UK SPECIALISTS IN GENDER THERAPY
I am a consultant Speech & Language Therapist, specialising in Voice and Speech work. Soon after qualifying as a Speech & Language Therapist in 1995, I began specialising in Voice work and have 20 years experience in the field.
My clinical ability and level of expertise allow me to work with a wide variety of voice clients, including voice disorder, performance voice, transgender voice and the singing voice.
I am the Leading UK clinician in the field of transgender voice and co-author of the World Professional Association For Transgender Health (WPATH) Standards of Care guidelines for Speech & Language Therapy.
Pre and post therapy voice feminisation samples. (Click to listen)
Therapist : Christella Antoni.
|Client 'C': Voice feminisation client|
|Voice at initial assesment||Voice sample, session 8|
I worked in the NHS since 1996 and have been Lead Clinician for voice for two separate NHS trusts:
My private practice now includes a wide range of voice therapy and voice development clients. My working locations have been varied and include settings such as hospitals, health clinics, private clinics, clients' homes, television and radio studios.
From 2006 - 2010, I was chairman of the London Voice Special Interest Group (SIG).
From 2004, I have acted as a National Advisor to the Royal College of SLT's (RCSLT) in the fields of Voice and Transgender Voice.Transgender voice specialist
As the leading UK clinician in the field of transgender voice, it has been a privilege to assist many hundreds of clients to modify their voices successfully. Whilst modifying the voice can seem a very daunting task, my established treatment model breaks the process down in a manageable way, ensuring that successful voice modification, whilst keeping the voice safe, can be achieved in a fully guided process. There is no doubt that the experience level of the clinician plays a large part in achieving successful outcomes and to this effect, I continue to train and supervisie other Speech & Language therapists to help them gain skills in transgender voice therapy.
|Qualifications and Professional membership|
|BA Hons Degree in Humanities (English and Hispanic Studies), University of Hertfordshire, 1989.|
|MSc in Speech & Language Therapy and Pathology, University College London, 1995.|
|Registered member of the Royal College of Speech & Language Therapists.
Membership number: RC0011573.
|Registered Speech & Language Therapist with the Health Care Professionals Council (HCPC).
Registration number: SL00989.
|Member of the WPATH international Standing Committee for Voice and Communication.|
|Member of the European Professional Association for Transgender Health (EPATH) standing Committee for Transgender Health.|
|December 2015: 'Principles of Speech & Language Therapy'. Christella Antoni (chapter 7) in 'Practical Laryngology' Ed. Declan Costello & Guri Sandhu, 2015,. Published by Taylor & Francis|
|December 2015: 'Gender Dysphoria & The Larynx'. Christella Antoni & Guri Sandhu (chapter 19) in 'Practical Laryngology'. Ed. Declan Costello & Guri Sandhu.|
|November 2015: 'Voice & Communication Change for Gender Non Conforming Individuals: Giving Voice to the Person Inside'. Shelagh Davies, Viktoria Papp & Christella Antoni. International Journal of Transgenderism, 16:3, 117-159, October 2015|
|july 2015: 'Service Delivery and the Challenges of Providing Service to People Who are Transgender'. Perspectives on Voice and Voice Disorders, Vol. 25, No. 2, pp. 43|
|2012: 'Vocal Hygiene'; Richard Adler & Christella Antoni, in Voice & Communication Therapy for the Transgender/Transsexual Client. Ed's R. Adler , S. Hirsch & Michelle Mordaunt. Plural Publishing, 2012|
|2007: 'The Role of the Speech and Language Therapist'. Feature articles for The British Voice Association's quarterly magazine, GT News, the Gender Trust's biennial magazine & bulletin (the professional magazine for The Royal College of Speech & Language Therapists).|
|I have written a chapter on 'The Role of the Speech and Language Therapist' in the text: 'Transsexual and Other Disorders of Gender Identity' - Ed J Barrett, 2007, Radcliffe Publishing Ltd.|
|I have written feature articles for the British Voice Association's quarterly magazine.|
|A regular contributor to the Gender Trust's biennial magazine, GT News.|
|2015: This Morning programme. ITV.|
|2014: Voice Advisor to Eddie Redmayne for 'The Danish Girl'. Working Title Films.|
|December 2014: BBC Radio 5 Live. Stephen Nolan on 5 Live.
DJ Stephanie Hirst discusses the long term process of voice change, her voice journey so far and the help she has received from 'world class expert' Christella Antoni.
|August 2010: BBC Radio 4. Fry's English Delight.|
|January 2010: BBC Radio 4. The Vox Project.|
|2008: BBC 4 television documentary, The Voice.
