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  • Writer's pictureTallulah Breslin, MS, CCC-SLP

How can we continue to provide gender-affirming care when threatened?

Updated: Jun 16, 2023

Background (please scroll to actions steps below if you're already aware of the current situation):


Discriminatory legislation in America is having a profound effect on the transgender and gender diverse community, and providers of all types of gender affirming care, including voice training This is despite there being no ruling or law currently in the United States that bans or limits gender affirming voice training. There have been many negative effects from politicians and discriminatory organizations and individual's efforts, and voice training has been directly targeted in some instances.

In Texas, after the attorney general released a non-binding opinion that gender-affirming HRT, puberty blockers, and surgery for minors is child abuse, CPS was directed to investigate anyone who sought gender affirming care for their children. People were fired from CPS who had transgender children. Families were investigated for providing care their doctors had determined was medically necessary (though this was since stopped by the courts). Some parents then began to privately pay for voice training, instead of using their insurance, to avoid "legal problems." Other parents were less likely to seek out voice training or other gender affirming care because they were unsure if it was allowed, and less likely to feel comfortable using the insurance benefits they had, or to believe insurance would cover this care. People who were using Medicaid to pay for voice training may in some places no longer be able to do so, or may choose not to out of fear. Then, in May, the attorney general began to investigate hospitals that provided gender affirming care. One hospital closed their adolescent care department because it was providing gender affirming care to minors. These investigations included requesting all documents that pertained to gender affirming speech therapy, including those with outside providers, even though there is no law or even ruling that gender affirming speech therapy, as they called it, is not ok. They have fortunately not yet gone after any speech therapists directly. This has had a chilling effect on providers being willing to provide this care. Some providers no longer let their other providers know about other gender affirming care being provided, or who that care is provided by, so as not to risk the other provider reporting this medically necessary, life saving care as child abuse. Families who can are moving out of Texas, even when they have lived here for generations, to get their children gender affirming care and to keep their loved ones alive and safe. Teens have had to stop taking puberty blockers or HRT because their providers have been fired or told by the organizations they worked for that they were no longer allowed to, and some entire practices have shut down. People have given up their businesses for fear that they will be shut down if people find out they are transgender. Everyone in the community is having to work very hard to maintain their mental health when they feel attacked and discriminated against by their government. Kids are having to quit sports because they're not allowed to play, even if it isn't competitive sports or affecting the fairness of the game. Kids and adults avoid drinking liquids before or during public outings, such as school or work, to limit the risk of needing to use a public bathroom. This can cause dehydration, which can negatively effect the voice and overall health. People are being attacked, verbally and physically, and some have been murdered or committed suicide.


So, what can we do? Action steps!

We currently are not threatened with jail time or losing our licenses in America for providing gender affirming voice training. If that happens, our decisions may change.


Here are things we can do now:


  • Advocacy is extremely important now. We need to call our representatives, but when possible, we also need to testify against the bills. Maybe you have to wait all day to only get two minutes to speak, but as a medical provider who provides this care our expert opinions need to be shared. We can also write to the president and organizations and encourage action.

  • Give news interviews. We did a news interview a few weeks ago when the local hospital shut down their care, and now the news people I was interviewed by are saying the dialogue has shifted and this is no longer something they're covering. We need to keep this conversation going, not allow it to be last week's news cycle.

  • If you are investigated yourself, contact the ACLU, or your local equivalents of Lambda Legal or Equality Texas here. Donate to organizations like these so they have resources to fight for affirming care. Do fundraisers to raise money for them.

  • Don't just let them shut our vital, life-saving work down. Continue to provide this care legally, even if you're no longer comfortable sharing online that you do. If you're not comfortable doing so, find the names of other providers who still are so when people reach out they're not left without resources.

  • Connect with your peers providing this and other vital gender affirming care and reassure them that it's worth it.

  • Reassure your clients not to stress if they can't handle reading the news or advocacy themselves, as protecting their own mental health, not letting people take that away from them, is a powerful act of resistance in and of itself.

  • Do sign petitions. Make your own petitions and encourage people to sign them.

  • Contact ASHA and tell them how important it is that they make a statement supporting gender affirming voice training.

  • If you're in a place that this care is legally protected, you especially need to advocate since your license is protected. This advocacy will allow those medical providers and clients who are at risk to avoid drawing attention to themselves and becoming targets. And, even if you're in a place where your license is protected, if community discrimination is making public advocacy unsafe, behind the scenes advocacy is also very much needed.

  • Educate people about what this care can do, how to locate it, how to ask insurance to cover it, anything you can to do support the community so that people feel safe, and heard, and aware of what care they can receive, and don't feel without options or support and end up considering suicide.

At the end of the day, providers of gender affirming care are saving lives.


Also, gender affirming voice training is completely reversible, and it doesn't sterilize anyone, or even change anything about their body. So, politicians, please find something else to target.


-Tallulah Breslin, MS, CCC/SLP (she/they)

Gender & Identity Affirming Voice Training @Harmonic Speech Therapy


Love your voice

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