Tag Archive for: Queer

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

Email: saskia.speechtherapy@gmail.com

Whatsapp: 079 966 3554

Website: slspeechtherapy.com

Queering Sexual Health

Initially, when I was asked to write something about queer sexual health, I assumed it would be fairly simple. I identify as queer, I’ve used queer theory in my research, I work with sexual health, and I boldly tell people that I am especially interested in queer sexual health. Yet, weeks after the request I found myself at my desk staring at an empty word document, trying to wrestle a pen away from one of my cats. I felt at that point, despite the lack of opposable thumbs, they would be better placed to write this than me.

The main reason for this drawn-out process actually has something to do with one of things I love most about queerness – its resistance to definition. The word ‘queer’ is often used in numerous ways, with the meaning changing from context to context. Something that is both rich with possibility and potential but can also feel somewhat out of reach.

Consequently, in the spirit of queerness itself, I propose instead to engage in a reflective imagining about what queering sexual health does. As Julie Tilsen (2021, p.6) notes, using ‘queer’ as a verb is its “queerest elaboration”, and, let’s be honest, we all know that queers love to queer things. I would not be remotely surprised if we started seeing research queering toilet paper, isolation, and lockdown. That is, if they don’t already exist.

Exploring what work the word ‘queer’ is doing in sexual health

My central imagining is about exploring what the work the word ‘queer’ is doing in queer sexual health. What does queer mean is this context? And most importantly, what does it do? A simplistic way of understanding the role of the word queer could be to say that queer sexual health is about sexual health for queer people. And while that is certainly an admirable and useful goal, my feeling is that queer sexual health is less about sexual health for particular kinds of people, and more about a queer approach to sexual health.

In this sense, queering sexual health is more about what possibilities become available to you as a healthcare professional when you start to queer your understanding and practice of sexual health. As Tilsen (2021, p.6) argues, “when we queer something, we question and disrupt taken-for-granted practices and we can imagine new possibilities”.

In a sexual health context, this could mean many things, and the remainder of this post will be about articulating some of these possibilities. For instance, this could mean an insistence on the importance of pleasure. Making our work about facilitating pleasure and wellbeing. This is as opposed to a focus on dysfunction, damage or disease. In centering pleasure and wellbeing, we can begin to see sexual health framed as erotic possibility, cultivating shared kindness, openness and curiosity in ourselves and our clients.

Challenging preconceived rules and ideas

A queering is almost always about challenging preconceived rules and ideas. In sexual health, this may mean challenging our own and our clients’ assumptions about gender, sexuality, anatomy, identity, relationships, and the relationships between these. This means tossing out the rulebook that suggests particular kinds of sexual play have anything significant to say about your identities. Or that particular body parts mean anything about your gender identity.

Queering sexual health is a rejection of binaries. It’s about a resistance to simplified labels, and instead embracing the beautiful messy complex reality of people’s experiences. What is allowed to emerge in sexual health practice when we take seriously that experiences cannot be reduced to boxes? And when we give our clients permission to exist and explore outside of them?

This therefore means embracing uncertainty and exploration. It’s a rejection of the idea that the simplest answer is often the right one, or the idea that there is a right answer in the first place. In much the same way as pleasurable sex embraces the journey and the process rather than a particular outcome; queer sexual health is about fluidity and a commitment to remaining open to new possibilities and realities.

As Tilsen (2021, p.6) argues “Queering is an ever-emergent process of becoming, one that is flexible and fluid in response to context, and in resistance to norms.” What happens when we center becoming instead of being, what do we remain open to and curious about in our own and clients’ lives?

Prioritising the client’s knowledge and experiences

Queering sexual health is also about starting from where your client is at and prioritising their knowledge and experiences. From this viewpoint, consultations can be viewed as the meeting of two (or more) minds. Each mind with their own perspectives and expertise.

