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a tempo Voice Center, LLC
at Fort Worth ENT

Vocal Function Exercises

The goals for voice exercises are much like those for other physical workouts or even
physical therapy. Muscles and structures may be weakened, damaged, or out of
coordination. These exercises will speed your recovery and prevent further problems by
strengthening the system and helping it be more efficient.

General rules for Vocal Function Exercises

Maintenance Schedule (subjective based on clinical judgment)
Week 1 - All steps 2x each, 2x per day
Week 2 - All steps 2x each, 1x per day
Week 3 - All steps 1x each, 1x per day
Week 4 Exercise 4 2x each, 1x per day
Week 5 Exercise 4 1x each, 1x per day
Week 6 - Exercise 4 1x each, 3x per week
Week 7 - Exercise 4 1x each, 1x per week
1. Exercises are done 2x each, 2x per day
2. All exercises are done as quietly as possible without breathiness

1. Warm Up Exercise
Sustain the vowel eee as quietly as you can for as long as possible on
the musical note
(F) below middle (C) for males
(F) above middle (C) for females
2. Stretching Exercise
Glide from your lowest note to your highest note on the word
knoll whoop or on a tongue or lip trill


3. Contracting Exercise
Glide from your highest note to your lowest note on the word
knoll whoop or on a tongue or lip trill


4. Power Exercise
Sustain the musical notes (C-D-E-F-G) for as long as possible on the word old
without the /d/.

Goal = ________ seconds (octave below middle (C) for males) (middle (C) for females)

Joseph Stemple, Ph.D.: The Blaine Block Institute for Vocal Analysis and Rehabilitation; Voice Therapy
for the Twenty-First Century
Answers to Your Questions

What does transgender mean? Have transgender people

Transgender is an umbrella term for persons always existed?
whose gender identity, gender expression, or Transgender persons have been documented in
behavior does not conform to that typically many indigenous, Western, and Eastern cultures
associated with the sex to which they were and societies from antiquity to the present day.
assigned at birth. Gender identity refers to a However, the meaning of gender nonconformity
persons internal sense of being male, female, may vary from culture to culture.
or something else; gender expression refers
to the way a person communicates gender What are some categories or
identity to others through behavior, clothing,
hairstyles, voice, or body characteristics. types of transgender people?
Trans is sometimes used as shorthand Many identities fall under the transgender
for transgender. While transgender is umbrella. The term transsexual refers to people

generally a good term to use, not everyone whose gender identity is different from their
whose appearance or behavior is gender- assigned sex. Often, transsexual people alter or
nonconforming will identify as a transgender wish to alter their bodies through hormones,
person. The ways in which transgender surgery, and other means to make their bodies
people are talked about in popular culture, as congruent as possible with their gender
academia, and science are constantly changing, identities. This process of transition through
particularly as individuals awareness, medical intervention is often referred to as sex
knowledge, and openness about transgender or gender reassignment, but more recently is
people and their experiences grow. also referred to as gender affirmation. People
who were assigned female but identify and live
as male and alter or wish to alter their bodies
What is the difference through medical intervention to more closely
between sex and gender? resemble their gender identity are known as
Sex is assigned at birth, refers to ones biological transsexual men or transmen (also known as
status as either male or female, and is associated female-to-male or FTM). Conversely, people
primarily with physical attributes such as who were assigned male but identify and
chromosomes, hormone prevalence, and live as female and alter or wish to alter their
external and internal anatomy. Gender refers

bodies through medical intervention to more
to the socially constructed roles, behaviors, closely resemble their gender identity are
activities, and attributes that a given society known as transsexual women or transwomen
considers appropriate for boys and men or girls (also known as male-to-female or MTF). Some
and women. These influence the ways people

