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Health Brigade Helps Local Trans Community Find Their Voice

David Streever | October 9, 2017

Catherine Wall didn’t want to worry about being misgendered on the phone anymore. “It’s difficult to say ‘Excuse me, I’m not a sir’, on the phone,” she says, talking about why she began vocal training with Cheryl Ware, a speech language pathologist who began offering voice and communications therapy for Health Brigade‘s transgender clients earlier this year.

Wall was drawn to the vocal training by a combination of factors. Part of it was wanting her inner and external voice to match. “My voice wasn’t what I wanted it to be,” she says, noting that every transition is unique. “Not every trans person is going to want to go into voice therapy, but it’s been part of my transition.”

The other concern was professional, seeking ways to handle discrimination in her prospective industry. “I want to be in academia, which is seriously an old boy’s club,” she says. “It’s difficult for women, and even more so for trans women, and I wanted to reduce the barriers I’d face.” She’s hoping to become a psychologist, looking to increase trans representation in a field full of harmful stereotypes and misconceptions about trans issues.

The two women share a deep interest in voice training techniques, something that Ware brings up early. “Catherine came to this process with a fantastic sense of how her voice worked. I see myself as a partner in this,” she says. Wall’s background in music makes the work easier. The self-described “giant nerd” has always been interested in vocal technique, supported by her studies into music and theater at two different universities.

Ware is a speech language pathologist, working full-time in her field, but she wanted to offer her services to a community that faces open hostility and widespread discrimination. She began volunteering at Health Brigade in February, with the specific intent to help the organization’s transgender clients. “I was inspired by the election,” Ware says, talking about the realization that political gains for the trans community could be undone by the sweep of a pen.

Existing resources for trans people seeking voice training were insufficient and even counter-productive. “This is hard work, and there is a lot of misinformation out there–YouTube videos, articles, that have very harmful advice about voice. It’s important to work with medical professionals,” she says.

The work begins with a simple intake form and a sample of audio clips to illustrate the difference training can make. “A lot of people don’t know what voice therapy can do. It’s exciting to see their eyes just light up when they hear the before and after,” Ware says, explaining voice therapy and comparing it to other treatments. “Testosterone changes the voice by thickening the vocal folds, dropping the voice. But estrogen has no effect. There are surgeries, but the jury is out. Research suggests voice therapy done right can be just as efficacious, and safer.”

She teaches people to listen carefully and to understand how the voice works, including resonance and pitch. “We work to elevate pitch safely through the use of facilitating words, sentences, reading certain articles,” says Ware. Pitch is easier than resonance because simple phone apps can provide detailed feedback.

Ware found Health Brigade through a series of contacts, starting with the trans coordinator at Planned Parenthood, who introduced her to the Transgender Health Alliance of Central Virginia. She became involved with the trans community and came to the attention of Health Brigade.

For 50 years the center operated as the Fan Free Clinic, but changed their name last year to reflect a facility move and the wide variety of services they offer. Ware’s weekly sessions expand their offerings, which were already comprehensive.

Wall was already a patient at Health Brigade, one of the only options she’s found for medical care. “There are so few providers who have the basic training. Endocrinology, cultural competence, all of it. Provider competency with trans individuals is pretty low,” she says. “And that’s not just here, that’s US wide.”

“This is where I came when I decided I had no choice but to transition.” She receives hormone replacement therapy as well as primary medical care from Health Brigade, and also undertook proactive counseling with a mental health therapist, building coping skills to deal with possible stressors from transitioning. Insurance companies require a diagnosis of disorder, but Wall didn’t have to have this; her care at Health Brigade is based on informed consent, and offered free of cost and of judgement. “This is an affirming practice,” she says. “The people who work here don’t think there is anything wrong with me.”

She’s happy with the way her voice sounds, and with the way people respond when she calls them. “Not getting misgendered on the phone is pretty awesome.” She recommends the practice, but stresses that not everyone will need or want it. “There is no one way to be trans. Some of my friends would not go through this, or any other, therapy. They are just as trans as I am, and they are the gender that they say they are.”