BRYAN MACKIE: You're listening to The 21st. I'm Bryan Mackie. For many of us, our voice can be a big part of our identity, especially if you happen to work in public radio. And at a basic level, it's a huge part of how we express ourselves to the world. But for some people who are transgender, their voice may not align with their gender identity or feel like an accurate reflection of who they are. That's where gender-affirming communication services may come into play.

Speech language pathologists here in Central Illinois are helping transgender clients by providing techniques that focus on the resonance, tone, and projection of our voices. Tricia Larkin is a clinical educator at Illinois State University's Speech and Hearing Clinic. She's with us from our partner station, WGLT, in Bloomington. And in our Urbana studio, we have Clarion Mendes. She's Director of Clinical Education in the Department of Speech and Hearing Science at the University of Illinois. Tricia, Clarion, thanks for being with us. Welcome to The 21st.

TRICIA LARKIN: Good morning.

CLARION MENDES: Good morning. Thank you.

BRYAN MACKIE: And also with us from WGLT, we have Kara Schutz. Kara's currently working with Tricia and her team at Illinois State University. Kara, thanks for being here as well.

KARA SCHUTZ: You're welcome. Good morning.

BRYAN MACKIE: So Tricia, I'm going to begin with you. Your clinic at ISU started offering this service about two years ago. Why were you interested in bringing gender-affirming communication to ISU?

TRICIA LARKIN: We had some graduate students explore the topic in one of our undergraduate courses. And from that course conversation, they became curious about why we weren't offering this service and investigated what that might look like if we were to expand the array of interventions and treatment options for our community. And from there, it's just really grown.

BRYAN MACKIE: And how common are these services throughout the rest of the state and country?

TRICIA LARKIN: So in my experience, Clarion and I are the only two individuals who can offer a clinic experience for individuals on the gender continuum in the Downstate area.

BRYAN MACKIE: So Kara, I want to bring you into this conversation. Our voice is something very personal to us as is our healthcare. I'm sure it wasn't easy to seek out these services in the first place. I wonder-- can you tell us-- how did you end up finding and pursuing this clinic?

KARA SCHUTZ: Actually, I had been just looking online on how to go about this. And I actually found Clarion first. And I went through her. And she did an evaluation on me and then sent me to Tricia Larkin here.

BRYAN MACKIE: So before you started working with Tricia at the Speech and Hearing Clinic, what was your relationship like with your voice?

KARA SCHUTZ: Pretty much a hate-hate relationship.

BRYAN MACKIE: And has that changed at all in your time with the program?

KARA SCHUTZ: Yes, it really has. I don't feel as strange and out of place. And people tend to respond to me better. And it does reflect a little better who I am.

BRYAN MACKIE: So Clarion Mendes is also with us, as we heard, from the University of Illinois Department of Speech and Hearing Science. Clarion, clients interested in gender-affirming communication services have now become the majority of your caseload, as I understand it. Would you say interest in the service is growing? Have you seen more people coming in?

CLARION MENDES: I'd say that the interest has definitely increased. However, the need hasn't. If we think about it, there's always been transgender women who have had a deep desire and need to modify their voice and communication. However, nowadays, I think there's just more awareness, either through the fact that graduate programs are now making it part of our curriculum, as well as there's a lot of rich, deeply-involved internet communities that have started to have a dialogue about the fact that, yes, there are things that can be very empowering that transgender women and gender diverse folks can do to shape the voice that they were meant to have.

BRYAN MACKIE: Yeah. You know, for this segment, you reached out to some of your former clients who've been through this program. The answers were anonymous. But I want to read something someone wrote.

CLARION MENDES: Absolutely.

BRYAN MACKIE: They write, quote, "I'm transitioning to survive. And I do not want any more attention than I think I already attract in my mind. It's about survival. It's that simple. We're just trying to live as normal a life as possible and be happy." Clarion, obviously, the services each client needs are probably different for every person that comes in the door. But what are some of the things you hear from your clients about why they're interested in pursuing gender-affirming communication services?