individuals who transition from one gender to
act, interact, and feel about themselves. While another prefer to be referred to as a man or a
aspects of biological sex are similar across woman rather than as transgender.
different cultures, aspects of gender may differ.
People who cross-dress wear clothing that
Various conditions that lead to atypical is traditionally or stereotypically worn by
development of physical sex characteristics another gender in their culture. They vary in
are collectively referred to as intersex how completely they cross-dress, from one
conditions. For information about people with article of clothing to fully cross-dressing. Those
intersex conditions (also known as disorders who cross-dress are usually comfortable with
of sex development), see APAs brochure their assigned sex and do not wish to change it.
Answers to Your Questions About Individuals Cross-dressing is a form of gender expression
With Intersex Conditions. and is not necessarily tied to erotic activity.
Cross-dressing is not indicative of sexual
orientation (see Answers to Your Questions for
a Better Understanding of Sexual Orientation &
Homosexuality for more information on sexual
orientation). The degree of societal acceptance
2 for cross-dressing varies for males and What is the relationship
females. In some cultures, one gender may be between gender identity and
given more latitude than another for wearing
clothing associated with a different gender.
sexual orientation?
Gender identity and sexual orientation are not the
same. Sexual orientation refers to an individuals
The term drag queens generally refers to men
enduring physical, romantic, and/or emotional
who dress as women for the purpose of
attraction to another person, whereas gender
entertaining others at bars, clubs, or other
identity refers to ones internal sense of being
events. The term drag kings refers to women who
male, female, or something else. Transgender
dress as men for the purpose of entertaining
people may be straight, lesbian, gay, bisexual,
others at bars, clubs, or other events.
or asexual, just as nontransgender people
may be. Some recent research has shown
Genderqueer is a term that some people use
that a change or a new exploration period
who identify their gender as falling outside
in partner attraction may occur during the
the binary constructs of male and female.
process of transition. However, transgender
They may define their gender as falling
people usually remain as attached to loved
somewhere on a continuum between male
ones after transition as they were before
and female, or they may define it as wholly
transition. Transgender people usually label
different from these terms. They may also
their sexual orientation using their gender as a
request that pronouns be used that are neither
reference. For example, a transgender woman,
masculine nor feminine, such as zie instead
or a person who is assigned male at birth and
of he or she, or hir instead of his
transitions to female, who is attracted to other
or her. Some genderqueer people do not
women would be identified as a lesbian or
identify as transgender.
gay woman. Likewise, a transgender man, or
a person who is assigned female at birth and
Other categories of transgender people
transitions to male, who is attracted to other
include androgynous, multigendered, gender
men would be identified as a gay man.
nonconforming, third gender, and two-spirit
people. Exact definitions of these terms vary
from person to person and may change over How does someone know that
time but often include a sense of blending or they are transgender?
alternating genders. Some people who use these Transgender people experience their
terms to describe themselves see traditional, transgender identity in a variety of ways
binary concepts of gender as restrictive. and may become aware of their transgender
identity at any age. Some can trace their
Why are some people transgender identities and feelings back
to their earliest memories. They may have
vague feelings of not fitting in with people
There is no single explanation for why some
of their assigned sex or specific wishes to
people are transgender. The diversity of
be something other than their assigned sex.
transgender expression and experiences argues
Others become aware of their transgender
against any simple or unitary explanation.
identities or begin to explore and experience
Many experts believe that biological factors
gender-nonconforming attitudes and behaviors
such as genetic influences and prenatal
during adolescence or much later in life. Some
hormone levels, early experiences, and
embrace their transgender feelings, while
experiences later in adolescence or adulthood
others struggle with feelings of shame or
may all contribute to the development of
confusion. Those who transition later in life

transgender identities.
may have struggled to fit in adequately as their
assigned sex only to later face dissatisfaction
How prevalent are with their lives. Some transgender people,
transgender people? transsexuals in particular, experience intense
It is difficult to accurately estimate the number dissatisfaction with their sex assigned at birth,
of transgender people, mostly because there physical sex characteristics, or the gender role

are no population studies that accurately and associated with that sex. These individuals
completely account for the range of gender often seek gender-affirming treatments.