Acted as Voice Consultant analysing a variety of professional voices belonging to singers and politicians. Also featured singing impersonations of famous singers, including Ella Fitzgerald, Barbara Streisand and Katie Melua and explaining vocal tract configurations in various voices.
|2007: Teachers TV, How Stressed is Your School?
Featured as voice expert discussing the impact of stress on teachers' voices.
|2006: BBC Radio 2. A Voice Like Honey
Featured in two part series discussing my voice work with transgender clients and performing and explaining differences in female singing voices including those of Dolly Parton, Cher and Dido.
|2005: Discovery Home and Health Channel, Sex Changes series.
Featured carrying out voice modification therapy for transsexual clients.
|2004: ITV's This Morning programme.
Featured discussing transgender voice therapy in their series on transsexualism.
The history of Transgender voice services in the U.K.
In 2001, I was appointed as the Transgender Voice specialist at Charing Cross Hospital (NHS) and developed the post from a one day a week post to a 4 day a week post as the demand for the service grew. My aptitude for this work was centred in my belief for equitable treatment for all and my knowledge of how the vocal tract works and how the voice can be modified.
I have been committed to increasing the availability of transgender voice services since I began working in this field. For many years I worked as a sole clinician in this field at the Charing Cross Gender Identity Clinic with a ten month waiting list! I steadily advocated for increasing the number of sessions available to treat transgender clients. This reduced the waiting list to four months and the profile of the service was raised both on a national & international level.
I went to my first international transgender conference in 2002—The Harry Benjamin Association for Gender Dysphoria—but did not come across any other SLT at this conference, or the subsequent ones I went to for a few more years...
I ran the first U.K training course based on my treatment model in 2002, and I continue to run these to the present day. For most of my time working for the gender identity clinic I saw clients from all over the UK, since the service was a national one. Although the GIC continues to accept national referrals, the commissioning changes from 2014 meant that the SLT service at The London GIC now only accepts London area patients. Speech and Language Therapy remained classed as a 'Core Procedure' but patients seeking SLT services would now be referred to local services. Unfortunately, whilst a few areas have well established services, many others have a limited or no service for transgender clients.
In 2009, I reduced my transgender NHS work to free up funding for a junior developing specialist post. Alongside leading the transgender SLT service, I trained and supervised the developing specialist, a newly qualified SLT who expressed an interest in voice work. This ensured a 5 day service at the West London Gender Identity Clinic. With the reduction of the referrals from country-wide to London only patients and the developing specialist achieving an appropriate level of competency, I left the West London GIC in August 2015 with a view to further developing my increasing private practice which includes the training and supervision of U.K. Speech & Language Therapists.
The field has evolved considerably in the last few years. There is now a WPATH Voice & Communication Standing Committee which has 5 international SLT members, with myself representing the U.K. In 2014 the European Professional Association for Transgender Health was also established, and I also represent the U.K. on that Voice & Communication Committee.
Through a lot of hard work by a few dedicated SLT's, The WPATH Standards of Care now include a section on Voice & Communication. Speech & Language Therapy is one of the few areas the has a companion document to the WPATH SLT Standards of Care, aimed at offering comprehensive guidelines for Speech & Language Therapists.
|INFORMATION FOR CLIENTS: VOICE FEMINISATION - FREQUENTLY ASKED QUESTIONS|
|Q:||Can I begin voice feminization if I am currently living as a man?|
|A:||Yes. Voice feminisation can begin prior to full time gender transition. Some individuals live dual role and wish to develop a female voice for when they present female. Some individuals have a specific transition date in mind but are currently living in male role and want to start their voice modification as soon as they can. Other clients may have made their gender social transition but have not had any previous speech therapy and seek this out after the social transition. There is no specific right way of beginning voice feminization. It is recommended that the the patient is fairly close to transition so that motivation for voice change remains high, particularly for clients seen in the NHS, as sessions are usually limited in number and the timing of treatment becomes more important so that the client can get the most out of the sessions. Experienced Speech Language Therapists (SLT's) can guide each individual client according to their individual circumstances, and for this reason, attendance at an Initial SLT Consultation is recommended. The timing of the follow up treatment sessions can be planned/suggested at the Initial Consultation.|
|Q:||What effect does oestrogen hormone therapy have on the voice?|
|A:||None. Unfortunately, oestrogen has no significant impact on the voice as once a person born male has gone through puberty, the larynx will have lowered in the body and increased in size. In addition, the testosterone that influences other bodily changes during puberty also thickens the vocal cords which makes the voice sound deeper. This cannot be reversed with oestrogen after a person has gone through puberty.|
|Q:||Will my female voice sound natural?|
|A:||The goal is to achieve a natural/authentic sounding female voice that fits the person. The modifications made will be by adjustments to each individual's vocal tract, so the 'essence' of the person should not be totally lost by developing their female voice. It is normal for clients to have doubts about their voice, or how well they are doing in the early stages of therapy. This is the case whenever we embark on acquiring a new skill, or are going through change. However, most individuals are inspired by the small initial changes which eventually increase to achieve the goals of treatment. In the early stages, the learning is a very conscious activity but as the treatment progresses, with the tasks used by the Slt and the guidance given, conscious learning becomes unconscious.|
|Q:||Will I need voice surgery as well as speech therapy to achieve a female voice?|
|A:||The majority of clients achieve at least a well feminised, or at least, a reasonably feminised voice without the need for voice feminization surgery. Voice feminization surgery is carried out to achieve pitch elevation. Pitch is an important marker for distinguishing between male and female voices. However, it is just one aspect and pitch elevation alone is not usually enough to achieve a female voice. Many other aspects of voice—such as intonation—are important for voice feminization, and these aspects need to be learnt and practiced to achieve a natural and authentic sounding voice.