CLARION MENDES: Yeah, so we're in a very privileged place in that we're entrusted with a lot of these desires that our clients have to modify their communication. And I have found that the reasons are both very individual, as well as very universal. Individual in the sense that sometimes I work with women who may only be out to me and their health professional-- their primary care provider, I should say. And they're using this as the first step in developing their authentic self.

In contrast, I work with some women who-- they sort of see this as the final step in their presentation. As far as the universal goals, there's this universal goal in shaping the voice that all of my clients have sort of mentioned. And that is they want to be able to find themselves and find their voice and to be able to participate in society as fully as possible, just like the rest of us.

BRYAN MACKIE: Tricia, the pitch of our voice is often thought to be most important, whether it's high or low. But I understand you work a lot on resonance and tone and how our mouth actually moves to make sound. I'm feeling self-conscious as I'm speaking now. Can you talk a little bit more about the actual techniques you talk to your clients about?

TRICIA LARKIN: It often comes as a surprise for the individuals we work with when they discover that we don't want to start with pitch bursts. And we talk about this idea of resonating. How do those sounds they produce with their larynx, or voice box as some might know it as, resonate those sounds through the entire vocal tract?

And so we have transgender women who seek services. But we also have transgender men who are looking to find a voice that also represents their identity. And so for those transgender men, we try to shift that resonance quality down towards the chest area, while transgender women, we spend a lot of time shaping the vocal tract so that the sound resonates more towards their jaw, their mouth, or in that head area.

And it produces a quality that's perceived as either more feminine or more masculine depending upon the voice that the client tells us they're looking for. And I think that's a really important point for us to remember, that we're not telling the client what their voice should sound like. They're telling us, I like this feature. I like this aspect. I'd like to follow it more so it becomes part of who I am as a speech pattern.

BRYAN MACKIE: Yeah, we're in a DIY era. I imagine some people try to take on this project themselves. But I gather that you can actually do damage to your vocal chords. Do you find people who've been through that process? Can you talk a little bit about that?

TRICIA LARKIN: I have. And so what often happens, in my experience, is they focus on the pitch. And they can create a higher pitch, for instance, if they raise that larynx, and they use a lot of tension in the voice production. But they don't understand how the system works. And so they're creating some vocal fold damage in that process. And when we can help them understand how the anatomy and the physiology works to create the voice that represents them, they're less likely to create that damage in that specific way.

BRYAN MACKIE: So Kara, I want to ask you. What's it been like to go through this program, these techniques if you're willing to say. Where are you now in learning about this process?

KARA SCHUTZ: I think I'm still in the middle. It's actually, it's-- Trish makes it fun. And it's been an eye-opening experience because it's not what people would expect from something like this. It's a lot of making strange sounds and learning how to, as she said, shift the resonance forward, which we use different vocal exercises that sound kind of silly to other people. But it does work. And over time, it just continues to evolve. And I end up where I'm at now.

BRYAN MACKIE: So, you know, so much of our voices, I think when we-- or I should say when we hear a voice, right, be it a friend or a family member or even somebody on NPR, we can usually place it, associate it with a specific person. Kara, how much would you say our voices are tied up with our identity and if-- was that the case for you as well?

KARA SCHUTZ: Yes. And I can say that-- the other day that I talked to my dad. And I had to kind of shift my voice back. And when I did, I actually spooked myself. It was almost like I was hearing a different human being at this point. And it is-- it is very much tied to your identity and who you are and how you perceive yourself.

BRYAN MACKIE: It sounds like what I'm hearing from you is that code-switching, as we refer to it, right-- being able to inhabit these different voices-- is the key to survival, maybe?

KARA SCHUTZ: Mm-hmm. Yeah. It can be kind of dangerous out there. And anything I can do to-- as that one person said in their letter-- draw less attention to myself is a better thing.

BRYAN MACKIE: Yeah. Well, thank you for sharing that.

Clarion, I think when people think about going to a speech pathologist or a therapist, they might think that someone is trying to fix a problem. But in your program, that's not the way you think of it. You steer clear of that assumption. Can you talk a little bit more about that idea?

