstrate improvements on the U-GPS, TWVQ, and acoustic measures. The speaking f0 values were significantly correlated with the PROMs, suggesting that the acoustic properties of the voice are associated with clients’ voice-related gender congruence and quality of life.

While individuals of all genders can seek GAVC intervention, the majority of clients in this article were in the trans female group, which is consistent with the literature on adult treatment.^1,44 The current article includes data from trans female, trans male, and nonbinary individuals to demonstrate that GAVC training may be beneficial for diverse populations. The authors do not intend to draw comparisons between gender or age groups in this publication, as we did not have the power to support such group comparisons. The largest age group was the 21 to 23-year-old cohort, which may be due to that group having relatively more agency to seek and access gender-related care. Still, the younger groups also seek services, and it is important to represent them in this study and in future research.

This review demonstrates that clients made significant improvements across treatment, as measured by two patient-report instruments. The U-GPS results are similar to improvements reported for an adult cohort of 86 clients.² That adult study showed a median improvement of 29 points by the end of treatment, and the current study for young people had a median improvement of 32 points; both studies had large effect sizes. The current review demonstrates that the U-GPS is appropriate for use with young people as it effectively tracks changes over time. Of note, when administering the U-GPS, it is recommended that the clinician explain the ten items to the client before they assign self-ratings, and this recommendation should be followed for young clients to ensure they understand the item parameters.

The TWVQ total score represents trans females’ self-perceived vocal function and social participation related to voice. One adult treatment study showed an average reduction of 21.2 points on the TWVQ after intervention for 74 trans women.²⁰ We observed a mean reduction of 27.1 points in young people, which is a slightly stronger outcome. It is possible that young people may respond differently to GAVC training than adults,^7,12 but additional work would need to investigate that question by directly comparing age groups in a single study. Previous reports of single cases showed TWVQ improvements in young people,^8,9 as well as improvements on a previous version of the instrument—the Transgender Self-Evaluation Questionnaire.⁷ The current study is the first to report the TWVQ in a group of young clients.

Acoustic measurements in this chart review included pitch changes following treatment in sustained vowel, reading, and spontaneous speech tasks. All three tasks had significant increases in pitch for feminizing goals. The sustained vowel task had the greatest increase, which led to an interaction effect between task and time point. This may indicate that clients have some difficulty applying voice changes to more complex tasks (i.e., spontaneous speech). Still, clients who aimed to raise their pitch did achieve a median f0 in the feminine range for all tasks. The sample of clients with the goal to lower pitch was too small to make a meaningful conclusion about their pitch change. While pitch is the acoustic parameter reported here as a salient gender cue, treatment also focused on other parameters such as resonance, intonation, loudness, articulation, gesture, posture, and more. Future studies may provide a detailed analysis into other acoustic parameters in GAVC training for young people.

The voice training protocol in this chart review was customized to fit the clients’ goals, which were largely centered around satisfaction with one’s own voice. The clinicians at the UUSLHC worked with the clients to develop dynamic treatment plans that helped clients achieve voice and communication qualities that were congruent with their gender identity. While the treatment had foundations in vocal function exercises³³ and resonant voice therapy,³⁵ we do not claim that one approach is superior to any other, as we did not plan to make treatment comparisons in this chart review. Few studies have assessed the effectiveness of specific techniques in GAVC training,^{22,25,36,40,45} and even they recommended interventions with a range of techniques that are appropriate for the individual client’s goals and abilities.

The ultimate purpose of this study was to assess voice-related improvement in TGD young people after a course of GAVC training. As this is the first group analysis in the literature focusing on young people, we elected to highlight quality of life as the primary indicator of success in treatment. A recent study on adult trans women presented a thorough analysis of treatment outcomes from various angles: patient-reported outcomes, acoustic measures, and listener perceptions.²⁰ Other studies have shown positive correlations between trans women’s quality of life and listener perceptions of femininity.^3,4 In the current chart review, we share patient-reported and acoustic measures with an aim of showing improvements with GAVC training. Acoustic measures should be interpreted as an alignment of acoustic properties with the client’s gender goals. This alignment can be effectively measured through PROMs, such as the ones used in this article.