identity and gender expression.
What should parents do if their The World Professional Association for 3
child appears to be transgender Transgender Health (WPATH), a professional
organization devoted to the treatment of
or gender nonconforming? transgender people, publishes The Standards of Care,
Parents may be concerned about a child who
which offers recommendations for the provision of
appears to be gender-nonconforming for a variety
gender affirmation procedures and services.
of reasons. Some children express a great deal of
distress about their assigned sex at birth or the
gender roles they are expected to follow. Some Is being transgender a mental
children experience difficult social interactions disorder?
with peers and adults because of their gender A psychological state is considered a mental
expression. Parents may become concerned when disorder only if it causes significant distress
what they believed to be a phase does not pass. or disability. Many transgender people do not
Parents of gender-nonconforming children may experience their gender as distressing or disabling,
need to work with schools and other institutions which implies that identifying as transgender
to address their childrens particular needs and does not constitute a mental disorder. For these
ensure their childrens safety. It is helpful to consult individuals, the significant problem is finding
with mental health and medical professionals affordable resources, such as counseling, hormone
familiar with gender issues in children to decide therapy, medical procedures, and the social
how to best address these concerns. It is not support necessary to freely express their gender
helpful to force the child to act in a more gender- identity and minimize discrimination. Many other
conforming way. Peer support from other parents obstacles may lead to distress, including a lack
of gender-nonconforming children may also of acceptance within society, direct or indirect
be helpful. experiences with discrimination, or assault. These
experiences may lead many transgender people to
How do transsexuals make a suffer with anxiety, depression, or related disorders
at higher rates than nontransgender persons.
gender transition?
Transitioning from one gender to another is a
According to the Diagnostic and Statistical Manual
complex process and may involve transition to a
of Mental Disorders (5th ed.; American Psychiatric
gender that is neither traditionally male nor female.
Association, 2013), people who experience
People who transition often start by expressing
intense, persistent gender incongruence can be
their preferred gender in situations where they
given the diagnosis of gender dysphoria. Some
feel safe. They typically work up to living full time
contend that the diagnosis inappropriately
as members of their preferred gender by making
pathologizes gender noncongruence and should
many changes a little at a time. While there is
be eliminated. Others argue it is essential to
no right way to transition genders, there are
retain the diagnosis to ensure access to care. The
some common social changes transgender people
International Classification of Diseases (ICD) is
experience that may involve one or more of the
under revision, and there may be changes to its
following: adopting the appearance of the desired
current classification of intense persistent gender
sex through changes in clothing and grooming,
incongruence as gender identity disorder.
adopting a new name, changing sex designation
on identity documents (if possible), using hormone
therapy treatment, and/or undergoing medical What kinds of discrimination do
procedures that modify their body to conform with transgender people face?
their gender identity. Anti-discrimination laws in most U.S. cities and
states do not protect transgender people from
Every transgender persons process or transition discrimination based on gender identity or gender

differs. Because of this, many factors may determine expression. Consequently, transgender people in
how the individual wishes to live and express their most cities and states face discrimination in nearly
gender identity. Finding a qualified mental health every aspect of their lives. The National Center
professional who is experienced in providing for Transgender Equality and the National Gay
affirmative care for transgender people is an and Lesbian Task Force released a report in 2011
important first step. A qualified professional can entitled Injustice at Every Turn, which confirmed

provide guidance and referrals to other helping the pervasive and severe discrimination faced by
professionals. Connecting with other transgender transgender people. Out of a sample of nearly

