Published on March 30th, 20210
Gender Affirming Voice Training: A Snapshot from Canada
Written by: Shelagh Davies, M.Sc, RSLP (Retired)
Voice therapy for gender diverse people is a new specialty that has grown exponentially in recent years. One of the pioneers in the field, Georgia Dacakis, was curious to know how this service is being offered around the globe and I volunteered to find out what we are doing in Canada.
So here is an informal snapshot of 35 Canadian S-LPs’ practice with gender diverse people. This information was obtained through web searches and over 100 emails and phone calls with colleagues. Please consider this an initial search rather than a final summary. I have only included information that I could verify by talking with the clinician or by taking it from a reputable website. It is likely I have missed some people and made some mistakes and for that I apologize in advance.
This survey looks at what was happening in pre-COVID times; I am not documenting the profound changes in practice that the pandemic has necessitated. Also I did not investigate the work of voice teachers and speech trainers who may offer help in this field.
I would like to thank everyone who took the trouble to contact me with information about their practice. In particular I am most grateful to Glen Nowell and Colleen Braun-Janzen who helped connect me with many colleagues I never would have found on my own.
A Brief History
While most Canadian S-LPs have come to this practice within the past 5 or 10 years, there are a few pioneers. In Quebec, Glenda Falovitch has offered voice training for gender diverse people, in both French and English, for the past 40 years. In Manitoba, publically funded gender affirming voice services have been available since around 1992. In the early days there were very few clients, perhaps 5 to 10 per year and the need was exclusively for voice feminization. In Alberta, the Calgary Voice Program has been providing these services for more than 20 years. In Saskatoon, Merrill Tanner worked with gender diverse people over 25 years ago and then continued the practice when she moved to Edmonton 20 years ago. In Vancouver, around 25 years ago, some limited service was offered through Vancouver General Hospital’s Gender Clinic. That program folded in 2002 and in 2004 Shelagh Davies developed a program of voice feminization for transgender women, which still runs today. In Victoria, Susan Edwards began gender confirming voice services in 2007. In Toronto, Gwen Merrick began gender affirming therapy in 2007 and in 2008 Janice Bennett launched the city’s first publically funded therapy program for transgender people, which ran until 2014. From 2015 to 2018, Lyne Defoy offered voice feminization training in Quebec through CHU de Québec. In 2018 she wrote a detailed report describing the critical need for this service, but unfortunately funding has not been available to keep the program running.
Current gender affirming voice training services across Canada
Clinicians are grouped by region or province but many also offer virtual service through web-based platforms. And during this time of pandemic that is what almost everyone is doing.
Glen Nowell is in Halifax and is the provincial voice specialist. He works with both adults and adolescents. Currently he sees clients individually but prior to the pandemic he offered both 1:1 and group training sessions. In Sydney, Erin Burke provides gender affirming voice training for adults 18+ years. These services are funded through Hearing and Speech Nova Scotia, a province-wide organization under Nova Scotia Health. Heather Maclean is in private practice and provides gender-affirming voice training.
There may be other clinicians across the province who offer services in French and/or English but I was not able to confirm their practice at this time.
Elissa Benjamin works in English with gender diverse clients through her private practice in Montreal and sees clients in both group and 1:1 settings. She accepts referrals from the Centre Meraki and directly from her website.
Glenda Falovitch has worked with a gender diverse population for 40 years. Now solely in private practice, she offers therapy in English and French and usually on a one to one basis, via Zoom
Cédric Maguin offers gender affirming voice training through his private practice.
Burlington: Linda Saarenvirta is in private practice with S L Hunter SpeechWorks and has practiced in this field for about 10 years. She sees clients both 1:1 and in group format, based on client preference. Typically clients are seen one to two weeks from time of referral.
Hamilton: In 2012, Anick Lamarche began seeing adult patients for individual therapy as part of her voice clinic role. Services in the city have expanded and there is now also a Youth Gender Affirmation Clinic available to youth under 18. An initial visit includes consults with an Adolescent Medical Specialist Physician, Endocrinologist and S-LP. Anick then works with interested youth in 1:1 setting. Her caseload includes a large number of young trans masculine patients and non-binary and two spirited folk.
St. Catharines: Natalia Evans is in private practice and has been providing gender affirming voice therapy for about 10 years, increasingly so in the past few years.
Alyssa McCarthy currently offers individual therapy only but hopes to be able to start either an introductory or maintenance group in the coming year. She is in private practice.
Gwen Merrick began offering gender affirming voice therapy at St. Michael Hospital in 2007. In 2018 she started a 10 week voice feminization training program composed of group and individual sessions. She also offers limited individual training, mostly for trans masculine clients.
As a speech-language pathologist in private practice, Jordan Scholl has worked with transgender clients for 5 years. He also has 5 years’ previous experience with this population as a voice teacher/vocal coach. Jordan also offers input for the singing voice.
Melanie Tapson has been working with gender diverse clients since she started private practice in 2013. She offers 1:1 gender spectrum voice and communication training and training for the singing voice of gender diverse people.