CLARION MENDES: Yes. So both Tricia and I are really careful to refer to our clients as clients rather than patients. And I think it's important to identify that it's not the person's gender identity that is problematic. It's the distress that the individual feels because they have a voice that's not congruent with themselves.

And like Tricia mentioned, with individuals that can cause damage to their larynx if they are trained improperly, we're not working with a vocal mechanism that has a physiological damage to it or structural damage to it. We're helping an individual that has, hopefully, a healthy larynx and vocal tract use it in a way that is more congruent with their voice-- with their identity-- excuse me. The other piece of this is that because it's really a collaborative effort and it's what the client wants and not what the clinician is dictating or being too authoritative about, that's where we're really getting into the piece that we're working with our clients. We're working collaboratively.

BRYAN MACKIE: I want to read another response Clarion got from a former client of the program at U of I. They write, quote, "Trans people have been abused for just being trans. And unfortunately, a voice that doesn't match one's gender presentation is a quick way to be outed." Tricia, I think as a society, we tend to make a lot of judgments about how someone with a certain appearance or level of authority should sound. Would you agree with that? Is that a concern you hear from your clients?

TRICIA LARKIN: It's been interesting to have clients who have different needs with regards to the voice. I mentioned that some individuals are looking for something that we'd call more masculine. But there are individuals out there who identify as non-binary. And so we've got to be really careful that we recognize what their need is. And sometimes, it's to be able to present-- or express their identity in a way that society will perceive as acceptable. And it's unfortunate that society has created that need.

But others feel less inhibited about doing that. And they just want to speak with something that really represents who they are as they know themselves. And so that's really the whole point of collaborating with our clients and ensuring that they feel seen and heard in our interactions with them.

BRYAN MACKIE: Kara, I want to ask you. You mentioned earlier a hate-hate relationship with your voice, at least in the past. And in another survey response, a former client of the U of I program writes, quote, "I feel like there's been a direct positive correlation between my voice training and my mental health. Voice training's been integral to becoming the person I want to be. And I feel like it's one of the most important aspects of transition." Kara, does that statement resonate with your experience?

KARA SCHUTZ: Absolutely. It's tough to look in the mirror. And the cognitive dissidence when you talk to yourself and you don't sound the way that you want to sound or that you think you should sound, it's very-- it's disturbing. And since my voice has changed a bit and gotten softer and a little bit more what I envision it-- even in my own head when I hear it without recording it-- it's a lot less cognitive dissidence when I'm seeing myself. So yes, it does help with your mental health quite a bit and your confidence.

BRYAN MACKIE: Kara, what's next for you in this program? Do you know how much longer you're going to be doing it?

KARA SCHUTZ: I have no idea. As Trish puts it, I'm here till we're finished.

BRYAN MACKIE: And do you have any-- if you could speak to other providers, maybe, who are not in this service, what do you want them to know-- other healthcare providers. What do you want them to know about this?

KARA SCHUTZ: This is one of those things that someone can do without surgeries and without humongous expense that can help somebody out so much. It's like getting a hug when you're upset, you know. It's such a-- it's a small thing that helps out in huge ways. And if they're not providing this, they should be providing this because it would help people out so much.

BRYAN MACKIE: Yeah. And I guess the last question I have for you is, do you feel better about your voice now?

KARA SCHUTZ: Oh, yeah, tons.

BRYAN MACKIE: Yeah. All right. Kara Schutz joined us from WGLT, one of our partner stations. We also spoke with Tricia Larkin, who is a clinical educator at Illinois State University's Speech and Hearing Clinic. And Clarion Mendes is with us from our Urbana studio. She's Director of Clinical Education in the Department of Speech and Hearing Science at the University of Illinois. Tricia, Clarion, and Kara, thank you so much for joining us today.

TRICIA LARKIN: Thank you so much.

CLARION MENDES: Thank you for having us.

BRYAN MACKIE: You're very welcome.

KARA SCHUTZ: Thank you.