people through peer support groups and transgender 6,500 transgender people, the report found that
community organizations is also helpful. transgender people experience high levels of
discrimination in employment, housing, health
4 care, education, legal systems, and even in desire for hormonal or medical treatment,
their families. The report can be found at or other aspects of their identity or transition plans. If you have a reason to
know (e.g., you are a physician conducting
Transgender people may also have additional a necessary physical exam or you are a
identities that may affect the types of person who is interested in dating someone
discrimination they experience. Groups with youve learned is transgender), ask.
such additional identities include transgender Dont confuse gender nonconformity
people of racial, ethnic, or religious minority with being transgender. Not all people
backgrounds; transgender people of lower who appear androgynous or gender
socioeconomic statuses; transgender nonconforming identify as transgender or
people with disabilities; transgender youth; desire gender affirmation treatment.
transgender elderly; and others. Experiencing
discrimination may cause significant Keep the lines of communication open with
psychological stress, often leaving transgender the transgender person in your life.
individuals to wonder whether they were Get support in processing your own
discriminated against because of their gender reactions. It can take some time to adjust
identity or gender expression, another to seeing someone you know well
sociocultural identity, or some combination of transitioning. Having someone close to
all of these. you transition will be an adjustment and
can be challenging, especially for partners,
According to the study, while discrimination parents, and children.
is pervasive for the majority of transgender
people, the intersection of anti-transgender Seek support in dealing with your
bias and persistent, structural racism is feelings. You are not alone. Mental health
especially severe. People of color in general professionals and support groups for
fare worse than White transgender people, family, friends, and significant others of
with African American transgender individuals transgender people can be useful resources.
faring far worse than all other transgender Advocate for transgender rights,
populations examined. including social and economic justice and
appropriate psychological care.
Many transgender people are the targets of
Familiarize yourself with the local and state
hate crimes. They are also the victims of subtle
or provincial laws that protect transgender
discriminationwhich includes everything
people from discrimination.
from glances or glares of disapproval or
discomfort to invasive questions about their
body parts.

How can I be supportive of

transgender family members,
friends, or significant others?
Educate yourself about transgender issues
by reading books, attending conferences,
and consulting with transgender experts.
Be aware of your attitudes concerning
people with gender-nonconforming

appearance or behavior.
Know that transgender people have
membership in various sociocultural
identity groups (e.g., race, social class,
religion, age, disability, etc.) and there
is not one universal way to look or be


Use names and pronouns that are
appropriate to the persons gender
presentation and identity; if in doubt, ask.
Dont make assumptions about
transgender peoples sexual orientation,
Parents, Families, and
American Psychological
Friends of Lesbians and Gays
750 First Street, NE (PFLAG) Transgender
Washington, DC 20002 Network (TNET)
202-336-6041 PFLAG National Office 1828 L Street, NW, Suite 660 Washington, DC 20036 202-467-8180
Childrens National Health
System Sylvia Rivera Law Project
Gender and Sexuality Advocacy and Education 147 W. 24th Street, 5th Floor
111 Michigan Ave., NW New York, NY 10011
Washington, DC 20010 212-337-8550
202-476-4172 212-337-1972 (fax)

Family Acceptance Project

San Francisco State University Transgender Law Center
3004 16th Street, #301 1800 Market Street
San Francisco, CA 94103 San Francisco, CA 94102 415-865-0176

(FTM means Female-to-Male) TransYouth Family Allies
601 Van Ness Ave., Suite E327 P.O. Box 1471
San Francisco, CA 94102-3200 Holland, MI 49422-1471
877-267-1440 888-462-8932

Gender Education & Advocacy World Professional Association for Transgender
Health (WPATH)
Gender Spectrum


National Center for

Transgender Equality
1325 Massachusetts Ave., NW, Suite 700

Washington, DC 20005

202-393-2241 (fax)
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.

American Psychological Association. (2006). Answers to your

questions about individuals with intersex conditions. Retrieved

American Psychological Association. (2008). Answers to

your questions for a better understanding of sexual orientation &
homosexuality. Retrieved from

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P.,

DeCuypere, G., Feldman, J., Zucker, K. (2012). Standards
of care for the health of transsexual, transgender, and gender
nonconforming people (7th version). International Journal of
Transgenderism, 13, 165232. doi:10.1080/15532739.2011.700873

National Center for Transgender Equality and the National

Gay and Lesbian Task Force. (2011). Injustice at every turn.
Retrieved from

World Health Organization. (1990). International statistical

classification of diseases and related health problems (10th ed.).
Retrieved from

Suggested Bibliographic Citation (modified

accordingly for different titles):
American Psychological Association. (2011). Answers to your
questions about transgender people, gender identity, and gender
expression. Retrieved from

This material may be reproduced in whole or in part

without permission provided that the reproduced content
includes the original bibliographic citation and the following
statement: Copyright 2011 American Psychological
Association. Updated in 2014.

