Gender Affirming Healthcare: The Speech Language Pathologist’s Role in Supporting and Advocating for Gender-Diverse Patients
By Kristen Lewandowski
June 3, 2021
Communication is a human right. Our voice, speech, written expression and nonverbal communication carry value and require respect. This is true regardless of race, ethnicity, age, sex, gender, religion, socioeconomic status, and veteran status. In the field of speech pathology, a clinician holds these truths high as it is our primary goal to ensure all people have a means to successfully communicate wants, needs, ideas, affection, emotion, and so much more. While many understand our role as clinicians who evaluate and treat children and adults with speech and language disorders, who and what we treat goes beyond that broad view. As we celebrate Pride Month, a time to lift up the LGBTQ+ community, let’s learn about the role speech language pathology plays in supporting gender affirming care.
Before we get started, it’s important to understand the key vocabulary related to gender affirming care, as defined by GLAAD (Gay and Lesbian Against Defamation):
Gender Dysphoria
the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics
Gender Affirming Therapy/Care
The interventions and healthcare to treat gender dysphoria
Transgender
An umbrella term for people whose gender identity differs from the sex they were assigned at birth. People under the transgender umbrella may describe themselves using one or more of a wide variety of terms – including transgender. Some of those terms are defined below. Use the descriptive term preferred by the person
Trans male
Someone assigned female at birth whose gender expression is male
Trans female
Someone assigned male at birth whose gender expression is female
Nonbinary
Terms used by some people who experience their gender identity and/or gender expression as falling outside the categories of man and woman. They may define their gender as falling somewhere in between man and woman, or they may define it as wholly different from these terms
Gender Nonconforming
A term used to describe some people whose gender expression is different from conventional expectations of masculinity and femininity
Sex
The classification of a person as male or female. At birth, infants are assigned a sex, usually based on the appearance of their external anatomy
Gender (Identity)
A person’s internal, deeply held sense of their gender. For transgender people, their own internal gender identity does not match the sex they were assigned at birth
Gender Expression
External manifestations of gender, expressed through a person’s name, pronouns, clothing, haircut, behavior, voice, and/or body characteristics. Society identifies these cues as masculine and feminine, although what is considered masculine or feminine changes over time and varies by culture. Typically, transgender people seek to align their gender expression with their gender identity, rather than the sex they were assigned at birth
Sexual Orientation
Describes a person’s enduring physical, romantic, and/or emotional attraction to another person. Gender identity and sexual orientation are not the same
Barriers to Gender Affirming Care
Far too often, patients seeking gender affirming care are met with practitioners and clinicians who lack the knowledge required to initiate referrals for gender affirming treatment as well as with barriers to access due to health insurance and discrimination. As anti-LGBTQ laws are again trending in state legislatures, gender-diverse patients are left feeling marginalized, unsafe and without the care they deserve. It is long past the time that our training programs not only educate healthcare professionals on the complex needs of transgender and nonbinary patients; but also provide the tools to ensure doctors, counselors, rehab therapists and more know how to advocate for the transgender community. As speech language pathologists, we have been granted the honor of playing a role in affirming the goals of transgender and nonbinary patients via their communication needs.
The SLP’s Role in Gender-Affirming Therapy
From the first visit to a speech pathologist for gender affirming therapy, a patient will require culturally competent and sensitive care. As the clinician, it is our role to be inclusive in our vocabulary, space, and approach. Some questions we must ask: is our clinic inclusive to gender-diverse populations, including artwork and reading material? Does our case history include questions supportive of a gender-diverse population, such as what is your gender pronoun? Including these practices in your space provides your gender-diverse patient with a safe and welcoming environment from the initial greeting.
Assessment and treatment of a gender-diverse patient is dependent upon the patient’s needs and goals. For example, a trans female who has identified a goal to present with their gender expression voice and speech qualities has a treatment plan that differs from a nonbinary patient seeking to present with qualities across the gender spectrum. The World Professional Association for Transgender Health highlights 7 areas within the speech language pathologist’s scope of practice when treating the communication needs of transgender patients: vocal health, resonance, voice (including pitch, intonation, and volume), articulation, language (including pragmatics, syntax, and semantics), nonverbal communication and real-life experiences. Assessing these domains requires the use of instrumentals, such as stroboscopy, quality of life measures (such as the Trans Woman Voice Questionnaire), and informal speech and voice evaluation, such as speech and language samples. Treatment within these domains includes comprehensive, multi-modal interventions such as feedback (for example, targeting a specific pitch range using a visual feedback tool), vocal hygiene education to prevent misuse of vocal folds, and resonant voice therapy.
While gender affirming care for patients seeking speech-language services is complex, the primary goal is not: to ensure our patient achieves their target communication needs. The gender-diverse population has much to think about in their day-to-day life. Access to services. Bias. Judgement. Counseling. Safety. Therapy provided by a speech language pathologist can contribute to improving the safety and mental health of the transgender community by affirming their gender needs via their voice, speech, and language. Being an advocate for gender-diverse populations encompasses not only providing culturally appropriate services, but also ensuring other healthcare practitioners are educated on our role in gender affirming care.
A Local SLP’s Experience and Expertise
UF Health Speech Language Pathologist, Robert Ruggles, M.S., CCC-SLP, who evaluates and treats for gender affirming therapy, shared his knowledge, passion, and support for gender-diverse populations. He highlighted it is important to practice whole-person care; meaning, the transgender part of a person is simply that: a part and not the entirety of them. They have hobbies, likes, dislikes, family, friends and more. To extend on whole-person care, Robert discussed the significant role listening plays in gender-affirming care. The gender-diverse client has to continuously share their story of gender dysphoria, gender identification and expression. Our role is to listen and be sensitive to their journey and history. Robert also added it is OK if we get the nomenclature wrong. We can apologize, learn the correct terms, and intentionally use them. Lastly, Robert stated to focus on the basics of our field: anatomy and physiology. To provide successful gender affirming therapy, we must adequately explore and explain the speech mechanism to our patients.
Kristen Lewandowski, M.A., CCC-SLP, Clinical Lecturer, University of Florida Department of Speech, Language, and Hearing Sciences
Additional Resources
For more resources on supporting gender-diverse populations, please refer to the sites below:
American Speech Language Hearing Association Practice Portal for Transgender and Gender Diverse Populations: For clinicians and practitioners seeking information on evaluation and treatment for gender diverse individuals.
ASHA Supporting and Working with Transgender and Gender Diverse Individuals: For clinicians and practitioners seeking information on best practice, including sensitivity, nomenclature and more, when working with gender diverse individuals.
L’Gasp: LGBTQ Audiologists & Speech Language Pathologists: the LGBT Q caucus of the American Speech Language Hearing Association and a caucus within the National Organization of Gay and Lesbian Scientists and Technical Professionals. A community of gay, lesbian, queer, bisexual, transgender, and allied Audiologists and Speech-Language Pathologists.
World Professional Association for Transgender Health: Research, information and more for healthcare professionals on healthcare for transgender individuals.
Parents, Families, and Friends of Lesbians and Gays: Organization supporting LGBTQ.
Gay, Lesbian and Straight Education Network: Organization supporting LGBTQ.
Gainesville Pride: Local organization supporting LGBTQ.