Limitations

The intention of this study was to examine clinical support for GAVC training in young people. While our chart review included the 10 to 23-year-old age range, the youngest client was 11.6 years old, and the majority of clients were in the 21 to 23-year-old age group. Additional work with this population could benefit from specifically focusing on adolescents and perhaps make comparisons between age groups.

A second limitation to this study is that we cannot confirm that GAVC training was fully responsible for the voice improvements observed. However, based on our clinical experience, we feel that the training was the primary catalyst for change. It has been shown previously that voice-related PROMs do not typically improve without some intervention.^2,20,46 As this is the largest group of TGD young people reported, we find it unlikely that all the clients would experience spontaneous improvements in response to events outside of treatment, but we acknowledge that other individual factors may have contributed. Many clients included in this study were also receiving gender-affirming hormone therapy. Most of our clients were on estrogen/progesterone, which have little to no effect on the voice,^18,19 but these details may be important to examine in future cohort studies.

Another limitation is that we cannot attribute clients’ improvements to specific components of treatment (e.g., one treatment approach vs. another, compliance with home practice, client self-efficacy, personality traits). Future research is needed to explore the impact of these variables on GAVC outcomes. Conversely, there may be other factors that could limit a client’s success in treatment. For example, smoking history may impair an individual’s ability to modify the voice, and young adults (ages 18–24) have been shown to use e-cigarettes more than older adults.⁴⁷ We regularly discuss smoking history in our clinic, but due to documentation concerns, we could not reliably collect these data in the current chart review. Other factors may also limit success, such as motivation and self-efficacy,⁴⁸ barriers to home practice,²⁰ and amount of time presenting as their gender.³ An in-depth analysis of these variables will be informative to better understand GAVC for young people, as well as GAVC training for all ages.

Lastly, this chart review spanned the years impacted by the COVID-19 pandemic, and that may have affected enrollment in clinical services. The UUSLHC remained open for most of the pandemic and offered services via telehealth and in person, and we found that GAVC training was effective in both modalities.⁴⁹ Still, given the circumstances of the pandemic, individuals may have been less inclined to seek services during that time.

Conclusion

This article demonstrates improvements in voice outcomes for TGD young people who participate in GAVC training. Until now, the GAVC literature has largely focused on work with adults, yet adolescents and young adults deserve special attention in this area of research. Young people are a particularly vulnerable population, and those who wish to work on their voice and communication may benefit from a referral to voice and communication specialists. The data presented here suggest that GAVC training for young people is associated with improvements in voice-related gender congruence, voice-related quality of life, and acoustic measures of the voice. This chart review serves as preliminary evidence for the benefits that TGD young people can receive from gender-affirming voice care.

Abbreviations Used

ANOVA

Analysis of variance

CAPE-V

Consensus Auditory-Perceptual Evaluation of Voice

GAVC

Gender-affirming voice and communication

M

Mean

PROM

Patient-reported outcome measure

REDCap

Research Electronic Data Capture

RVT

Resonant Voice Therapy

SD

Standard deviation

SLP

Speech-language pathologist

TGD

Transgender and gender-diverse

TWVQ

Trans Woman Voice Questionnaire

U-GPS

Utah Gender Presentation Scale for Communication

UUSLHC

University of Utah Speech-Language-Hearing Clinic

VFEs

Vocal Function Exercises

Authors’ Contributions

B.R.M.: Conceptualization, data curation, formal analysis, methodology, project administration, resources (lead), supervision, visualization, writing—original draft, writing—review and editing (lead). C.D.: Resources (Secondary), writing—review and editing (secondary).

Author Disclosure Statement

The authors have declared that no competing financial or nonfinancial interests existed at the time of publication.

Funding Information

This work was not specifically supported by any research funding agency.

Cite this article as: Myers BR, DeLong C (2025) Benefits of gender-affirming voice and communication training for young people, Transgender Health 10:4, 364–374, DOI: 10.1089/trgh.2024.0207.