Babajanians (2019)



(also known as Expert Opinion)


C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist


Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.


Reviewer(s):  pmh


Date:   February 3, 2019


Overall Assigned Grade:  no assigned grade because there was no supporting data


Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.


Take Away:  This brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.


  1. Was there a review of the literature supporting components of the intervention?No


  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)


  1. Was the intervention based on clinically sound clinical procedures? Yes


  1. Did the author provide a rationale for components of the intervention? Yes


  1. Description of outcome measures:

∞    Are outcome measures suggested?  Yes


∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)


  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.


  1. Was maintenance addressed?




PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults


ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, duration, and concordance

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan





  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.


  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.


  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing


  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.


  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)



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