Since services began almost 30 years ago the demand has grown exponentially with 100+ requests per year. As in other places across Canada, the demand outstrips the funding and available service and there have been long waiting lists. Clients now include non-binary and trans masculine people.
There is an introductory educational session for all new clients, followed by a 1:1 voice assessment. Voice therapy is offered in a group or on a 1:1 basis, depending on the best fit for each individual. Province-wide service is run out of the Deer Lodge Centre in Winnipeg, by S-LPs Colleen Braun-Janzen, Dina Kyriakopoulos and Leslie Sarchuk.
Christie Ife provides gender affirming voice services in Saskatoon through the Adult Speech Language Centre in Saskatoon City Hospital.
Calgary: The Calgary Voice Program has been providing publically funded voice services for trans adults for more than 20 years. Current clinicians are Meri Andreassen, Shari Beveridge and Renata Terra. In the past, treatment began with an educational, introductory group session, but now all therapy is 1:1. There is a strong focus on patient self-efficacy, with S-LP input as guide/resource.
Sable Chan has been working with gender diverse people in her private practice since 2018, after acquiring specialized training in the field.
Teresa Hardy and Merrill Tanner provide publically funded voice therapy for gender diverse people at the Glenrose Rehabilitation Hospital. Teresa is a specialist in transgender voice and this year was awarded her PhD from the University of Alberta for her research into helping transgender individuals find voices that match how they want to be perceived. Merrill has a Master of Music in Voice Performance and a PhD in group voice therapy. These highly qualified clinicians see gender diverse clients for the speaking voice and Merrill also offers training for the singing voice.
In this program voice therapy is offered in a combination group/1:1 model. There is an individual assessment/training session before and after group therapy. Almost all clients receive introductory training in a group format (5 sessions) with one individual training session provided after the first group session. After the group is complete, 1:1 sessions may follow as the client needs/wants. This model helps to manage caseload demands while still having the opportunity to do some 1:1 trouble-shooting (to establish healthy voicing at the new target frequency). The exceptions are clients from out of town or whose schedules cannot accommodate the weekly group sessions. In the New Year they hope to use virtual practice to include out of town clients in group training sessions.
Trans Care BC offers a publically funded, province-wide program of voice and speech feminization therapy for trans feminine people. The program, Changing Keys, combines 1:1 and group therapy sessions and may include 1:1 telehealth sessions where applicable. Before the pandemic, in-person sessions ran over 9 consecutive weeks in Kelowna, Surrey, Vancouver and Victoria. In some smaller communities the program was delivered in an intensive group session over a long weekend. For people in remote communities, 1:1 therapy is offered through telehealth platforms. Facilitators for Changing Keys include Abby Brooks in the Island Health Authority, Gillian Grevstadand Mia Mosters in Vancouver Coastal Health Authority, Tassani Hoskyn in Interior Health Authority and Sherri Zelazny in Fraser Health Authority. All of these clinicians also see gender diverse clients privately.
Victoria: Susan Edwards has seen gender diverse people in her private practice since 2007.
Megan Morrison sees gender diverse people in her private practice that serves Vancouver and Pender Island.
Alannah Turner works with gender diverse people through Columbia Speech & Language Services. She also offers a limited number of sessions through the Provincial Voice Care Program at Vancouver General Hospital.
A changing practice
Clinicians across Canada have noted that their caseloads are changing. Ten or twenty years ago most clients were middle aged or older; now they tend to be younger, with more people in their 20’s or teens. In response to this shift in demographics Nova Scotia and Ontario have developed programs specifically for adolescents.
There has also been a broadening in the scope of gender identity of clients seeking our services. In the past most clients identified as trans feminine and our input was almost exclusively voice feminization. Currently clinicians are seeing an increasing number of people who identify as trans masculine, gender non-binary and two spirit. Teresa Hardy in Edmonton reported that they used to get 5 referrals per year for trans masculine voice; now they get 5 a month.
Voice therapy is generally unfunded or underfunded across Canada and gender affirming voice training is no exception. Waiting lists for publically funded programs remain distressingly long and tend to grow as the service becomes more widely known. In Manitoba clinicians reported 100+ referrals per year. In other provinces clients may wait up to 2 years for service. However across Canada there are clinicians in private practice who are qualified in this specialty and have minimal wait times. Clients with third party coverage can check for funding under the heading ‘speech therapy’.
We don’t yet know all the effects of the pandemic but we can be fairly certain that service delivery will be forever changed and possibly expanded in ways as yet unknown. Currently almost all 1:1 therapy is online and in BC, and probably elsewhere, clinicians are experimenting with Zoom therapy groups. How this will affect therapy outcomes and experience is still to be determined, but it may allow more uniform access to this highly specialized service.
And as to this report, my dear colleagues, what you do with it is up to you. It could be the start of a support group, a special interest group or simply provide some reassurance that you aren’t alone. As for me, I’m going to send this to Georgia then go back to being retired and learning to play the cello. It has been a great pleasure to connect with you all and I wish you well,