Northern Region Gender Dysphoria Service (NRGDS) – Voice and Communication Therapy Information Leaflet

NRGDS offers Voice and Communication Therapy as part of their service for people who experience gender dysphoria related to their voice. This leaflet will provide more information about what the Voice and Communication Therapy journey is from referral to discharge.

Quality Approved Resource logo

This leaflet may not be reproduced in whole or in part, without the permission of Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

PDF leaflet for printing

  • Introduction

    NRGDS offers Voice and Communication Therapy as part of their service for people who experience gender dysphoria related to their voice. This service is open to everybody who has begun their treatment with NRGDS. You do not have to be on hormones to have voice therapy.

    The aim of Voice and Communication Therapy within NRGDS is for people to explore their own voice and find a voice that is a better match with their gender identity. You can have voice and communication therapy at any stage of your treatment pathway.

    This leaflet will provide more information about what the Voice and Communication Therapy journey is from referral to discharge.

  • What do we work on in voice and communication therapy?

    There are many areas of voice to be explored which can impact how someone feels about their own voice, and how it is perceived by others. These include:

    • Pitch – how high or low your voice sounds.
    • Resonance – the tone of your voice.
    • Intonation – how voice is varied for meaning, expression or emotion.
    • Volume – how loud the voice is.
    • Posture, breath support, and relaxation.
  • Hormones and voice

    Oestrogen hormone therapy cannot change voice or pitch as it does not have any impact on the vocal cords or larynx (also called the voice box, which allows you to make sounds). Some people receiving oestrogen want Voice and Communication Therapy to guide them how to make changes to their voice.

    Testosterone hormone therapy causes the vocal cords to get thicker which can make it sound deeper. Testosterone hormone therapy does not always help people achieve their desired voice; therefore, Voice and Communication Therapy can help individuals taking testosterone.

  • Our therapy pathway

    Our pathway varies depending on your voice goals and identities. Those looking to pitch up or brighten their voice may follow a feminisation pathway, and those looking to pitch down or darken their voice may follow a masculinisation pathway.

    If you are non-binary, the pathway will be adapted to your goals, and what you want to get out of Voice and Communication therapy. The pathways are there to support your individual needs.

    Initial appointment with a qualified Speech and Language Therapist

    Individual therapy sessions (Up to five sessions)

    Group therapy sessions
    These are optional. Most people choose to join a group

    Review and discharge

  • Initial appointment

    This is an appointment for exploration, both for you and the therapist. This can take place by online consultation or face to face at Benfield House. The therapist will ask you about your hopes and concerns, and your goals that you hope to achieve within the block of therapy. We will:

    • Gather background information about your voice.
    • Listen to your voice, understand your perception of your voice, and explore your pitch.
    • Provide information about how the voice works.
    • Explain what is possible in therapy.
    • Plan for therapy.
    • Provide resources.

    After this appointment, you may decide that you are not ready for voice and communication therapy right now, or that it isn’t for you at all. The focus of this appointment is for you to explore more about your voice and consider your options.

    Please note that voice surgery is not offered on the NHS.

  • Individual therapy sessions

    The individual sessions following the initial appointment will be focusing on working towards your personal goals which may include:

    • Raising or lowering your pitch, comfortably and without strain
    • Exploring resonance and speech pattern
    • Working on a telephone voice
    • Projecting voice at the same pitch
    • Coughing at pitch
    • Understanding the role of testosterone in changing the voice
    • Developing stronger breath support needed following testosterone therapy

    In between these sessions, homework is provided. Research has shown that the more you practice, the easier it will be to achieve these skills.

  • Group therapy sessions

    Group sessions are offered after individual sessions. These support you in applying skills in day-to-day situations. The groups are made up of up to 10 members and can take place face-to-face or online.

  • Tips for looking after your voice before and during therapy:


    • Drink water regularly. Aim for 6-8 glasses per day.
    • Reduce intake of things that dehydrate you such as caffeine and alcohol.
    • Steam inhalation with plain water for 10 minutes a day.


    • Avoid shouting and straining your voice.
    • Limit coughing and throat clearing.


    • Reduce smoking/vaping.
    • Manage any acid reflux or heartburn.
    • Manage allergies.


    • Make sure you have enough breath to support your voice, taking top up breaths as you need to.
  • Discharge

    When reaching the end of the therapy pathway, discharge from voice and communication therapy will be discussed. This is not a fixed process, and your needs will be taken into consideration.

  • Interpreters

    Staff can arrange an interpreter if you need one.

  • Travel information

    Contact Traveline on 0871 200 22 33

  • References

    • Sharing the Clinical Space – Mills and Stoneham 2021
    • Working With Trans Voice – Mills and Pert 2023
    • Oates, J. M., Dacakis, G., & Douglas, J. M. (2019). Voice and communication therapy for transgender individuals: Satisfaction with care and treatment outcomes.
      International Journal of Speech-Language Pathology, 21(2), 158-170.
    • London Gender Identity Service website
    • Nottingham Centre for Transgender Health website

    (websites accessed January 2024)

  • What if I have a comment, suggestion, compliment or complaint about the service?

    If you want to make a comment, suggestion, compliment or complaint you can:

    We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention. You can provide feedback in the following ways:

    • the quickest way for you to do this is to complete our short online survey at
    • complete a Your Voice survey, available on wards, reception areas or from staff
    • other options for sharing your feedback and experience

    Patient Advice and Liaison Service (PALS)
    PALS provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.

    We act independently when handling patient and family concerns, liaising with staff, managers and, where appropriate, relevant organisations, to negotiate prompt solutions. If necessary, we can also refer patients and families to specific local or national-based support agencies.

    North of Tyne
    Tel: 0800 032 0202
    Email: [email protected]

    South of Tyne
    Tel: 0800 328 4397
    Text: 07825 061 035
    Email: [email protected]
    Post: Patient Advice and Liaison Service, Garden Lodge, Hopewood Park, Ryhope, Sunderland, SR2 0NB

    9am – 4.30 pm, Monday to Friday
    An answerphone is available at all times for you to leave a message. A member of the PALS team will aim to return your call as soon as possible.

  • Information about content, other formats and version control

    Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

    This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

    Published by the Patient Information Centre
    2024 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    Ref, PIC/908/0624 June 2024 V1 Tel: 0191 246 7288
    Review date 2027