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Transgender Voice Speech And Communication


Our team has;specialized interest and training in evaluating and working with transgender patients to provide behavioral and medical/surgical interventions. Much about voice that identifies gender relates to word choice, phrase structure, and intonation patterns. As with all evaluations related to voice and interpersonal communication, the assessment begins when you walk through the door. People are often unaware of habitual communication patterns. These habitual patterns convey more about gender perception than vocal pitch or quality alone. Therefore, pragmatics will be evaluated during the initial visit. In addition, vocal pitch, quality and resonance along with the size of the voice box will be assessed.

As a team we will identify areas to target to help you reach your voice and communication goals. This usually begins with behavioral intervention targeting communication patterns and easily accessible pitch range that allow the patient to produce an efficient voice that is more in line with their gender identity. Once these behaviors have been maximized then consideration can be given to surgery to alter pitch. This is rare, as most patients can achieve a gender authentic voice without surgical intervention. Finally, surgeons;at the Voice and Swallowing Center are able to perform Adam’s apple reduction surgery , and can coordinate with other surgeons to be performed at the same time as other facial procedures.

Information Accuracy And Risks Of Hrt

Its a fact that some transsexuals chooseusually because its the only option available to themto self-prescribe hormones and/or androgen-blocking drugs. This article compares recommendations from medical and non-medical sources, and explains conditions that could result from HRT, whether therapy is medically monitored or not. This information is not provided or intended as a substitute for professional medical advice or care.

I am not a medical professional. Please also note that the glossary at the end of this article is just that: a glossary, and not a dictionary. The descriptions of the terms in the glossary are meant to help you interpret their use in this article only, and are not comprehensive definitions.


Transgender Women May Get Small Breasts With Hormones

By Lisa Rapaport, Reuters Health

5 Min Read

– Transgender women who take sex hormones to feminize their bodies may not experience as much breast development as they expect, a new European study suggests.

Researchers followed 229 people transitioning from male to female for one year after they started taking whats known as cross-sex hormones. For this type of transition, hormone therapy consists of both anti-androgens to block the activity of male sex hormones and curb male characteristics as well as estrogens to encourage breast development and feminization.

Only 21 of the trans women attained a bra size of an A cup or larger after one year of hormone therapy, the study found.

In our experience, trans women have high expectations of the breast size they gain with hormone therapy, said lead study author Dr. Christel de Blok of the Center of Expertise on Gender Dysphoria at the VU University Medical Center in Amsterdam.

This study provides doctors with some evidence that it is less than often thought or hoped, de Blok said by email.

Participants were patients at specialized clinics in Amsterdam; Ghent, Belgium; and Florence, Italy.

To assess breast growth, researchers measured the circumference of the chest underneath the breasts and at the largest part of the breasts. The difference between these two measurements can be used to determine breast growth and bra sizes.

Most of the breast growth happened during the first six months of treatment.

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Information On Estrogen Hormone Therapy

Overview of Feminizing Hormone TherapyUCSF Transgender CareUniversity of California – San FranciscoJuly, 2020

Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California San Francisco , and Medical Director for UCSF Transgender Care. In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.

As you prepare to begin treatment, now is a great time to think through what your goals are. Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan.

Many people are eager for hormonal changes to take place rapidly which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors primarily include your genetics and the age at which you start taking hormones.

There are four areas where you can expect changes to occur as your hormone therapy progresses. Physical, emotional, sexual, and reproductive.

The first is physical.

Sexual changes

How To Learn More


If you want to learn more about estrogen-based GAHT, the best place to start is by talking to your healthcare provider. However, if you dont have one, you can find a local gender-affirming provider near you by visiting the WPATH provider directory or checking to see if you live in a state covered by Plume, a telehealth company providing gender-affirming care, made by and for trans people.;

Plume offers a mobile app where you can consult with a provider, develop an individualized treatment plan, and have your prescriptions delivered to your door, all for a flat monthly fee of $99 .; You can learn more about Plumes GAHT services on their website.;

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Treatment And Gender Surgery

Currently, most surgeons recommend that transgender women and transfeminine people stop taking estrogen before they undergo gender affirmation surgery. This is because of the potentially increased risk for blood clots that is caused both by estrogen and by being inactive after surgery. However, it is unclear whether this recommendation is necessary for everyone.

Transgender women and non-binary feminine people who are considering surgery should discuss the risks and benefits of discontinuing their estrogen treatment with their surgeon. For some, discontinuing estrogen is no big deal. For others, it can be extremely stressful and cause an increase in dysphoria. For such people, surgical concerns about blood clotting may be manageable using postoperative thromboprophylaxis.

