Gender Affirming Voice and Communication Therapy for the Trans and Gender Diverse Population

Hi! I am Saskia (she/they), a speech therapist based in Cape Town.

I am thrilled to offer gender affirming voice and communication therapy as the main focus of my practice, SL Speech Therapy. 

Gender affirming speech therapy is a relatively new branch of speech therapy, especially in South Africa. As such, I offer online sessions so that I can make my service more accessible to South Africans not based in Cape Town.

How does it work?

Broadly speaking, gender affirming speech therapy falls under three main categories: ‘masculinising’, ‘feminising’ and ‘neutralising’. To understand a bit better how this works, I will describe some of the prominent differences between ‘masculine’ and ‘feminine’ voices. 

(Please note that the descriptions that follow, are based on studies done on cis people, and hopefully future studies will include gender diverse participants.)

Most people’s initial thought on these differences relate to ‘pitch’. Generally lower voices are perceived as more masculine and higher voices are perceived to be more feminine. Gender affirming speech therapy can assist individuals to either raise or lower their habitual pitch in a way that is healthy, and not damaging, to the vocal mechanism. However, pitch is only one component of voice, and even though it is often the most obvious one to people, it is not the most important component.

Have you ever heard a deep voice that is still clearly feminine, or a high voice that is still distinctly masculine? This would be due to the other vocal characteristics (such as resonance, intonation patterns, articulation and vocal quality) allowing you to perceive the voice as masculine or feminine, despite the pitch being high or low.

This brings us to the next component of voice, resonance. Resonance describes how a voice is filtered and enhanced as it travels along the open chambers of the vocal tract (the lungs, trachea, pharynx, oral and nasal cavities). Resonance gives a voice depth and timber. It is each person’s unique body and habits around resonance that makes their voice distinct, allowing us to distinguish one voice from another and recognise those of the people we know. 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. 

Gender affirming speech therapy teaches the individual how to adapt and refocus their resonance, so as to align with their identity.

Another important component in 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 nonverbal communication such as gesture, body language and facial expressions.

A note on testosterone and voice

Individuals on testosterone generally experience a drop in their pitch. While this can be very gender affirming, some clients are still not completely happy with their voices and feel that they do not sound “masculine enough” or that while they have a deeper voice they sound more like a boy than a man. This is because the other components such as resonance and intonation patterns have not changed. Speech therapy can help the client to adapt the other characteristics of their voice so as to match the new deeper pitch.

Of course in some cases someone wants a deeper pitch but they do not wish to, or are unable to take testosterone for whatever reason. A speech therapist can still assist in these cases with safely habitualising a deepening your pitch, with or without testosterone.

Why is gender affirming voice therapy important?

Voice and communication are essential aspects of a person’s identity. It conveys 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 huge source of dysphoria, distress, and 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. Sadly, safety is also a concern for many of my clients. People can behave unpredictably and aggressively in the face of gender diversity. 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. It can empower them to express their authentic self and live more fully.

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. 

It is also important to me to not reinforce binary stereotypes, I do not believe that there is a right or wrong way for anyone to sound, or that someone’s voice should ‘match’ their physical expression of gender.

The logistics

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. Sessions are ideally weekly, but every two weeks is also an option for those who struggle with affordability of weekly sessions. Between every session clients 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.

To refer a client or if you would like to connect with me:

You can send me an email or whatsapp me using the details below.

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


Saskia Lilienfeld

Speech Therapist


Whatsapp: 079 966 3554