This is the third edition of this brochure. The first was written
by the APA Task Force on Gender Identity and Gender
Variance and published in 2006. The second edition was
revised and updated by members of the APA Committee on
Lesbian, Gay, Bisexual, and Transgender Concerns (CLGBTC),
Vic Muoz, EdD, and Kevin Nadal, PhD; and APA Division

44 liaison to the CLGBTC Michael L. Hendricks, PhD,
ABPP; with the assistance of the Division 44 Committee
on Transgender & Gender Variance Issues; Jill Davidson,
PhD, NCSP; J. Rhodes Perry, Associate Director of Policy &
Programs, Parents, Families, and Friends of Lesbians and
Gays (PFLAG); and Anneliese Singh, PhD, LPC, NCC.

Produced by the APA Lesbian, Gay, Bisexual, and Transgender Concerns Office and APA Public and Member Communications

The American Psychological Association Public and Member Communications

750 First Street, NE 202.336.5700
Washington, DC 20002
GENDER DIVERSE youth (also known as gender non-conforming, gender creative, or
gender variant) may prefer clothing, accessories, hair length/styles, or activities that are not
expected in the culture based on their sex assigned at birth. They typically feel comfortable
with being a girl who looks or acts like a boy or vice versa and are usually not interested in
transitioning from one gender to another, although some may explore transitioning options.

Gender TRANSGENDER youth typically consistently, persistently, and insistently express a cross-
gender identity and feel that their gender is different from their assigned sex. Transgender
dysphoria youth are more likely to experience gender dysphoria (i.e., discomfort related to their bodies
not matching their internal sense of gender) than gender diverse youth, although some
that continues transgender youth are comfortable with their bodies. While many transgender youth have
expressed their gender since they were old enough to talk, still many others do not realize their
through feelings about their gender until around puberty or even later. Transgender youth may desire
to make a social, legal, or medical gender transition while in school. They may or may not be
the onset of perceived by others as androgynous or as a different sex than they were assigned at birth.

puberty or Gender diverse and transgender youth are not part of a new phenomenon. History suggests
that they have existed in a wide range of cultures for thousands of years. Although no

increases at consensus exists on the etiology of gender diversity, neurobiological evidence for sexually
dimorphic brain differences in transgender people are being explored. Youths sense of their

puberty is internal gender is not caused by anything a family member did or did not do. Importantly,
by adolescence, ones gender identity is very resistant, if not immutable, to any type of

unlikely to environmental intervention. Some gender diverse and transgender youth may identify their
sexual orientation as lesbian, gay, bisexual, queer, or heterosexual relative to their gender

desist. identity.


Prevalence of gender diverse and transgender adolescents has been difficult to estimate given
barriers to research, treatment, and disclosure. No systematic epidemiological studies have
been published on the prevalence of gender diversity or transgender identity in youth. Gender
diverse youth are thought to be more prevalent than transgender youth and may make up 5 to
12% of birth assigned females and 2 to 6% of birth assigned males. Transgender youth may
be as prevalent as 0.5%.

Adolescence is often a time of marked distress given the pubertal development of secondary
sex characteristics that may differ from ones internal sense of gender. As a result, adolescents
may begin to seek therapy and consider pubertal suppression or cross-sex hormone therapy.

Gender dysphoria that continues through the onset of puberty or increases at puberty is
unlikely to desist. Early medical intervention to treat gender dysphoria may be recommended
for these youth.


