In the seventh version of their Standards of Care, WPATH recognizes that, as each person is unique, so is the person's gender identity. The goal of speech-language therapists/ pathologists is to help transgender people develop voice and communication that reflects their unique sense of gender. When outer expression is congruent with an inner sense of self, transgender people may find increased comfort, confidence, and improved function in everyday life. Transgender voice and communication is a relatively new area of practice within speech-language pathology/therapy and this document is intended to support clinicians and researchers working in this field. It begins with a review of the evidence-based literature in transgender voice and communication. The paper then discusses these clinical topics: trans-specific voice-and-communication assessment, voice feminization protocols and voice feminizing surgeries. There is also a section on speech and voice masculinization-an area that has received little previous attention. As minimal standards have yet to be established in this field the paper concludes with recommendations for good clinical care.

Purpose The aim of the study was to examine associations between speaking fundamental frequency ( f os ), vowel formant frequencies ( F ), listener perceptions of speaker gender, and vocal femininity–masculinity. Method An exploratory study was undertaken to examine associations between f os , F 1 – F 3 , listener perceptions of speaker gender (nominal scale), and vocal femininity–masculinity (visual analog scale). For 379 speakers of Australian English aged 18–60 years, f os mode and F 1 – F 3 (12 monophthongs; total of 36 F s) were analyzed on a standard reading passage. Seventeen listeners rated speaker gender and vocal femininity–masculinity on randomized audio recordings of these speakers. Results Model building using principal component analysis suggested the 36 F s could be succinctly reduced to seven principal components (PCs). Generalized structural equation modeling (with the seven PCs of F and f os as predictors) suggested that only F 2 and f os predicted listener perceptions of speaker gender (male, female, unable to decide). However, listener perceptions of vocal femininity–masculinity behaved differently and were predicted by F 1 , F 3 , and the contrast between monophthongs at the extremities of the F 1 acoustic vowel space, in addition to F 2 and f os . Furthermore, listeners' perceptions of speaker gender also influenced ratings of vocal femininity–masculinity substantially. Conclusion Adjusted odds ratios highlighted the substantially larger contribution of F to listener perceptions of speaker gender and vocal femininity–masculinity relative to f os than has previously been reported.

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Parent report data on 82 preschool children with complex neurodevelopmental disabilities including Down syndrome, dyspraxia, autism, and global developmental delay suggests communicative language use must reach a threshold level before vocabulary size becomes the best predictor of word combining. Using the Language Use Inventory and the MacArthur-Bates CDI (with sign vocabulary option), statistical modelling using regression trees and random forests suggests that, despite high linear correlations between variables, (1) pragmatic ability, particularly children's emerging ability to talk about things, themselves and others is a significantly better predictor of the earliest word combining than vocabulary size; and (2) vocabulary size becomes a better predictor of later word combining, once this pragmatic base has been established.

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