a tempo Voice Center, LLC

www.atempovoicecenter.com
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

Goal = NO VOICE BREAKS

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

Goal = NO VOICE BREAKS

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
ABOUT TRANSGENDER PEOPLE, GENDER
IDENTITY, AND GENDER EXPRESSION
What does transgender mean?
Transgender is an umbrella term for persons
whose gender identity, gender expression, or
behavior does not conform to that typically
associated with the sex to which they were
assigned at birth. Gender identity refers to a
persons internal sense of being male, female,
or something else; gender expression refers
to the way a person communicates gender
identity to others through behavior, clothing,
hairstyles, voice, or body characteristics.
Trans is sometimes used as shorthand
for transgender. While transgender is
Q
generally a good term to use, not everyone
whose appearance or behavior is gender-
nonconforming will identify as a transgender
person. The ways in which transgender
people are talked about in popular culture,
academia, and science are constantly changing,
particularly as individuals awareness,
knowledge, and openness about transgender
people and their experiences grow.
What is the difference
between sex and gender?
Sex is assigned at birth, refers to ones biological
status as either male or female, and is associated
primarily with physical attributes such as
chromosomes, hormone prevalence, and
external and internal anatomy. Gender refers
&
to the socially constructed roles, behaviors,
activities, and attributes that a given society
considers appropriate for boys and men or girls
and women. These influence the ways people
A
act, interact, and feel about themselves. While
aspects of biological sex are similar across
different cultures, aspects of gender may differ.
Various conditions that lead to atypical
development of physical sex characteristics
are collectively referred to as intersex
conditions. For information about people with
intersex conditions (also known as disorders
of sex development), see APAs brochure
Answers to Your Questions About Individuals
With Intersex Conditions.
Have transgender people
always existed?
Transgender persons have been documented in
many indigenous, Western, and Eastern cultures
and societies from antiquity to the present day.
However, the meaning of gender nonconformity
may vary from culture to culture.
What are some categories or
types of transgender people?
Many identities fall under the transgender
umbrella. The term transsexual refers to people
whose gender identity is different from their
assigned sex. Often, transsexual people alter or
wish to alter their bodies through hormones,
surgery, and other means to make their bodies
as congruent as possible with their gender
identities. This process of transition through
medical intervention is often referred to as sex
or gender reassignment, but more recently is
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
through medical intervention to more closely
resemble their gender identity are known as
transsexual men or transmen (also known as
female-to-male or FTM). Conversely, people
who were assigned male but identify and
live as female and alter or wish to alter their
bodies through medical intervention to more
closely resemble their gender identity are
known as transsexual women or transwomen
(also known as male-to-female or MTF). Some
individuals who transition from one gender to
another prefer to be referred to as a man or a
woman rather than as transgender.
People who cross-dress wear clothing that
is traditionally or stereotypically worn by
another gender in their culture. They vary in
how completely they cross-dress, from one
article of clothing to fully cross-dressing. Those
who cross-dress are usually comfortable with
their assigned sex and do not wish to change it.
Cross-dressing is a form of gender expression
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
transgender?
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

Q
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.