Adolescents seeking gender-affirming treatment have been found to have healthy
Transgender Identity psychological functioning. Slight elevations in anxiety, mood, and behavioral problems have
been found in a subgroup of gender diverse and transgender youth, with some cases of self-
in Adolescents harm, suicidality, PTSD, substance abuse, and body image issues. This incidence has been
attributed to external factors such as peer bullying, family distress, parental rejection, trauma,
abuse history, harassment, inadequate housing, legal problems, lack of financial support,
educational problems, co-occurring psychiatric problems, and body dissatisfaction, rather than
Project Lead: Colt Meier, PhD gender diversity in and of itself. Supportive psychotherapy and medical gender affirmation
Authors: Lauren Mizock, PhD; Effie treatment have been associated with a reduction in behavioral and emotional symptoms.
Research suggests that family support and a sense of a positive future are resilience factors
Mougianis, BA; Colt Meier, PhD that protect against negative health and psychosocial outcomes.
Acknowledgments: Ry Testa, PhD;
Sean Moundas, PsyD; Deb Coolhart, PhD EVIDENCE-BASED ASSESSMENT
Early intervention may improve outcomes for gender diverse and transgender youth who are
experiencing distress. Comprehensive assessments of biopsychosocial influences on youth
may be indicated. Working within an interdisciplinary team of psychologists, physicians, and
other mental health and health care providers who have been trained to work with gender
diverse and transgender youth is recommended. Reflecting the social ecological context,
relevant domains of assessment include Gender History, Current Health and Psychological
Functioning, Interpersonal Relationships, and Resources. Within a gender history, clinicians
evaluate the chronology of gender identity issues (including behaviors, beliefs, appearance,
preferences, sense of self, consistency, and development) along with the youths goals and
expectations of transition. Domains to be assessed in current health and psychological
functioning include: individual and family health history, level including extracurricular activities, provide resources for families
of distress of all family members, physical and mental health and schools, and support the creation of social and support groups
history, sources of social support, levels and sources of distress, for LGBTQ youth in schools.
education and employment history, legal history, substance use
and abuse, history of physical and sexual abuse, self-esteem, Early medical intervention is recommended for peri-pubertal
trauma, co-occuring mental health disorders, hobbies and transgender youth who have a history of gender dysphoria and
interests, strengths and resilience, as well as religious beliefs and a desire to live as another gender. Puberty delaying treatment,
background. Relationship assessment covers family dynamics, cross sex hormone treatment, and/or surgical intervention(s) may
sexual/relationship development, high-risk sexual behavior, social be indicated to treat gender dysphoria. Similar to psychological
history, current intimate relationships, and response to youth by interventions, these treatments are provided on an individualized
family, peers, and school. Clinicians can also assess the youths basis to meet the needs of the youth.
living conditions and resources (including housing, transportation,
medical care, etc). KEY REFERENCES
Cohen-Kettenis, P. T., Delemarre-van de Waal, & Gooren, L. J. G. (2008).
Psychologists and other mental health providers may be called on The treatment of adolescent transsexuals: Changing insights.
to evaluate youth before they are treated with medically necessary Journal of Sexual Medicine, 5, 18921897.
interventions. It is recommended that all such assessments be
conducted by a specialist with gender and sexuality competence. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G.,
Feldman, J., . . .Zucker, K. (2011). Standards of care for the health
The World Professional Association for Transgender Health
of transsexual, transgender, and gender non-conforming people.
Standards of Care 7th edition presents guidelines for medical (7th version). International Journal of Transgenderism, 13, 165-
and psychological treatment of transgender youth. Although 232. Retrieved from:
different perspectives on what is appropriate for medical and SOC,%20V7.pdf
social transition in transgender youth still exist, these guidelines
have been developed with consideration for the current state of Coolhart, D., Baker, A., Farmer, S., Malaney, M., & Shipman, D. (2012).
knowledge. Therapy with transsexual youth and their families: A clini-
cal tool for assessing youths readiness for gender transition.
Journal of Marital & Family Therapy, DOI:10.1111/j.1752-
AND DEVELOPMENTAL FACTORS de Vries, A. L. C., Kreukels, B. P. C., Steensma, T. D., Doreleijers, T. A. H.,
Gender diversity and transgenderism occurs in all cultural, ethnic,
& Cohen- Kettenis, P. T. (2011). Comparing adult and adoles-
and racial groups. Notably, high rates of HIV infection have been cent transsexuals: An MMPI-2 and MMPI-A study. Psychiatry
found among African American male-to-female (MTF) transgen- Research, 186, 414418.
der youth who have encountered family rejection. In addition, an
elevated rate of autism spectrum disorders (formerly Aspergers Garafolo, R., Deleon, J., Osmer, E., Doll, M., & Harper, G. W. (2006). Over-
syndrome) has been identified among gender diverse adolescents. looked, misunderstood, and at-risk: Exploring the lives and HIV
risk of ethnic minority male-to-female transgender youth. Journal
There is no single trajectory of development of gender diversity or of Adolescent Health, 38, 230-236.
transgenderism. Many transgender youth present with a history Leibowitz, S. & Telingator, C. (2012). Assessing gender identity concerns in
of gender dysphoria from childhood, yet others experience gender childrenand adolescents: Evaluation, treatments, and outcomes.
dysphoria for the first time around the onset of puberty. Still others Current Psychiatry Reports, 14, 111-120.
do not report a history of gender dypshoria. Because of this, an
Medicus, J. (2012). Practice parameter on gay, lesbian, or bisexual sexual
individualized approach to treatment is indicated. Warning signs
orientation, gender nonconformity, and gender discordance in
suggesting urgency of care are externalizing (i.e., aggression) or children and adolescents. Journal of the American Academy of
internalizing behaviors (i.e., withdrawing). Some gender diverse Child & Adolescent Psychiatry, 51(9), 957-974.
and transgender youth may come out to family, teachers, mentors,
or friends right before they are considering self-harm or suicide. Meier, S. C. & Labuski, C. (2013). The demographics of the transgender
population. In Baumle, A. (Eds.) The International Handbook
EVIDENCE-BASED PSYCHOLOGICAL on the Demography of Sexuality. (pp. 289-327). New York, NY:
Springer Press.
Psychological interventions are highly individualized to meet the Olson, J., Forbes, C., & Belzer, M. (2011). Management of the transgender
needs of the adolescent within their environmental and social adolescent. Archives of Pediatric & Adolescent Medicine, 165,
context. General approaches to therapy have used empirically
supported cognitive and behavioral strategies to reduce the impact Zucker, K.J., Wood, H., & Singh, D. (2012). A developmental, biopsycho-
of the psychosocial stressors the adolescent is facing, widening social model for the treatment of children with gender identity
social support through environmental involvement (family, school, disorder. Journal of Homosexuality, 59(3). 369-397.
etc.), making timely referrals to transgender-competent health
care providers if indicated, and improving youth resilience and ego RESOURCE ORGANIZATIONS
strength. Attempts to force gender diverse and transgender youth American Academy of Child and Adolescent Psychiatry (AACAP)
to change their behavior to fit into social norms may traumatize the American Counseling Association (ACA)
youth and stifle their development into healthy adults.
American Gay and Lesbian Psychiatric Association (AGLP)
Psychologists can advocate for gender diverse and transgender American Psychological Association (APA)
students in schools by providing education, recommending that Family Acceptance Project
schools create and implement policies and procedures to prevent Lesbian and Gay Child and Adolescent Psychiatric Association (LAGCAPA)
harassment, honor students preferred names and pronouns, ensure National Association of School Psychologists (NASP)
bathroom safety for all students, allow access to all possible gender- World Professional Association for Transgender Health (WPATH)
segregated activities that honor all students gender identities
Creating Choirs that Welcome Trans* & Gender-Queer singers

