Speech therapy

This page is about your options for changing how your voice sounds.

You might want to do this if you want to make your voice sound more masculine, feminine, or neutral, or you want to be able to change how your voice sounds at different times. This doesn’t just mean changing the pitch of your voice – it can include qualities like resonance, intonation, rhythm, and volume.

Not everyone who is trans makes changes to their voice. However, if you want to, you can choose to use or more of these options:

  • Professional support: Support around making changes to your voice can be provided by an expert – this is normally a Speech and Language Therapist or a vocal coach who has specialist experience and training in trans voice. This can help you change the average pitch of your voice and other qualities of your voice like resonance, intonation, rhythm, and volume. However, it can’t make your voice be able to hit deeper pitches than it could already, and it requires a significant amount of practice to perfect.

  • Teaching yourself: You can also teach yourself how to make changes to qualities of your voice using books, videos, and apps. However, this may be more difficult than doing this with professional support. You can find some suggestions for resources to use in the Trans voice resources section.

  • Testosterone: Testosterone therapy allows many people to reach lower pitches with their voice than they would otherwise be able to. However, it’s not the right choice for everyone – testosterone has lots of different effects, many of which are permanent, including making it harder to reach higher pitches with your voice. If you want to read more about all of the different effects testosterone has, read our Hormone Therapy page. Some people find that in addition to the effects of testosterone allowing them to reach lower pitches, they want to change other aspects of their voice, and professional support can help with this.

  • Surgery: some people have surgery to make changes to their voice. There are types of surgery which can allow you to reach lower pitches, or which can raise the pitch of your voice, but they don’t change other aspects of your voice. However, there are risks to consider – your voice could be affected in ways you don’t want, and as with all significant surgeries, there’s a small chance of more serious effects on your health. Your surgeon should talk through these risks with you. Surgical options to change your voice are not normally funded by the NHS and you would have to pay for these yourself. This is one of the reasons that not many trans people in the UK decide to get vocal surgery.

    You can find details of how to access private surgeons offering vocal surgeries on our Private Care page. Surgery is usually most effective when it is combined with professional speech therapy support, and surgeons may require you to have spent time working with a professional before you are eligible to have surgery with them.

The rest of this page will cover professional support around trans voice, and resources for working on your voice independently.

NHS funded services for trans voice are normally only available to people who are 18 or older, as there is currently limited research on providing these services to younger people. 

Trans adults in the UK may be able to access NHS funded speech and language therapy or vocal coaching, but this will depend on:

  • which area you live in;
  • whether you have been referred or assessed to an NHS gender clinic; and
  • which NHS gender clinic you have been referred to or assessed by.

You can read about the voice services offered by each NHS gender clinic on their websites – there is a full list of the websites of NHS gender clinics on our Gender Clinics page.

In many areas, there are also local NHS voice services that you can use without needing a referral from the gender clinic, though they may not have specialist training in working with trans voice. Find the local organisation responsible for your healthcare and search for their Speech and Language Therapy service for more information about the support available in your local area. Depending on your area, you may be able to self-refer, or you may need to ask your GP to make a referral for you. If a GP referral is needed, it may be useful to take details of any local policies about trans voice or details of your local Speech and Language Therapy service as your GP may not know how to make a referral or where to refer you to.

The amount of sessions available to you on the NHS is often few in number – many services provide 4-6 sessions. Whether this is enough sessions for you will vary based on your situation and how quickly you make progress.

Many trans people decide to pay for support with their voice. You might choose to access private services because you want more sessions than the NHS will offer you, because you want more choice of who you work with and how they work, or because you’re not expecting to be offered support by the NHS for a long time.

The cost of private support can vary a lot depending on who you’re working with. You may want to research different providers to consider your options. More expensive providers aren’t always the ones with more experience or qualifications. There are some tips later on in this page about how to stay safe when choosing a private service.

You can find more information about private services that provide support around voice on our Private Care page.

If you’re having an appointment using video call software like Zoom, Teams, or similar, think about whether the microphone you are using is good enough for the vocal coach to hear you clearly. If you normally use a headphone designed just for chat or phone calls, you might want to consider buying a microphone specifically designed for making quality recordings of voice, such as a ‘podcaster’ microphone. One appointment with a private professional can cost more than the price of a good quality microphone! Vocal professionals may need to look at your posture and the movement of muscles in your neck, so make sure you’re well lit and using a camera that lets the professional see your whole face and neck clearly.

