Gender Affirming Voice and Communication Therapy for Trans and Gender Diverse Individuals

by | 17/05/23 | LGBTI+

Gender affirming voice and communication therapy is such an important, but often neglected, aspect of gender affirming healthcare. Therefore I asked the lovely Saskia Lilienfeld, a speech therapist specialising in gender affirming voice and communication therapy in Cape Town, to tell us a little bit more about it and give us more insight into who may potentially benefit from this service.

The following blog post is written by Saskia Lilienfeld.

Who am I?

Hello! My name is Saskia. I am a speech therapist based in Cape Town. The main focus of my practice, SL Speech Therapy, is gender affirming voice and communication therapy. I offer sessions online so that anyone, anywhere in South Africa can access my service. In person consults are also available in Cape Town.

What is Gender Affirming Voice and Communication Therapy?

Gender affirming voice and communication therapy is a specialised speech therapy service that aims to help transgender and gender diverse individuals adapt their voice and communication patterns to achieve congruence with their gender identity and expression. It can involve changing vocal characteristics such as pitch, resonance, intonation, loudness, and vocal quality, as well as non-verbal communication patterns such as facial expressions, gestures, posture, and eye contact.

Gender affirming voice and communication therapy can have various goals depending on the individual’s needs and preferences. Some may want to feminize, masculinise, or neutralise their voice and communication style. Others may want to enhance their vocal health, flexibility, or confidence. Some may want to explore different aspects of their gender expression through voice and communication.

Why is it important?

Voice and communication are essential aspects of our identity and expression. They convey who we are, how we feel, and what we want to say to the world. For many transgender and non-binary individuals, voice and communication can be a source of dysphoria, distress, or discrimination. They may feel that their voice does not match their gender identity or expression, or that their voice gets in the way of them being their authentic self. Every person deserves to feel the freedom and confidence in their communication!

Unfortunately for many, safety is also an issue as people can behave unpredictably and aggressively in the face of gender diversity. Many of my clients have reported fear around talking to strangers. If for example, a stranger notices that a femme presenting person has a masculine voice (or visa versa) – they could potentially respond with discrimination or even violence.

Gender affirming voice and communication therapy can have significant benefits for transgender and nonbinary individuals. It can improve their self-esteem, well-being, social relationships, and quality of life. It can also reduce their risk of vocal injury or vocal abuse. And most importantly, it can empower them to express their authentic self and live more fully.

Gender characteristics in voice and communication

What are the differences between ‘masculine’ and ‘feminine’ voices?

The first thing most people tend to consider is ‘pitch’ – how deep or high a person’s voice is. Generally lower voices are perceived as more masculine and higher voices are perceived to be more feminine. While this is true, and you can learn to adopt a higher or a lower pitch in gender affirming speech therapy, pitch is only one component of voice, and it is certainly not the most important one.

Have you ever heard a deep voice but you can immediately tell its feminine? Or have you heard a high voice that is still clearly masculine? In such instances,  the other vocal characteristics such as resonance, intonation patterns, articulation and vocal quality allowed you to perceive the voice as masculine or feminine, despite the pitch being high or low.

Resonance describes how a voice is filtered and enhanced when travelling along the spaces of the vocal tract (such as the space in your lungs, throat, mouth and nose).

Through this process, your voice is given depth and timber. In masculine bodies, the open spaces along the vocal tract are bigger and the resonance is mainly in the chest. This results in masculine voices sounding “rich”, “dark” or “gravelly” in quality.

In contrast, the open spaces along the vocal tract are smaller in the feminine body, and the resonance is focused more in the head and mouth. This results in a voice quality that is “clear”, “bright” or “crisp”. Resonance is a major factor in how a voice is perceived in terms of gender! In gender affirming speech therapy, you can learn how to adapt and refocus your resonance to align with your identity. 

Another important component of voice is intonation. Intonation patterns refers to how a voice rises and falls during speech, to add emphasis, meaning and emotion to the utterance. Masculine voices tend to use more downward inflections (voice going down) and tend to use volume to emphasise something. Feminine intonation patterns incorporate more upwards inflections (voice going up) and words are emphasised by going up in pitch (more than increasing volume).

Other characteristics include articulation styles (masculine voices produce syllable and words distinctly separately from each other, whereas feminine voices let words and syllables blend into one another), vocal quality (how clear, smooth, breathy or rough a voice sounds) and non-verbal communication, such as gesture, body language and facial expressions.

Keep in mind that the information outlined above comes from studies done on cis people, and hopefully in the future studies will include gender diverse participants!

Testosterone and the voice

Those taking testosterone generally experience a drop in pitch, and while this can be very gender affirming, some people are still not completely happy with their voices and feel that they do not sound “masculine enough”. This is because the other components such as resonance and intonation patterns have not changed. Speech therapy can help you adapt the other characteristics of your voice so as to match your new pitch.

In some cases someone wants a deeper pitch but they do not wish to, or are unable to take testosterone. A speech therapist can assist you in deepening your pitch with or without testosterone!

My approach

Although therapy broadly works to ‘masculinise’, ‘feminise’ or ‘neutralise’ a voice, I do not believe in a one-size-fits-all approach. The aim is not to give the client a new voice or to copy someone else’s voice. Rather, we aim to find the clients own authentic voice.

Therefore my approach is a gentle and playful journey of self-discovery, and I encourage my clients to play around within the components and discover what brings them euphoria and connection. 

The logistics

During gender affirming voice and communication therapy, the speech therapist works collaboratively with the individual to assess their current voice and communication skills, identify their goals and expectations, develop a personalised treatment plan, and monitor their progress and outcomes.

The length of the gender affirming voice therapy journey is different for everyone and depends on multiple factors, but generally takes between 4-8 months for most people. Sessions are ideally weekly, but every two weeks is also an option for those who struggle with affordability of weekly sessions. Between every session there will be voice exercises to practise and become familiar with. For optimal progress, clients should get into a routine of doing the exercises daily to allow them to form new vocal habits.

Interested, or have any questions?

Follow me on Instagram @sl_speech_therapy where I share tips, resources, and stories about gender affirming voice and communication therapy.

If you are interested in gender affirming voice and communication therapy or want to learn more about it, you can contact me at or Whatsapp me on 079 966 3554. You can also visit my website

Make sure to share this post with your family and friends if you think there’s a good chance it could help them too. Thank you!

Disclaimer: This blog consists of only my opinions and doesn’t reflect the opinions of the Department of Health of South Africa or The Southern African Sexual Health Association. All information is accurate and true to the best of my knowledge, but it’s possible that there may be omissions, errors or mistakes. While I am a registered medical practitioner, I am not YOUR doctor. The information presented on this blog is for entertainment and/or informational purposes only and shouldn’t be seen as professional medical advice. If you rely on any information presented, it’s at your own risk. Please consult a professional before taking any sort of action.

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