A
identity and gender expression.
What should parents do if their
child appears to be transgender
or gender nonconforming?
Parents may be concerned about a child who
appears to be gender-nonconforming for a variety
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
children experience difficult social interactions
with peers and adults because of their gender
expression. Parents may become concerned when
what they believed to be a phase does not pass.
Parents of gender-nonconforming children may
need to work with schools and other institutions
to address their childrens particular needs and
ensure their childrens safety. It is helpful to consult
with mental health and medical professionals
familiar with gender issues in children to decide
how to best address these concerns. It is not
helpful to force the child to act in a more gender-
conforming way. Peer support from other parents
of gender-nonconforming children may also
be helpful.
How do transsexuals make a
gender transition?
Transitioning from one gender to another is a
complex process and may involve transition to a
gender that is neither traditionally male nor female.
People who transition often start by expressing
their preferred gender in situations where they
feel safe. They typically work up to living full time
as members of their preferred gender by making
many changes a little at a time. While there is
no right way to transition genders, there are
some common social changes transgender people
experience that may involve one or more of the
following: adopting the appearance of the desired
sex through changes in clothing and grooming,
adopting a new name, changing sex designation
on identity documents (if possible), using hormone
therapy treatment, and/or undergoing medical
procedures that modify their body to conform with
their gender identity.
Every transgender persons process or transition
differs. Because of this, many factors may determine
how the individual wishes to live and express their
gender identity. Finding a qualified mental health
professional who is experienced in providing
affirmative care for transgender people is an
important first step. A qualified professional can
provide guidance and referrals to other helping
professionals. Connecting with other transgender
people through peer support groups and transgender
community organizations is also helpful.
The World Professional Association for 3
Transgender Health (WPATH), a professional
organization devoted to the treatment of
transgender people, publishes The Standards of Care,
which offers recommendations for the provision of
gender affirmation procedures and services.
Is being transgender a mental
disorder?
A psychological state is considered a mental
disorder only if it causes significant distress
or disability. Many transgender people do not
experience their gender as distressing or disabling,
which implies that identifying as transgender
does not constitute a mental disorder. For these
individuals, the significant problem is finding
affordable resources, such as counseling, hormone
therapy, medical procedures, and the social
support necessary to freely express their gender
identity and minimize discrimination. Many other
obstacles may lead to distress, including a lack
of acceptance within society, direct or indirect
experiences with discrimination, or assault. These
experiences may lead many transgender people to
suffer with anxiety, depression, or related disorders
at higher rates than nontransgender persons.
According to the Diagnostic and Statistical Manual
of Mental Disorders (5th ed.; American Psychiatric
Association, 2013), people who experience
intense, persistent gender incongruence can be
given the diagnosis of gender dysphoria. Some
contend that the diagnosis inappropriately
pathologizes gender noncongruence and should
be eliminated. Others argue it is essential to
retain the diagnosis to ensure access to care. The
International Classification of Diseases (ICD) is
under revision, and there may be changes to its
current classification of intense persistent gender
incongruence as gender identity disorder.
What kinds of discrimination do
transgender people face?
Anti-discrimination laws in most U.S. cities and
states do not protect transgender people from
discrimination based on gender identity or gender
Q
expression. Consequently, transgender people in
most cities and states face discrimination in nearly
every aspect of their lives. The National Center
for Transgender Equality and the National Gay
and Lesbian Task Force released a report in 2011
entitled Injustice at Every Turn, which confirmed
&
the pervasive and severe discrimination faced by
transgender people. Out of a sample of nearly
A
6,500 transgender people, the report found that
transgender people experience high levels of
discrimination in employment, housing, health
4 care, education, legal systems, and even in
their families. The report can be found at
http://endtransdiscrimination.org.
Transgender people may also have additional
identities that may affect the types of
discrimination they experience. Groups with
such additional identities include transgender
people of racial, ethnic, or religious minority
backgrounds; transgender people of lower
socioeconomic statuses; transgender
people with disabilities; transgender youth;
transgender elderly; and others. Experiencing
discrimination may cause significant
psychological stress, often leaving transgender
individuals to wonder whether they were
discriminated against because of their gender
identity or gender expression, another
sociocultural identity, or some combination of
all of these.
According to the study, while discrimination
is pervasive for the majority of transgender
people, the intersection of anti-transgender
bias and persistent, structural racism is
especially severe. People of color in general
fare worse than White transgender people,
with African American transgender individuals
faring far worse than all other transgender
populations examined.
Many transgender people are the targets of
hate crimes. They are also the victims of subtle
discriminationwhich includes everything
from glances or glares of disapproval or
discomfort to invasive questions about their
body parts.
desire for hormonal or medical treatment,
or other aspects of their identity or
transition plans. If you have a reason to
know (e.g., you are a physician conducting
a necessary physical exam or you are a
person who is interested in dating someone
youve learned is transgender), ask.
Dont confuse gender nonconformity
with being transgender. Not all people
who appear androgynous or gender
nonconforming identify as transgender or
desire gender affirmation treatment.
Keep the lines of communication open with
the transgender person in your life.
Get support in processing your own
reactions. It can take some time to adjust
to seeing someone you know well
transitioning. Having someone close to
you transition will be an adjustment and
can be challenging, especially for partners,
parents, and children.
Seek support in dealing with your
feelings. You are not alone. Mental health
professionals and support groups for
family, friends, and significant others of
transgender people can be useful resources.
Advocate for transgender rights,
including social and economic justice and
appropriate psychological care.
Familiarize yourself with the local and state
or provincial laws that protect transgender
people from discrimination.

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

Q
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

&
transgender.

A
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,
 5
WHERE CAN I FIND MORE INFORMATION ABOUT TRANSGENDER
HEALTH, ADVOCACY, AND HUMAN RIGHTS?
Parents, Families, and
American Psychological
Friends of Lesbians and Gays
Association
750 First Street, NE (PFLAG) Transgender
Washington, DC 20002 Network (TNET)
202-336-6041 PFLAG National Office
lgbc@apa.org 1828 L Street, NW, Suite 660
www.apa.org/pi/lgbt/index.aspx Washington, DC 20036
www.apa.org/pi/lgbt/programs/transgender/ 202-467-8180
index.aspx info@pflag.org
http://community.pflag.org
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)
http://childrensnational.org/gendervariance info@srlp.org
http://srlp.org

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
fap@sfsu.edu 415-865-0176
http://familyproject.sfsu.edu info@transgenderlawcenter.org
http://transgenderlawcenter.org

FTMInternational
(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
info@ftmi.org info@imatyfa.org
www.ftmi.org http://www.imatyfa.org

Gender Education & Advocacy World Professional

http://gender.org Association for Transgender
Health (WPATH)
Gender Spectrum wpath@wpath.org
510-788-4412 www.wpath.org
info@genderspectrum.org

Q
www.genderspectrum.org

National Center for

Transgender Equality
1325 Massachusetts Ave., NW, Suite 700

&
Washington, DC 20005
202-903-0112

A
202-393-2241 (fax)
NCTE@NCTEquality.org
http://transequality.org
6
References:
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
from http://www.apa.org/topics/lgbt/intersex.aspx

American Psychological Association. (2008). Answers to

your questions for a better understanding of sexual orientation &
homosexuality. Retrieved from http://www.apa.org/topics/
lgbt/orientation.aspx

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 http://endtransdiscrimination.org

World Health Organization. (1990). International statistical

classification of diseases and related health problems (10th ed.).
Retrieved from http://apps.who.int/classifications/icd10/
browse/2010/en

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 http://www.apa.org/topics/
lgbt/transgender.aspx

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

Q
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.

&
A
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 AND COURSE

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.

FACT SHEET
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.