From clinical observation, it appears that in the U.K. approximately 20 % of male to female individuals may seek voice feminization surgery.
My clinical observations over 15 years working with pre and post voice feminization surgeries have strongly indicated to me that the individuals who have better pitch and voice outcomes with voice feminization surgery are theses individuals who have first had a course of Speech & Language Therapy. This is because the muscles involved in voice change have already adapted prior to surgery, which supports the surgery and prevents the pitch dropping or changing after surgery. In addition, pitch surgery cannot address other aspects of female voice and communication, such as intonation and speech style features. Prior to deciding to proceed to voice feminization surgery, the client should have undergone a pre-surgical assessment with an SLT and an ENT Consultant.
|Q:||What is the recommended process for accessing voice feminization therapy?|
|A:||The strongly recommended approach is:
1. Voice therapy with a suitably qualified SLT
2. Pre-surgical assessment with an SLT, which will involve accurate pitch measurements being made by the therapist and discussed with the client. The possible benefits and possible limitations of surgery will also be discussed (not all SLT's have experience with pitch elevation surgery so they may refer you to an experienced SLT). An explanation of the surgery will also be given to the client.
3. Referral to an experienced Ear, Nose & Throat (ENT) doctor for an assessment.
4. If surgery is carried out, post surgical review with the SLT is very important. This is to give post surgical exercises and guidance and to review the voice quality. If the person had a course of speech therapy prior to the surgery, fewer sessions are required post surgically - sometimes only 2 - 3 are required.
|Q:||Is Speech & Language Therapy available on the NHS?|
|A:||Yes. Your GP can refer you to your local service for this. If you are under a Gender Identity Clinic (GIC), there may be an in-house SLT that the psychiatrists or psychologists can refer you to. The West London Gender Identity Clinic (known as Charing Cross GIC) can offer Speech & Language Therapy for clients under their care IF the client is a London area patient. For individuals living outside of London, they will need to seek referral to their local adult Voice SLT service.
Unfortunately, not all areas of the UK have a service for transgender individuals. Voice feminisation therapy has traditionally been very niche and specialist, not least due to the small numbers of clients within the population as a whole. However, as the rates of referral have increased, so have the number of treating clinicians. Since 2002, I have run training courses for SLT's role to ensure carry-over of skills and broaden the availability of this specialist kind of Voice therapy, and am happy to see that more SLT's now wish to acquire skills in this area and continue to attend the 3 day courses I run. From 2008, I developed the junior developing specialist role at the West London GIC, offering full training within that role to the developing specialist with a view to succession planning.
|Q:||Can I refer myself for private speech and language therapy?|
|A:||Yes. You can do this at any point in your transition.|
|Q:||Can I start voice feminization with a private speech & language therapist while I am waiting to be seen by an NHS therapist?|
|A:||Yes. Many individuals seek therapy with a suitably experienced SLT prior to seeing their NHS therapist.|
|Q:||Can I have treatment with a private speech & language therapist as well an NHS therapist?|
|A:||Yes. It is possible to continue with a private SLT whilst having NHS speech & language therapy. However, the private SLT and the NHS SLT must not be the same person. If your private SLT also works in your local NHS voice service, you should be discharged from their private caseload first and then transferred to their NHS caseload.|
|Q:||Is it possible to achieve a fully feminized voice?|
|A:||YES! I have over 20 years experience of achieving this for a very wide range of clients using my established treatment model. The key elements required for success are motivation for change; an ability to comment to the therapy sessions; some practice time and development of social confidence. The skill and experience of the therapist can play a vital role both in the treatment model offered and in guiding the client through the process of voice change.|
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