1. When posting for singer auditions keep language about voice parts gender-neutral. Encourage
gender-queer individuals to staff your information booth at Pride and other events.
2. In the audition setting ask new singers their preferred pronoun.
3. If a singer shares that they are transitioning via testosterone ask when they started and how
the transition has affected their vocal range, etc. It will typically take 6-12 months for a singers
voice to settle to a consistent range and can take up to 2 years to be reached.
4. Assign voice sections for each singer dependent on their voice range and voice color. If a
singers voice is still transitioning check their range every 3-4 months and assist them in moving
to a new vocal part as needed.
5. You may encounter a transwoman who wants to sing alto or soprano. She has been wanting to
live as a woman possibly her whole life and has finally transitioned. But, unless shes lucky
enough to be a countertenor or has the finances to undergo a new vocal adjustment surgery,
singing in a treble range is likely an unrealistic goal. You can support her by listening to her voice
and helping her sing in as high a range as you feel is healthy for her. It is all right to be clear that
you assign all singers to sections based on vocal range.
6. Post signs for gender-neutral bathrooms in rehearsal and concert spaces. Educate your chorus
and audience regarding the protocol and importance of gender-neutral restroom space.
7. Use gender-neutral language in rehearsal and insist that all section leaders and singers also
follow these same guidelines.
8. Adopt a gender-neutral language statement for your organization (see below).
9. Update your guest artist and musician contracts to ask that they use gender-neutral language
when working with your chorus.
10. Invite all singers to audition for any solo that fits their vocal range.
11. Invite trans* and gender-non-conforming individuals, artists, speakers, and song writers to
perform as a guest artists in your concerts.
12. Program music by trans* and gender-non-conforming composers and song-writers. Share
stories in the concert setting that educate the audience regarding gender non-conforming
individuals in history or current day experiences.
13. Commission a piece of music exploring the experience of gender-diverse people.
14. Examine requirements mandating gender-specific concert attire. Forcing singers into gender-
specific (or incongruent) clothing may be seen as a public devaluing of identities and
communicates indifference to the spectrum of gender identity and expression.
15. Explore the use of the acronym LGBT in your chorus. GLBT flows off the tongue easily, but
it might be more accurate to say LGB and T. Gay, lesbian, bisexual, straight, etc. are all labels
for sexual orientation, describing various forms of relationships with other people. Gender
identity, on the other hand, describes ones relationship to oneself.

