Event Recap: WPATH Discussion on Standards for Becoming a Gender-Affirming Voice Clinician

In November, we hosted a discussion on the WPATH Standards of Care 8, and their new guidance for the education and training of voice & communication professionals that assist with voice training for transgender and gender diverse people.

WPATH is the World Professional Association for Transgender Health. Founded in 1979, they publish Standards of Care documents to “provide clinical guidance for health professionals to assist transgender and gender diverse people with safe and effective pathways to achieve lasting personal comfort with their gendered selves, and to maximize their overall health, psychological well-being, and self-fulfillment.”

The first edition was published in 1979, and last revised in 2012 and 2022, and has grown to become inclusive of many areas, including voice and communication services. Newer editions have trended towards depathologizing gender diverse identities, expanding topics, and integrating evidence. For example, the 6th Edition, published in 2001, is 22 pages with no citations, while the 8th Edition, published in 2022, is 260 pages, 70 of which are citations.

Regardless, the LGBTQ+ CSDSA recognizes the history of the standards of care as a gatekeeper to medically necessary gender affirming care, and acknowledges that WPATH leadership, SOC contributors, and providers of gender affirming care are not exempt from transphobia, and may promote and perpetuate harmful ideas.

At our event, we compared the two most recent editions, and discussed their guidance on training and credentialing for voice and communication specialists, and the implications for speech-language pathology students interested in pursuing careers in that area.

Standards of Care 7

The 7th Edition of the WPATH Standards of Care were released in 2012. This was the first edition with a dedicated chapter on voice and communication. An additional companion document on Voice & Communication published in 2015 by Davies, Papp, & Antoni addressing the available clinical evidence.

The document shares the following recommendations regarding the competency of voice and communication specialists:

• “Specialists may include speech-language pathologists, speech therapists, and speech-voice clinicians. In most countries the professional association for speech-language pathologists requires specific qualifications and credentials for membership.” (p.52)
• “Other professionals such as vocal coaches, theatre professionals, singing teachers, and movement experts may play a valuable adjunct role. Such professionals will ideally have experience working with, or be actively collaborating with, speech-language pathologists.” (p.53)

Minimum credentials for voice and communication specialists (p. 52-53) include:

• Specialized training and competence in the assessment and development of communication skills in transsexual, transgender, and gender-nonconforming clients.
• A basic understanding of transgender health, including hormonal and surgical treatments for feminization/masculinization and trans-specific psychosocial issues as outlined in the SOC; and familiarity with basic sensitivity protocols such as the use of preferred gender pronoun and name
• Continuing education in the assessment and development of communication skills in transsexual, transgender, and gender-nonconforming clients.

Standards of Care 8

The 8th Edition of the WPATH Standards of Care were released in September 2022. This edition greatly expanded the Voice & Communication chapter, and was the first edition to be developed using an “evidence-based approach.”

This edition carried over many of the overarching themes, but increased the specificity and scope of their recommendations. They recommend “specific education” (p. S140), but make important observations about the state of current academic training programs:

• “Academic and licensing credentials of voice and communication specialists (e.g., speech-language pathologists, speech therapists, singing voice teachers, voice coaches) vary by location but typically do not specify criteria for working with specific populations. Standard curricula in formal education for these professions often do not include specific or adequate training for working with TGD populations.” (p.S140)
• “General knowledge and skills related to the vocal mechanism and interpersonal communication are foundational but insufficient for conducting culturally responsive, person-centered care for TGD people that is effective, efficient, inclusive, and accessible.” (p.S140)

In place of a specific credential, the standards outline the skills and knowledge needed by professionals, as well as components that must be included in educational programs.

Specialists should…

• Have working knowledge of “applicable intervention principles, mechanisms, and effectiveness, competence in teaching and modeling voice and communication modification skills, and a basic understanding of transgender health, including hormonal and surgical treatments and trans-specific psychosocial issues.” (p.S140)
• Have knowledge of the “ongoing and dynamic agency of speaker and listener practices,” as well as “relevant processes related to biophysiology, sociocultural meaning-making, and external material forces.” (p.S138)
• Have skills in “conducting appropriate assessments to inform the TGD person’s choice and support the exploration of goals and intervention options by providing guidance in a culturally responsive, person-centered approach.” (p.S138)

Education should…

• “invite [learners] to develop self-awareness, cultural humility, and cultural responsiveness in order to be respectful of and attentive to gender diversity and other aspects of a client’s identifications that can take a variety of forms and imply a range of different support needs.” (p.S140)
• “inform the setting up of a training space or clinic and administrative practices that are designed to be welcoming to TGD people and allow TGD people to feel safe and respected when raising concerns or issues with the voice and communication support team.” (p.S140)
• “include methodologies and practices that have been developed within TGD communities and shown to be effective and should ideally be presented by or in collaboration with TGD people with lived experience of voice and communication support.” (p.S140)

In comparison

Skills, knowledge, and experience recommended by the 7th edition:

• Be a speech-language pathologist (or international equivalent).
• Specialized training and competence in the assessment and development of communication skills in TGD people, and continuing education in this area.
• Basic understanding of transgender health, including hormonal and surgical treatments and trans-specific psychosocial issues.
• Familiarity with basic sensitivity protocols such as the use of preferred pronoun and name.

Skills, knowledge, and experience recommended by the 8th edition:

• Ability to conduct appropriate assessments.
• Knowledge of relevant intervention principles, mechanisms, and effectiveness.
• Competence in teaching and modeling voice and communication modification skills.
• Basic understanding of transgender health, including hormonal and surgical treatments and trans-specific psychosocial issues.
• Self-awareness, cultural humility, and cultural responsiveness.
• Knowledge to set up a training space/clinic and administrative practices welcoming to TGD people.
• (Regarding education) inclusive of methodologies and practices developed within TGD communities and shown to be effective, ideally presented by or in collaboration with TGD people with lived experience.