Voice and Communication in Transgender and Gender Diverse Individuals

This book serves as a guide to any patient, clinician, or person who desires to understand how transgender and gender diverse individuals can be assisted in achieving voice and communication congruity with gender. Voice serves as an intricate link to one's identity and is a central aspect of the gender transition process. Communication styles and voice are internal to our personality and represent us. Judgments are often made on first impressions. Each transgender or gender diverse patient seeks to attain a voice and the ability to communicate in a manner that aligns with their gender expression. Voice and communication are most effectively addressed through a combination of behavioral, medical, and surgical interventions. The gap in our field is the lack of synthesis of this knowledge from the different professional disciplines that treat transgender and gender diverse patients. Guiding a transgender or gender diverse patient through this transition is complex, requiring an understanding of the patient's desires, the ability to identify and work with patients to achieve sustainable patterns of behavioral modification that affect voice in a positive manner, and an understanding of the role of newly emerging surgical techniques. This is best addressed by an interdisciplinary team, and this book makes this material available in one source.

This text is designed and structured for professionals who help patients achieve gender congruity in voice and communication patterns. It provides a basic understanding of the physiology of voice production for the lay person and medical professional as well as a detailed discussion of behavioral and surgical techniques for professionals specializing in voice.

The first section of the book consists of introductory chapters written by primary care physicians, endocrinologists and psychiatrists addressing the complex nature of transition from the medical standpoint. A review of hormonal replacement therapies, psychological evaluations, and potential effects of hormone replacement on voice are also included. The second section describes the behavioral techniques available in speech and voice therapy for voice change. In addition, this section addresses outcomes that can be expected from behavioral intervention. Each chapter addresses the physiologic principles of therapeutic techniques for effecting change, techniques of instruction, nuances for transgender and gender diverse patients, methods of generalization, and methods of maintenance. Finally, the third section of the book details the surgical techniques available to assist patients in voice transition and their expected outcomes for voice modification. Each chapter includes an introduction, preoperative assessment, role of preoperative therapy, surgical technique, postoperative management, and expected outcome. This section also includes a surgical atlas.

This is an ideal guide for otolaryngologists, speech-language pathologists, primary care providers, as well as psychiatrists and endocrinologists caring for transgender and gender nonconforming patients.

Mark S. Courey, MD

Professor and Vice Chair of Quality, Otolaryngology/Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery

Vice Chairman of Quality

Director, Division of Laryngology Mount Sinai Health System

Director, Eugen Grabsheid Voice and Swallowing Center

Mark S. Courey, MD, currently works at Mount Sinai Hospital in New York City where he serves as the Director of the Grabscheid Voice and Swallowing Center, Division Chief of Laryngology, and Vice Chair of Quality for the Department of Otolaryngology-Head and Neck Surgery. He is well-regarded nationally and internationally for his skills in the clinical management of patients with airway, voice, and swallowing disorders, as well as his interdisciplinary approach to patient care, incorporating speech-language pathologists, vocal trainers, laryngologists, neurologists, radiation oncologists and voice scientists into each patient's treatment when appropriate. He is also one of few laryngologists in the country focusing on transgender voice care with vast experience performing the thyroid cartilage reduction and endoscopic vocal fold shortening procedures.

Sarah K. Rapoport, MD

Department of Otolaryngology/Head & Neck Surgery

Washington DC Veterans Affairs Medical Center

Georgetown University Hospital

Sarah K. Rapoport, MD is currently an Assistant Professor in the Department of Otolaryngology/Head & Neck Surgery at Georgetown University Hospital and is a Laryngologist at the Veterans Affairs Medical Center in Washington, D.C.. She completed her laryngology fellowship at the Grabscheid Voice and Swallowing Center at Mount Sinai in 2021 where she was trained by Dr. Mark Courey in the management of voice disorders with a focus on surgical management of trans gender voice care. Dr. Rapoport now serves on the Veteran Health Administration (VHA)'s National Surgery Office's Gender Affirmation Surgery Surgical Advisory Board where she counsels the VHA on optimal management of voice care for trans and nonbinary veterans, and is authoring the surgical guidelines for voice care among trans and nonbinary veterans.

Leanne Goldberg, MS, CCC-SLP

Director of Speech-Language Pathology

Department of Otolaryngology

Mount Sinai Health System

Clinical Specialist

Grabscheid Voice and Swallowing Center

Mount Sinai

Leanne Goldberg, MS, SLP-CCC, is the Director of Speech Language Pathology at the Mount Sinai Health System in New York City where she works extensively with singers and actors with voice problems, professional voice users, and transgender and non-binary patients seeking voice modification.

Sarah K. Brown MS, CCC-SLP

Department of Otolaryngology Head and Neck Surgery, Division of Laryngology,

Mount Sinai Health System

Sarah is a voice-specialized speech-language pathologist and singing teacher. She is New York City based where she runs her private vocal studio for voice rehabilitation and habilitation.

Sarah earned a BM in Vocal Performance from Chapman University and an MS in Speech-Language Pathology from Northwestern University where she focused her studies and training in voice rehabilitation. She completed her clinical fellowship as well as her first several years in clinical practice at the Grabscheid Voice and Swallowing Center of Mount Sinai. Her singing background combined with her clinical expertise has enabled her to serve elite performers including Broadway singers and recording artists.

In addition to maintaining her private studio, Sarah serves as adjunct faculty at Pace University, where she teaches the graduate level Voice Disorders course. She also regularly presents educational lectures on vocal health and performance voice. Her research projects have covered a wide variety of topics in voice, swallowing, and upper airway disorders.