Jane Ramseyer Miller,

* What does transgender mean?
Broadly speaking, transgender people are individuals whose gender expression and/or gender identity differs from
conventional expectations based on their physical sex. The word transgender or trans* is an umbrella term which is
often used to describe a wide range of identities and experiences, including: transsexuals, Female-to-Male, Male-to-
Female, cross-dressers, drag queens or kings, two-spirit, gender queers and many more expressions of gender.

Is being transgender the same as being gay or lesbian?

Like all other people, transgender people can be gay, straight, lesbian, bisexual, or anything in between. Sexual
orientation is different from gender identity or expression and can not be assumed about anyone.

GALA Choruses Gender-Neutral Language Statement

GALA Choruses strives for gender neutrality with regards to language in recognition of the many genders
represented within our member choruses, singing sections and the LGBT community. When working and
communicating with singers and choruses within the GALA community please keep the following
guidelines in mind.
Please refer to sections by voice part rather than gender, ie; tenors and basses rather than men
or women.
There are also gender inclusive ways that you can address a chorus as a whole. People or folks
or simply everyone are more gender-neutral options (as opposed to Ladies and Gentlemen).
We know that gender specific language is a part of our culture and we dont expect each individual to
overcome years of conditioning overnight. We would, however, appreciate your attempt to address our
members in the most gender-neutral way possible.

Tips for Allies of Transgender People

These tips can help you move toward becoming a better ally to transgender people. The list is not
exhaustive and cannot include all the "right" things to do or say because there is no "right" answer to
every situation you might encounter.

1. You can't tell if someone is transgender just by looking. If you don't know what pronouns to use,
listen and respect the terminology a transgender person uses to describe their identity.
2. Don't make assumptions about a transgender person's sexual orientation.
3. Don't ask a transgender person what their "real name" is.
4. Be careful about confidentiality, disclosure, and "outing."
5. Understand there is no "right" or "wrong" way to transition - it is different for every person.
6. Don't ask about a transgender person's genitals, surgical status, or sex life.
7. Challenge anti-transgender remarks or jokes in public spaces - including LGB spaces.
8. Support gender neutral public restrooms.
9. Actively make your company, place of worship or group truly trans-inclusive.
10. Know your own limits as an ally. Don't be afraid to admit when you don't know something.

GLAAD updated May 2015 / Adapted from MIT's "Action Tips for Allies of Trans People." For the
complete resource see: