Progressing Toward High-Quality Voice Care for People of All Genders.

Forty years ago, recommendations for gender-affirming voice interventions were based on stereotypes and differences between cisgender men and women, the occasional conference presentation (e.g., Kalra 1977), and just two peer-reviewed case studies of women assigned male at birth: one changing their fundamental frequency (Bralley et al 1978) and another their non-verbal behaviors (Yardley 1976). It was also around this time that Kitajima Tanabe& Isshiki (1979) were refining parameters of cricothyroid approximation surgery on excised human larynges to have a surgical option for trans women seeking to elevate their vocal pitch. Today voice and communication interventions are guided by higher-quality empirical research on effectiveness, professional standards informed bymulti-disciplinary and international collaborations of researchers and practitioners, and people who are in the gender-expansive community (e.g., transgender, non-binary, genderqueer). Voice specialists supporting well-being directly (i.e., balancing communication-based stressors and resources) is an approach informed by clients and colleagues with lived experience in the gender expanse and the minority stress model from the mental health field. This is more affirming than an indirect approach focused on achieving congruence (i.e., changing behaviors to align with sociocultural normative practices) that potentially builds a stressor of ongoing concealment (Azul et al 2022). Remarkable exponential progress continues as we navigate new – and some longstanding – sociopolitical challenges. The purpose of this issue of Seminars in Speech and Language is to feature the understandings and practices of today as a clear benchmark in the story of progress. The issue begins with a paper by linguists Hope and Lilley investigating how speech is used in social indexing (i.e., signaling belonging in social groups) for gender. This study fills scientifically and socially important gaps in the speech perception literature by including synthetic stimuli that are outside of binary gender norms and a group of gender-expansive listeners. The findings have implications for clinical use of auditory perception in gender-affirming care, as well as for a multiply marginalized group: non-binary people who use speech generating devices. Overall, the direction of this work promises to improve and expand how speech-language pathologists serve non-binary people. The next two articles improve our ability to inform and empower clients to make their own decisions in a biopsychosocial approach, a central tenant of the person-centered care model that much of healthcare is striving toward today (Grover et al 2022). People need providers who explain information and support their chosen path to well-being. Voice surgery may be a part of that path, so Dwyer et al have written about the current surgical options for voice in the