Voice and Speech Therapy

Transgender Voice, Speech, and Communication

Our team has specialized interest and training in evaluating and working with transgender patients to provide behavioral and medical/surgical interventions. Much about voice that identifies gender relates to word choice, phrase structure, and intonation patterns. As with all evaluations related to voice and interpersonal communication, the assessment begins when you walk through the door. People are often unaware of habitual communication patterns. These habitual patterns convey more about gender perception than vocal pitch or quality alone. Therefore, pragmatics (social communication patterns) will be evaluated during the initial visit. In addition, vocal pitch, quality and resonance along with the size of the voice box will be assessed.

As a team (patient, physician, speech pathologist) we will identify areas to target to help you reach your voice and communication goals. This usually begins with behavioral intervention targeting communication patterns and easily accessible pitch range that allow the patient to produce an efficient voice that is more in line with their gender identity. Once these behaviors have been maximized then consideration can be given to surgery to alter pitch. This is rare, as most patients can achieve a gender authentic voice without surgical intervention. Finally, surgeons at the Voice and Swallowing Center are able to perform Adam's apple reduction surgery (reduction thyrochondroplasty), and can coordinate with other surgeons to be performed at the same time as other facial procedures.

What to expect at your appointment

During your initial appointment, you will be evaluated by a physician and speech pathologist. This visit could last up to two hours. A nurse will seat you in an examination room and will take an initial history, then a resident/fellow (physician in training) will ask you questions about your medical history and initiate the physical examination. The speech pathologist and laryngologist will then perform specialized tests (that will include a recording of your voice and examination of your mouth and throat with a telescope). This examination will be recorded and reviewed with you. This will help the team complete their assessment to help you meet your goals.

You and your voice team will work together to determine the best treatment plan for you. This often begins with voice and communication therapy, which takes place over multiple visits with one of our licensed Speech and Language Pathologists to develop a communication style and voice that is aligned with your internal gender identity and sense of self.

The Airway, Voice, and Swallowing Center at UCSF is world renowned as a leading multidisciplinary center designed to serve patients with voice, airway, and swallowing disorders. We provide advanced medical, surgical, and behavioral services for the accurate diagnosis and appropriate treatment of a wide range of voice and speech complaints, swallowing complaints, and other disorders of the upper airway, including larynx and trachea.

The mission of the Center is to provide state-of-the-art care for patients, develop technology for the diagnosis and management of upper airway disorders, participate in research for improved understanding of voice and swallowing disorders, and develop educational programs for trainees interested in field of laryngology.

The UCSF Voice and Swallowing Center is staffed by internationally recognized fellowship-trained otolaryngologists (laryngologists), speech-language pathologists, voice therapists, and swallowing specialists. Our team works closely with neurologists, pulmonologists and physical therapists to care for the entire patient and manage their voice and swallowing difficulties in a holistic environment. Together, we strive to provide personalized, comprehensive care for each patient that enters our Center.


Sarah L. Schneider, MS, CCC-SLP

Sarah Schneider photo

Sarah L. Schneider, MS, CCC-SLP, is Speech Language Pathology Director and Health Sciences Assistant Clinical Professor in the Department of Otolaryngology – Head and Neck Surgery. She practices clinically at the Voice and Swallowing Center. Clinical and scholarly interests include the evaluation and treatment of all aspects of voice and upper airway with special expertise in the professional speaking and singing voice, transgender voice and communication, spasmodic dysphonia and vocal tremor, irritable larynx including PVFM and chronic cough, and alaryngeal voice restoration. In addition, she has experience with pediatric voice and instrumental assessment of velopharyngeal insufficiency.

She joined the UCSF Department of Otolaryngology, Head and Neck Surgery at the Voice and Swallowing Center in 2007. Since that time, she has helped to further develop the speech language pathology program throughout the Department of Otolaryngology striving to provide interdisciplinary and world-class care to those with voice, swallowing, and communication complaints. She has her Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) from the American Speech Language and Hearing Association (ASHA) and is licensed in the state of California.

Ms. Schneider is active in several research projects within the department and acts as a research consultant in the area of voice. She is on the editorial board for the Journal of Voice, contributor to voice texts, and an active speaker locally, nationally, and internationally on vocal health and rehabilitation. She is a leader in coordinating voice conferences and other educational activities, in addition to providing training and mentorship to students, residents, fellows and other healthcare providers. She has studied voice and performed as a soloist, in choral settings and in musical theatre which helps further guide her clinical practice.

Ms. Schneider earned her undergraduate and graduate degrees at Marquette University where she was awarded the Alfred J. Sokolnicki Clinical Excellence Award at each commencement. She completed her clinical fellowship at the Vanderbilt Voice Center in Nashville, TN and was hired to continue work there following her fellowship. Prior to joining the UCSF Voice and Swallowing Center team, she also worked in the private practice of Dr. Robert T. Sataloff in Philadelphia, PA.

Professional affiliations include ASHA, the Special Interest Groups (SIG) - Voice and Voice Disorders (SIG3) and Telepractice (SIG18) of ASHA, and the California Speech and Hearing Association. She is a Lee Silverman Voice Treatment (LSVT) certified clinician.