Before your first appointment, you might also want to prepare a list of things you’d like the voice professional to know about you. This is particularly important if you have specific needs related to a disability, medical condition or because you’re neurodivergent.

You can find out more about communication with medical professionals on the Communicating about my needs page.

Your voice appointments may be group sessions or one-on-one sessions with just you and the voice professional.

In these sessions, you’ll:

  • Discuss about what qualities of your voice you want to change – what is it you actually want to sound like?
  • Learn how to work on your voice in ways that minimise risk to your voice – including learning how to take care of your voice (vocal hygiene).
  • Learn how to do exercises that build specific skills with your voice and breathing – these exercises can seem strange or not directly related to gender, but they’re really important to build up the skills that let you achieve your voice goals.
  • Get an opportunity to experiment with your voice in front of the professional – this will help you to build confidence in using your voice differently around other people.
  • Get feedback on how you’re progressing – encouragement from someone else can be really important.

You might also be taught how to use digital tools to analyse your voice and track your progress.

Some local NHS voice services are under extremely high demand and aren’t able to offer this level of service to everyone referred to them. People in some areas might be offered training in a webinar format.

In your appointments, you shouldn’t be taught to speak in a certain way or to imitate a particular person. A voice professional with proper training for working with trans people should be helping you work out what you want your voice to sound like, and help you reach your goals. 

In between your appointments, you’ll also be expected to do an amount of ‘homework’. This will normally involve practicing voice exercises.

Working between sessions is really important. You’ll be expected to practice regularly, ideally for some time every day, in order to get the most out of your appointments. Think of it like practicing the violin – you need to do it in between lessons to get better.

If you live with other people you might be worried about them hearing you making unusual noises that they aren’t expecting. If you’re concerned about maintaining your privacy while practising, consider:

  • finding times of day when your home is empty
  • using white noise sources like the shower or loud music to help disguise the sound of your voice
  • going a walk, or walking the dog, as a reason to get out of your home to somewhere you can practice more privately
  • practising while commuting in a car (if you do that), as cars are designed to be relatively soundproof
  • visiting a supportive friend who doesn’t mind you practicing at their house

You may find you can build up some of the same skills you are using to alter your voice when doing other things. For example, practising singing might help with resonance, and playing many musical instruments can help with breath control.

An important thing to practice in between sessions is using your voice in front of other people to build up your confidence. Some easy places to practice using your voice in front of other people are:

  • in-person LGBTQ+ events, activities, and meetups – take a look at our Sources of Support page for places to find these kind of spaces
  • voice calls – could you make a food order on the phone, or call a new person in the workplace?
  • public transport – saying ‘thank you’ to the bus driver, or buying a ticket at a ticket counter , can be much easier than speaking to someone you are likely to meet again
  • online games – do you play anything that is online multiplayer and that has a voice chat feature?
  • online trans communities – many will have a voice chat and be happy for you to speak in whatever voice you want to

It’s important to make sure that you’re working on your voice safely.

If you’re working with any voice professional, also check that they’re properly trained. You can ask what specialist training they’ve received in working with trans service users, and how long they’ve been working with trans clients. 

If you’re working with a speech and language therapist, at a minimum they should be registered with the Health and Care Professions Council (HCPC), and you may also want to find out if they are a member of a professional association like the RCSLT or ASLTIP. 

Whether you’re working with a professional or not, it’s important to make sure you’re warming up properly, just like if you were doing sports or athletics.

These resources explain how to work on your voice, including how to warm up and work safely on your voice.

You can read more about what to expect from working with a voice professional in these resources:

You can find information about changing your singing voice on:

There is information about surgical options for altering your voice in these guides:

Community voices

  • “I’d found a YouTube video that gave tips on training my voice into a lower pitch. I practiced in the car on my way to work as a teacher. Doing this felt like it was helping me to prepare for a day of talking and projecting my voice in a pitch that felt closer to right for me. There were certain phrases I’d practice saying in a deeper and deeper voice and then I’d follow up with singing along to songs by bands with singers with deeper voices than mine. I now know the words to lots of songs by The Killers, James and The Stone Roses!”
  • “Some good voice training resources I know are free YouTube videos—like the Trans Voice Lessons channel. There are also more structured paid options, such as Seattle Voice Lab with its supervised courses. I also follow a few people on Reels and TikTok for quick hints and tips here and there. Different approaches work for different people, so it’s worth exploring and seeing what feels right for you.”
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This page is based on information originally posted on genderkit.org.uk with permission.

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A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of legal services.

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