Gender Diversity and HEALTH AND PSYCHOSOCIAL CONSEQUENCES

Transgender Identity
in Adolescents
Project Lead: Colt Meier, PhD
Authors: Lauren Mizock, PhD; Effie
Mougianis, BA; Colt Meier, PhD
Acknowledgments: Ry Testa, PhD;
Sean Moundas, PsyD; Deb Coolhart, PhD
Adolescents seeking gender-affirming treatment have been found to have healthy
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-
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
gender diversity in and of itself. Supportive psychotherapy and medical gender affirmation
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
that protect against negative health and psychosocial outcomes.
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
of distress of all family members, physical and mental health
history, sources of social support, levels and sources of distress,
education and employment history, legal history, substance use
and abuse, history of physical and sexual abuse, self-esteem,
trauma, co-occuring mental health disorders, hobbies and
interests, strengths and resilience, as well as religious beliefs and
background. Relationship assessment covers family dynamics,
sexual/relationship development, high-risk sexual behavior, social
history, current intimate relationships, and response to youth by
family, peers, and school. Clinicians can also assess the youths
living conditions and resources (including housing, transportation,
medical care, etc).
Psychologists and other mental health providers may be called on
to evaluate youth before they are treated with medically necessary
interventions. It is recommended that all such assessments be
conducted by a specialist with gender and sexuality competence.
The World Professional Association for Transgender Health
Standards of Care 7th edition presents guidelines for medical
and psychological treatment of transgender youth. Although
different perspectives on what is appropriate for medical and
social transition in transgender youth still exist, these guidelines
have been developed with consideration for the current state of
knowledge.
CULTURE, DIVERSITY, DEMOGRAPHIC,
AND DEVELOPMENTAL FACTORS
Gender diversity and transgenderism occurs in all cultural, ethnic,
and racial groups. Notably, high rates of HIV infection have been
found among African American male-to-female (MTF) transgen-
der youth who have encountered family rejection. In addition, an
elevated rate of autism spectrum disorders (formerly Aspergers
syndrome) has been identified among gender diverse adolescents.
There is no single trajectory of development of gender diversity or
transgenderism. Many transgender youth present with a history
of gender dysphoria from childhood, yet others experience gender
dysphoria for the first time around the onset of puberty. Still others
do not report a history of gender dypshoria. Because of this, an
individualized approach to treatment is indicated. Warning signs
suggesting urgency of care are externalizing (i.e., aggression) or
internalizing behaviors (i.e., withdrawing). Some gender diverse
and transgender youth may come out to family, teachers, mentors,
or friends right before they are considering self-harm or suicide.
EVIDENCE-BASED PSYCHOLOGICAL
INTERVENTIONS
Psychological interventions are highly individualized to meet the
needs of the adolescent within their environmental and social
context. General approaches to therapy have used empirically
supported cognitive and behavioral strategies to reduce the impact
of the psychosocial stressors the adolescent is facing, widening
social support through environmental involvement (family, school,
etc.), making timely referrals to transgender-competent health
care providers if indicated, and improving youth resilience and ego
strength. Attempts to force gender diverse and transgender youth
to change their behavior to fit into social norms may traumatize the
youth and stifle their development into healthy adults.
Psychologists can advocate for gender diverse and transgender
students in schools by providing education, recommending that
schools create and implement policies and procedures to prevent
harassment, honor students preferred names and pronouns, ensure
bathroom safety for all students, allow access to all possible gender-
segregated activities that honor all students gender identities
including extracurricular activities, provide resources for families
and schools, and support the creation of social and support groups
for LGBTQ youth in schools.
Early medical intervention is recommended for peri-pubertal
transgender youth who have a history of gender dysphoria and
a desire to live as another gender. Puberty delaying treatment,
cross sex hormone treatment, and/or surgical intervention(s) may
be indicated to treat gender dysphoria. Similar to psychological
interventions, these treatments are provided on an individualized
basis to meet the needs of the youth.
KEY REFERENCES
Cohen-Kettenis, P. T., Delemarre-van de Waal, & Gooren, L. J. G. (2008).
The treatment of adolescent transsexuals: Changing insights.
Journal of Sexual Medicine, 5, 18921897.
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G.,
Feldman, J., . . .Zucker, K. (2011). Standards of care for the health
of transsexual, transgender, and gender non-conforming people.
(7th version). International Journal of Transgenderism, 13, 165-
232. Retrieved from: http://www.wpath.org/documents/IJT%20
SOC,%20V7.pdf
Coolhart, D., Baker, A., Farmer, S., Malaney, M., & Shipman, D. (2012).
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-
0606.2011.00283.x
de Vries, A. L. C., Kreukels, B. P. C., Steensma, T. D., Doreleijers, T. A. H.,
& Cohen- Kettenis, P. T. (2011). Comparing adult and adoles-
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RESOURCE ORGANIZATIONS
American Academy of Child and Adolescent Psychiatry (AACAP)
American Counseling Association (ACA)
American Gay and Lesbian Psychiatric Association (AGLP)
American Psychological Association (APA)
Family Acceptance Project
Lesbian and Gay Child and Adolescent Psychiatric Association (LAGCAPA)
National Association of School Psychologists (NASP)
World Professional Association for Transgender Health (WPATH)
 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, AD@GALAChoruses.org

* 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: www.glaad.org/transgender/allies