Interview With Dr. Linda Hoag of Kansas State University
Linda Hoag, Ph.D., CCC-SLP, is a Professor in the Program in Communication Sciences and Disorders at Kansas State University. She teaches in the areas of voice disorders, cleft palate, and speech science. Her clinical practice focuses on voice disorders, paradoxical vocal fold motion, transgender voice and communication, as well as cleft palate. Her research interests also include voice disorders, transgender voice and communication, and augmentative and alternative communication.
Note: You should consult with your doctor or speech pathologist for recommendations on treatment. The views and opinions expressed in this article are those of Dr. Hoag and do not necessarily reflect the official policy or position of SpeechPathologyMastersPrograms.com
How did you become interested in transgender voice and communication?
I have worked with clients with voice disorders for many years but began working in the area of transgender voice and communication about ten years ago when a friend approached me about modifying her voice to sound more feminine. I have found this area of practice to be very challenging and rewarding because it draws upon much of what we know and understand about communication, not just vocal physiology and gender-related voice characteristics. It is a unique opportunity to share in the client’s personal discovery of what sounds and feels like their authentic communication. It has certainly reinforced my appreciation for how important our voices are to us and how liberating it is to express ourselves in a way that reflects our identity.
How can speech-language pathologists (SLPs) help transgender people find a voice that better matches their true identity?
The first step in helping transgender individuals find and use their authentic voice is to recognize that they perceive a mismatch between the voice that comes out and the truly representative one. In order to discover the nature of that mismatch, the SLP needs to listen to what clients have to say and collaborate with them every step along the journey to finding that authentic voice. Often the specifics of that voice are initially difficult for clients to identify. In that case, we need to be able to provide some guidance in what aspects of communication might be considered, in concrete, non-technical terms. During voice sessions, we actively make use of our knowledge of the entire speech mechanism, as well as principles and approaches used in speech/voice therapy to guide clients in producing their desired voice characteristics in an easy/strain-minimized, durable way and in adopting other habits that will keep their voices healthy.
Is it easy for transgender people to access voice therapy? How often is voice therapy a part of transition?
According to a report of a survey in 2015 in the US (James, S.E., Herman, J.L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality), only 14% of transgender women reported that they had received gender-affirming voice modification services, while 48% said they want it someday. The question is whether there is adequate access to SLPs who provide these services. The American Speech-Language-Hearing Association (ASHA) ProFind site lists 71 speech-language pathologists who provide transgender voice services, and although this does not appear to be a complete list, it suggests that these services are not always readily available at the present time.
What are the challenges to effectively altering one’s voice, with and without the help of a professional?
With or without the guidance of a SLP, it is challenging for adults to change their vocal habits and other communicative behaviors. The physical differences between males and females in terms of the speech mechanism after puberty also need to be factored into expectations for modifications to voice and resonance. Additionally, it can be challenging for clients to identify exactly how they want to sound and express themselves. It is a process which may take a considerable amount of time and effort even after working with a SLP. Individuals who have attempted to modify voice on their own and/or use information found on the internet often report to me that they can reach their desired pitch, but their voice feels strained and effortful and it isn’t reliable, flexible (expressive of emotion), or durable. Some come with voice problems that warrant referral to a laryngologist. I think it is wise to have a SLP provide guidance in gender-affirming voice modification to avoid these problems.
You have many research projects in process, what else are you researching and how do you select new projects?
I am interested in a variety of aspects of communication disorders, including areas of voice disorders and augmentative and alternative communication. I am finishing up a project about how typical speakers respond to risky communication, that is, things people say that don’t quite fit the situation. After that project is completed, I plan to start two projects in voice disorders. I select projects based mostly on my specific interests in voice and language, but am often constrained by what is feasible in my clinical environment.
What aspect of your research are you most proud of?
In terms of the project I completed with a transgender client, I was most proud of the client herself and the courage and tenacity she showed in discovering and mastering her true voice. In order to do this, she devised a very creative and effective way (using a supportive community of massively multiplayer online gamers) to practice the voice she was learning in her voice sessions. This was prior to coming out to her family and those closest to her, eliminating all the people easily available for practice. We can appreciate how this might affect her progress, given the need for practice and opportunities to generalize skills outside of sessions. I wanted to share this client’s experience with other SLPs to demonstrate in a concrete way how clients often have the best, that is, most feasible and meaningful, solutions to their problems, if we frame our clinical interactions in a way that allows us to hear and work with what our clients are saying about their motivations and perspectives.
What is your advice for future SLP students?
My experience with undergraduate and graduate students tells me that they are attracted to the profession because they are strongly motivated to help others. I am continually impressed by their demonstration of it in a variety of ways. Given that, my advice would be to channel that motivation to sustain a lifelong commitment to learning. One career-long challenge will be to identify what out of all the information available should inform clinical practice. I would encourage students to focus their learning on how to identify high quality research and how to make use of it.
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