VyVy Young, MD

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VyVy Young, MD, is an Associate Professor of Clinical Otolaryngology in the Division of Laryngology in the University of California, San Francisco Department of Otolaryngology – Head and Neck Surgery. Dr. Young is a summa cum laude graduate of the University of Louisville. During her matriculation at the University of Louisville School of Medicine, she was the recipient of the Dean’s Scholarship and was elected to Alpha Omega Alpha Honor Medical Society. She trained in Otolaryngology-Head and Neck Surgery under Jeffrey M. Bumpous, MD at the University of Louisville. During her residency, she was the recipient of the Francis Lejeune, Sr. Resident Research Award from the Southern Section of the Triological Society.

Dr. Young then accomplished her fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh. She was previously on faculty at the University of Pittsburgh as an Associate Professor as well as the Associate Director of the Otolaryngology Residency Program and the Assistant Director of Otolaryngology Medical Student Education. She has a passion for and a focus upon education as part of her professional career interests. She was recognized as the Otolaryngology Clerkship Preceptor of the Year in 2014 at the University of Pittsburgh School of Medicine.

Dr. Young has authored 26 original articles and 4 book chapters and has given presentations at over 40 regional, national, and international conferences. She was peer selected as one of the Best Doctors in Pittsburgh in 2016 and 2017 for the Pittsburgh Business Times. She is currently the Chair of the Voice Committee and the Chair-Elect of the Women in Otolaryngology Communications Committee for the American Academy of Otolaryngology – Head and Neck Surgery.

Dr. Young will concentrate her clinical efforts in the Voice and Swallowing Center at UCSF and will be the Associate Program Director working closely with our Residency Program Director, Steve Pletcher. Her research interests include vocal fold paralysis, age-related voice, and voice outcomes.

Erik Steele, MFA, MA, CCC-SLP

Erik Steele photo

Erik Steele, MFA, MA, CCC-SLP, is a Speech Language Pathologist at the UCSF Voice and Swallowing Center and Head and Neck Surgical Oncology in the Department of Otolaryngology Head and Neck Surgery. He specializes in the evaluation and treatment of patients with wide ranging voice, swallowing, and upper airway problems. Clinical and scholarly interests include individualized care of the professional voice, the use of advanced instrumental diagnostics in voice and swallowing, patient-centered rehabilitation of voice, speech and swallowing following head and neck cancer treatment, and community outreach to promote greater awareness of voice, swallowing and upper airway problems and therapies.

Before joining the Department of Otolaryngology and Head and Neck Surgery at UCSF, Mr. Steele completed his graduate work at San Diego State University, a clinical internship at the Scripps Center for Voice and Swallowing in San Diego, and his postgraduate fellowship at the Center for Voice and Swallowing at UC Davis, where he then remained for two years.

Mr. Steele is a former professional actor who has performed on and off Broadway, at major U.S. regional theaters, internationally, and as an audiobook narrator. He was a member of a classical singing ensemble at Vassar College, where he received his BA in Drama, before going on to earn an MFA in acting at New York University’s Tisch School of the Arts. He maintains AEA and SAG-AFTRA membership, along with current professional affiliations with the American Speech Language and Hearing Association (ASHA), ASHA's Voice and Voice Disorder Special Interest Group (SIG 3), ASHA's Swallowing Disorder Special Interest Group (SIG 13), and the National Foundation of Swallowing Disorders (NFOSD). He is a Lee Silverman Voice Treatment (LSVT) certified clinician.

Clark Rosen, MD

Clark Rosen photo

Clark Rosen, MD is a Director of the UCSF Voice and Swallowing Center, Chief of the Division of Laryngology, Professor of Otolaryngology-Head and Neck Surgery.

Dr. Rosen is originally from Los Gatos, California and is a proud graduate of Cal (Go Bears!). He attended Rush University for his medical degree, accomplished his residency in Otolaryngology – Head & Neck Surgery at Oregon Health Sciences University at OHSU, and completed a fellowship in Laryngology and Upper Airway Physiology at the University of Tennessee in Memphis under the tutelage of Gayle Woodson MD. Dr. Rosen inaugurated modern laryngology at the University of Pittsburgh beginning in 1995 creating a dedicated center of excellence in Laryngology, University of Pittsburgh Voice Center. Dr. Rosen originated the outstanding Fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh in 2002 and since has trained over 15 fellows in Laryngology and numerous visiting Otolaryngologists from around the world.

Dr. Rosen has had amazing productivity as a clinician scientist. He has authored over 160 peer reviewed publications, 30 book chapters, 5 books including being the co-editor for Bailey’s Head and Neck Surgery-Otolaryngology which is one of two main textbooks in our field. Dr. Rosen also authored (with Blake Simpson MD) a key operative atlas, Operative Techniques in Laryngology which has international reach and has been translated into to Mandarin and Spanish.

Dr. Rosen has been a Co-Investigator on numerous NIH grants as well as grants from the Triological Society, the VA, and private industry.

Dr. Rosen has been a sought after speaker internationally and has had major service to multiple publications and professional societies. He is a founding member of the Fall Voice Conference, is the Vice Chair of the Annual Meeting Program Committee for the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS), and is the Treasurer of the American Laryngological Association (ALA) which puts him in line to be the president of the ALA.