Consequently, we can resist conventional notions of medicalised professionalism by being able to identify and disrupt the power dynamics which are so present in healthcare settings today. This is about rethinking informed consent as an ongoing process, always giving your clients all the of the options available and letting them make the decisions that are best for them, perhaps guided by, but not determined by our own ideas and beliefs.

In order to facilitate this kind of reflective process, healthcare workers need to be mindful of our own beliefs, values and assumptions, and the ways in which these may create blind spots and/or undermine our clients’ agency. Being aware of the complexity of our clients’ identities and experiences is also about a commitment to intersectional practice.

Intersectionality and diversity

Intersectionality has recently become something of a buzzword which treats inclusivity and diversity as little more than a box-ticking exercise. Queering sexual health is about remaining aware of all our own intersecting identities, experiences and social realities, and the recognition that each client comes with their own. Some of these identities and experiences are less visible than others. We need to ensure we are able to listen out for these as and when they are articulated (or not), and the ways in which they may enter the consultation room and our lives. This requires an ongoing commitment to authenticity which can hopefully facilitate the same for our clients.

Tilsen (2021, p.6) says that a queering is about breaking rules “in order to liberate people who have been held hostage by what the rules require or prevent”. Sexual health tends to operate from the viewpoint of cisgender, heterosexual, vanilla, monogamous, able-bodied white humans, and their relationships. Rules about what kinds of sex and relationships are legitimate and normative are widespread, whether they are explicitly stated or not. As a result, breaking the rules is about identifying and labelling the discrimination and marginalisation experienced by those outside of Rubin’s (2011) Charmed Circle, and instead turning the circle inside out.

In healthcare settings like South Africa where white, middle class, able-bodied, cisgender men continue to be a large focus of research and intervention, we can queer our sexual health practice by centering the experiences of those who are currently on the margins.

What does sexual health look like when we start with the experiences of sex workers? Ace, intersex, trans and gender fluid humans? Non-monogamies and kinksters? What erotic possibilities are opened up by moving away from heteronormativity and monogamism?

Expanding our toolbox

Queering sexual health is about recognising that the toolbox we’ve been given is limited, comes with sets of rules and expectations and frames client experiences in ways that can have negative consequences for their emotional and sexual wellbeing. For instance, defining sex as a penetrative act that involves only a penis and a vagina has consequences for the ways in which we are able to engage with clients around their sexuality. It creates a hierarchy around what kinds of sexual practices are considered legitimate and normalised, makes assumptions about body parts and pleasure, and limits the ways in which we can talk about consent, play and safety.

A queering of sexual health is about offering new and alternative frameworks that challenge essentialism, reject binaries and facilitate fluidity. Let’s begin from the perspective of those on the margins, make a commitment to inclusivity and authenticity and dismantle power dynamics. Let’s center pleasure and wellbeing and suspend our assumptions and judgements long enough to work collaboratively towards facilitating sexual health, whatever that looks like from person to person.

In line with my feeling about the importance of locating yourself socially and being authentic, it would be remiss of me not to own that this is a vision of what queering sexual health could/does look like from my perspective: a queer, white, middle class, mental health professional in South Africa. I can also acknowledge from personal experience that it may feel anxiety-provoking and difficult to toss the rulebook out the window (although not your ethics please). It can leave you feeling stuck or wondering “Well, where do we go from here?” While that uncertainty isn’t always easy, it is also rife with potential.

Where do we go from here? Where can we go now that we could not previously? I invite you to dive headfirst into this beautiful complexity with your clients – who knows where the adventure will take you.


  • Rubin, G. S. (2011). Deviations: A Gayle Rubin Reader. Duke University Press: Durham & London.
  • Tilsen, J. (2021). Queering Your Therapy Practice: Queer Theory, Narrative Therapy, and Imagining New Identities. Routledge: London & New York.


Chant Malan
Counselling Psychologist
SASHA Executive Committee & Media Committee
Email: malan.chantelle@gmail.com