However, individual risks depend on a number of factors including the type of estrogen, smoking status, type of surgery, and other health concerns. It is important that this be a collaborative conversation with a doctor. For some, discontinuing estrogen treatment may be unavoidable. For others, risks may be managed in other ways.

Working With Young Trans People & Families

A Family Court of Australia ruling , the medical practitioner and the young person themselves with regard to:

  • The Gillick competence of an adolescent; or

  • A diagnosis of gender dysphoria; or

  • Proposed treatment for gender dysphoria

Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re. Imogen 20206.

Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a childs parents or legal guardians consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers , hormones or surgical intervention without court authorisation.

Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.

Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents 7

For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court must be involved. Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones, or seeking to access them outside of medical care and oversight.

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Lower Doses And Temporary Use

For some trans people, being on a lower dose of feminising hormones, or using them occasionally or temporarily is a part of how they seek to hormonally affirm their gender.

It can be difficult to try and implement one feminising change and not another, as once a hormonal threshold is reached, a range of secondary sex characteristics will begin to change.

This is especially the case for breast growth, which may occur even at lower estrogen levels .

Consultation with a specialist Endocrinologist may be helpful.

The use of hormonal suppression without gender affirming hormonal therapy can lead to adverse health effects, and so is to be undertaken carefully, and with regular oversight.

It is possible to achieve testosterone and estrogen hormone levels that are between the male and female ranges. However, at this point, there is little evidence for this practice as most research only considers binary gender options.

A Guide To Transgender Health, Heath R, Wynne K 4

Causes Of Low Estrogen In Women

How to Increase Estrogen levels for MTF Transgender

The three main causes of low estrogen in women are :

  • Menopause: Ovum supply declines in number and quality as a woman reaches her late 30s or early 50s, resulting in hormone imbalances
  • Poor Diet and Exercises: Consuming less healthy foods such as fruits, vegetables and taking unhealthy fats and excessive alcohol can contribute to low estrogen levels.
  • Medical Conditions: Pituitary gland infection can cause estrogen levels to decline. The pituitary gland is responsible for regulating amounts of estrogen produced by the ovaries.

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Without Help Of A Parent Or Guardian

It is better to get help from your family. That is the choice I hope you will make. These other options are often not as safe.

From a family planning clinic

  • Planned Parenthood
  • At this time, only some Planned Parenthood health centers have hormones for trans people.;Even fewer can help young trans people. The best way to find out is to call your;nearest Planned Parenthood health center.
  • Some young transfeminine people have been able to get birth control pills or other drugs with hormones through a clinic. Birth control pills are not what you need. They have low doses of feminizing hormones. You would need to take a lot. They also do not have much androgen blocker, which is important for stopping you from going through puberty.
  • From adult friends and peers

    • You might ask a trusted friend or family member who is over 18 to help you. You will need to come out to them. There is a chance they might tell your family, so think hard before talking to someone.
    • If you know trusted adults in your area who are making a gender change, you may be able to get one of them to help you.
    • Do not ask people you meet online, even other people who say they are like you. Only ask people you have already met in person and trust.
    • You can ask them to order what you want from a foreign pharmacy. Then you can pay them. They need to know this is probably against the law.

    From your doctor

    Through legal options

    Traveling outside your country

    Ordering online or by mail

  • If you wish to take that risk, go here:
  • Erik Steele Mfa Ma Ccc

    Erik Steele, MFA, MA, CCC-SLP, is a Speech Language Pathologist at the UCSF Voice and Swallowing Center and Head and Neck Surgical Oncology in the Department of Otolaryngology Head and Neck Surgery. He specializes in the evaluation and treatment of patients with wide ranging voice, swallowing, and upper airway problems. Clinical and scholarly interests include individualized care of the professional voice, the use of advanced instrumental diagnostics in voice and swallowing, patient-centered rehabilitation of voice, speech and swallowing following head and neck cancer treatment, and community outreach to promote greater awareness of voice, swallowing and upper airway problems and therapies.

    Before joining the Department of Otolaryngology and Head and Neck Surgery at UCSF, Mr. Steele completed his graduate work at San Diego State University, a clinical internship at the Scripps Center for Voice and Swallowing in San Diego, and his postgraduate fellowship at the Center for Voice and Swallowing at UC Davis, where he then remained for two years.

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    What To Expect From Testosterone Or Androgen Blocker Therapy

    Using T-blocker therapy to inhibit the effects of testosterone can allow estrogen to work more quickly while testosterone levels gradually drop. The effects of these therapies in conjunction with estrogen can vary significantly. Generally speaking, the changes you should expect are similar to the ones outlined above in estrogen therapy, though perhaps a bit faster.;

    Indications For Bmd Screening

    MTF 18 5 months HRT
    • Clients over 65 years old
    • Clients over 50 years old and with higher risk for osteoporosis
    • Clients with any other risk factors for osteoporosis or bone loss
    • Agonadal clients with eleveated LH levels
    • Clients at any age having undergone orchiectomy and having been off exogenous hormones for any significant length of time
    • Clients on anti-androgen therapy for a significant length of time without co-administration of exogenous estrogen

    Breast exam

    Use the diagram below to find out whether your client needs breast cancer screening.

