Speech therapy supports people to become their true selves

A specialist service to support transgender people align their voices with their true selves has been set up in Swansea Bay.

The new Trans and Gender Diverse service will support transgender and gender diverse people with voice and communication skills.

A dedicated speech and language therapist (SLT) will teach them about voice care and explore different aspects of communication associated with gender.

Swansea Bay is the first, and currently only, health board in Wales to provide a dedicated SLT role specifically for this role.

The service aims to support and guide transgender and gender diverse people towards their gender identity.

Gender diverse is used as an umbrella term to encompass all those whose gender identity does not align with the sex assigned to them at birth.

Rebekah Gabbitas (pictured), the service’s speech and language therapist, said: “SLT services have always offered services to transgender and gender diverse people.

“Those referrals were previously few and far between but since the Welsh Gender Service was set up we have been receiving lots more.

“Gender affirming services support people who feel there is a physical incongruence between their physical appearance and their gender, but that can be in their speech and their voice too.

“It can be very distressing for somebody - even hearing their voice, because it doesn’t match who they are or their sense of self.

“It can also mean that other people will misread their gender causing embarrassment and distress. Unfortunately, gender diverse people regularly experience transphobia, which can manifest as harassment and violent attacks.

“It’s worth stating that no-one owes the world a particular voice or gender presentation but for those who experience dysphoria around their voice, it can be distressing.

“You can see how that has very important impacts on their participation in society as it can result in a lack of confidence to speak.

“So simple things like going on a bus and asking for a ticket, asking for something in a shop or ordering a drink in a bar, and more significant things like participating in education or in work can be difficult.

“Our role is looking at the different aspects of voice and communication and helping that person align it with something that feels authentic to them.”

Patients receive 1:1 support which focuses on aspects including vocal exercises and changes in pitch.

There is also the option to take part in group sessions to build on the skills and techniques that have been learned.

“We work with them on specific voice exercises to explore their vocal flexibility and aspects of their voice they can change that are associated with gender,” Rebekah added.

“Often people will think of pitch as something they want to work on but also it’s the musicality of the voice and how we stress the voice and do things to make it resonate in a different way.

“For someone who wants to feminise their voice we would look at ways of boosting the higher frequencies and letting the lower frequencies drop out.

“While someone who wants to masculinise their voice, we do things to boost the lower frequencies.”

Patients over the age of 18 are eligible for the service and can be referred by their GP, the Welsh Gender Service or sexual health teams.

The Welsh Gender Service is a multidisciplinary administrative and clinical team, made up of consultants, gender clinicians, clinical psychologists, SLTs and management who work together to provide holistic patient-centred care focussing on hormonal, psychological, and social aspects of transition.

Usually, people are initially referred to the Welsh Gender Service by their GP and following a consultation they will then be referred to local teams depending on what support they require.

For many patients, the support they receive goes far beyond the speech therapy.

Rebekah said: “We can spend a lot of time with our patients so I feel we also have a very important role in supporting them as well and hearing their stories and supporting them in their well-being.

“For some people speech therapy is right up there in terms of importance and what they need.

“It really supports them in their gender transition in terms of feeling whole and aligned with themselves and comfortable.

“It reduces distress, anxiety and depression but also enables them to participate and have the confidence to do things they wouldn’t have had the confidence to do before.

“In this way, the potential impact of speech therapy may be far-reaching.”

Jo Bradburn, Head of Speech and Language Therapy, said: “SLT plays an important role in ensuring the best possible outcomes for trans and gender diverse people.

“SLT interventions are a crucial part of the psychological and psychosocial part of the gender care pathway.

“SLT aims to alleviate gender dysphoria around voice and communication by facilitating an individual’s sense of vocal comfort and authenticity.

“We have already seen positive outcomes for patients by offering this service in terms of the impact SLT has had on well-being, self esteem and confidence.

“I am thrilled to say that we are the first, and currently only, health board in Wales to have a dedicated SLT for the trans and gender diverse population.”