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    Sarah L Schneider Ms Ccc

    Sarah L. Schneider, MS, CCC-SLP, is Speech Language Pathology Director and Health Sciences Assistant Clinical Professor in the Department of Otolaryngology Head and Neck Surgery. She practices clinically at the Voice and Swallowing Center. Clinical and scholarly interests include the evaluation and treatment of all aspects of voice and upper airway with special expertise in the professional speaking and singing voice, transgender voice and communication, spasmodic dysphonia and vocal tremor, irritable larynx including PVFM and chronic cough, and alaryngeal voice restoration. In addition, she has experience with pediatric voice and instrumental assessment of velopharyngeal insufficiency.

    She joined the UCSF Department of Otolaryngology, Head and Neck Surgery at the Voice and Swallowing Center in 2007. Since that time, she has helped to further develop the speech language pathology program throughout the Department of Otolaryngology striving to provide interdisciplinary and world-class care to those with voice, swallowing, and communication complaints. She has her Certificate of Clinical Competence in Speech-Language Pathology from the American Speech Language and Hearing Association and is licensed in the state of California.

    Professional affiliations include ASHA, the Special Interest Groups – Voice and Voice Disorders and Telepractice of ASHA, and the California Speech and Hearing Association. She is a Lee Silverman Voice Treatment certified clinician.

    Transgender Ftm & Mtf Hrt

    If youre interested in hormone replacement therapy in Atlanta, you are in good hands. Transitioning is the single-most important decision an individual can make. While transgender hormone replacement therapy is a safe treatment that comes with minimal risks and undesirable side-effects, its important to start HRT with a specialist who can help design your program, all the while providing support and advice.

    Whether youre making the transition from male-to-female or female-to-male, as a transgender individual, you need to consider the quality of your overall health care. Unfortunately most general physicians and healthcare providers are not properly equipped to care for transgender patients. In turn, you can benefit from having a supportive and experienced specialist by your side as you begin a new chapter in your life.

    Erin Everett, NP-C, AAHIVS, is a provider of healthcare for transgender patients in Atlanta who offers hormone replacement therapy for both transgender men and women. Erin is committed to providing a safe, nondiscriminatory space for everyone to receive the highest quality healthcare especially those within Atlantas LGBTQ community. For more information about transgender hormone replacement therapy in Atlanta, contact Erin to learn more.

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    Gender Affirming Hormone Therapy

    Planned Parenthood of Southwest and Central Florida offers;Gender Affirming Hormone Therapy, either testosterone or estrogen, for transgender patients. We see hormone therapy as an important service that really goes to the core of our mission. This service can be found at any of our health centers.

    Our transgender hormone services include:

    • Transgender Female ;hormone therapy including estrogen and spironolactone
    • Transgender Male ;hormone therapy including testosterone

    We may be able to start or continue hormone therapy and provide referrals for gender-qualified therapy and resources if needed. If you are on hormone therapy, you can utilize the health center for ongoing care and monitoring.

    In order to receive Gender Affirming Hormone Therapy;you need to be over 18 and capable of providing consent. If you are 17, you will need your parent/guardian to accompany you for your appointment. If you are 16 or younger, additional paperwork is required. Please be aware that there are special consents for these services. Contact us at 941-567-3800 for specific details and to make your appointment.

    What to expect on your first visit:

    At Planned Parenthood we want to make sure you have all the resources you need to live a healthy and strong life. You can find additional resources for transgender care and services through one of our coalition partners, Equality Florida here.

    Choose Where The Order Will Be Sent


    To your home

    • Because it is against the law, you do not want the police to see your home or work address on the package.
    • Do not have hormones mailed to your job. You might get fired or your coworkers might find out.
    • It is better not to send them to your home, even if you live alone.

    To your private mailbox

    • You can rent a private mailbox to get packages at a local UPS Store or other store that has private mailboxes.
    • This will probably cost $200 to $300 a year for a small box.
    • Some private places may offer them to minors. Some do not.

    US Post Office mailbox

    • This will probably cost $20 to $200 a year for a small box.
    • People under age 18 can get a post office box. I have written a separate page on;getting a post office box for minors.

    Friend or relative

    • You need to trust them.
    • You need to come out to them.
    • You need to be sure they will not tell others.
    • You need to tell them the local laws that cover your order.

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