Gender-Affirming Voice and SLP Specialties with Ruchi Kapila

Mai Ling Chan 00:00 
Have you ever thought about how much your voice shapes who you are? For many transgender individuals, voice isn't just about communication, it's about authenticity, identity, and being recognized as their true selves. And in today's episode, we're diving into the world of transgender voice therapy.

Ruchi Kapila 00:22 
The message that I want to share with people who are listening is that like all of us are likely going to interact with somebody who is trans or gender nonconforming at some point in our career, and we can learn to make our practices more inclusive and our services more client centered.

Mai Ling Chan 00:42 
I'm Mai Ling Chan, and together with James Berges, we're getting you top tips and resources for building and scaling your disability -focused offerings straight from the forefront of disability advocacy and leadership.

James Berges 00:58 
Today, we're talking to Ruchi Kapila, an SLP and vocologist. We'll be exploring how voice therapy has become a crucial component of gender -affirming care.

We'll unpack the science, share personal stories, and examine how something as fundamental as our voice can profoundly impact mental health and social participation. But here's something that might surprise you. While news headlines tell us about vocal surgeries and different medical procedures, voice therapy is actually far more common than surgical interventions for trans individuals. In fact, about 14% of transgender women pursue voice therapy, compared to just about 1% who opt for voice surgery. And one of the reasons is it's much more expensive and invasive.

Mai Ling Chan 01:42 
Thank you for those stats, James. I find them very interesting.

And I think on the other side of it, we want to know what's the actual impact of voice therapy. So we're finding that two thirds of trans women report significantly increased satisfaction with their voice after training. So that's pretty good.

And even though that this isn't just about changing their pitch, it's also about finding their authentic voice through this complex interplay of resonance, intonation, and even nonverbal communication patterns. And that's the psychology that goes with it. So I just want to share that Ruchi is one of the best people to be providing intimate individualized services in this area. She's been a thought leader in the space for years, James, and I'm honored to have her join us for this episode.

And I'm really excited for you, the listener, to hear this, I guess this perspective in this new area from her perspective.

James Berges 02:31 
Absolutely. But before we get to the interview, Mai, do you have anything interesting to share from this week?

Mai Ling Chan 02:36 
I do this past weekend we celebrated my dad's 80th birthday, and it was rich with Chinese culture, complete with two dancing lions. Have you ever seen that, James?

For Chinese New Year, you see the dragon.

James Berges 02:48 
Yeah.

Well, I would love to actually see that in person. All I know is that I'm from the year of the snake, but I don't know how to honor it.

Mai Ling Chan 02:55 
Cool.

Yeah, so this is two dancing lions and there's about three people inside of them So one is doing the head and also like maneuvering the eyelashes and just it's so like makes it very realistic, right? And so we also had specific family style Chinese dishes on each of the tables so we had tables of like 10 to 12 people and Each of the foods reflect things like prosperity and happiness and then it was really poignant I did the the long toast, you know to my dad and in there I shared that we have to admit that there are severely fading ties to our Chinese culture as our family grows and you know We we marry people outside of the culture and then our children and our children's children are just so much more removed from this personal Experience, you know, and it was just it was Exciting happy and then also a little sad to know like we probably won't be doing anything more like this You know for the rest of our family

James Berges 03:48 
How special? What a beautiful moment. I mean, it is like that bittersweet symphony as that verb song goes.

That's life.

And I think about that a lot, about cultural traditions. What do I want to keep alive if I have children?

What do I want to give up? What is the thing tying us to our former identities and what are the parts we would want to change while honoring our past selves?

Mai Ling Chan 04:13 
Yes.

And I wanted to add some humor in my speech because I did not want to cry. And I said things that are really true that the things that we have and my children have, my brother and my brother's children is we all use chopsticks. We all take our shoes off at the door.

It's just required. We just know as soon as you walk in the door, even at like other people's houses, we'll take our shoes off at the door. And another funny thing is we all love Kung Fu movies.

James Berges 04:35 
Hmm. Who doesn't like a good Kung Fu movie? Come on.

I love that.

Yeah. So you'll keep those alive.

And, you know, it's like a part of a shared cultural code. And, you know, as the world changes faster and faster, whether it's through, you know, your lineage or just through your voice, these are all these themes that we're going to be exploring in this podcast episode with Ruchi. So with that in mind, join us as we explore the art and science of people finding their voice to truly reflect who they are.

Mai Ling Chan 05:12 
I am very, very excited to have Ruchi Kapila, fellow speech language pathologist and a trained vocologist here with me today because I feel like this has been a journey over a number of years watching Ruchi grow and just be an amazing pioneer and leader in this space. And so this is a very exciting time for me and a warm welcome to you, Ruchi.

Ruchi Kapila 05:33 
Thank you so much, Mei Ling. I really appreciate you having me today.

Mai Ling Chan 05:37 
Oh, it's amazing.

You have done so much work. Just as every one of our guests on this podcast have been doing, and yours has been growing and changing over years. I think we went back on the trail to 2021, but I know that you and I have known each other for years before that, but you really have stepped into a very unique space. I'd like to welcome you to share a little bit about what you've been focusing on recently.

Ruchi Kapila 06:05 
Sure, a lot of this has been about developing my private practice as well as offering gender affirming voice services kind of on a monthly basis at the Oakland LGBTQ Center just to be able to provide some access to gender affirming voice like tools that people can start to incorporate. I started teaching phonetics at Minnesota State University and I'm covering the voice and resonance class at San Francisco State as well this fall. The other things that have been really present in my life are collaborating with Trans Voice Initiative on doing live education for other trans and gender non -conforming or gender expansive SLPs and SLP students as well as voice teachers, voice coaches in that vein.

Ruchi Kapila 06:56 
Yeah, I mean, to be honest, if something comes across my desk or comes up as an opportunity, I've been playing the yes and game with it for the most part and hitting a stride of being pretty busy. So a lot of the focus has been on voice work, neuroforming considerations for doing voice work and particularly gender affirming voice as well as just expanding a little bit as an educator. I definitely feel like I'm being pulled in all sorts of different directions right now, but it's been a really good learning process for me.

Mai Ling Chan 07:32 
Thank you.

Thank you so much for sharing all of that. This month that the episode is dropping in is November and it's Transgender Awareness Month and that is really the reason why I wanted to reach out to you and have you on the show. There's a couple of terminology words that you're using. Can I ask you to kind of take a step back and help us just to come into your world with the vocabulary? Sure.

Not a problem.

So great. The first one that I wrote down was gender affirming voice.

Ruchi Kapila 07:59 
Yep.

Gender affirming voice can be a lot of things. I think one of the things that I want to make sure to be clear about is that not every transgender person is seeking voice services to modify their voice to align better with their, their gender. And there are cisgender people who do seek voice services to seek, you know, a voice configuration that presents more authentically in terms of a self determined way in terms of gender affirming voice. I've seen, in my opinion, anytime we look at things like pubraphonia, or for looking at, you know, cis women who've been exposed to testosterone at some point and have vocal fold thickening and thus, like a lower habitual pitch as a result.

Ruchi Kapila 08:44 
Those people are also in some ways seeking gender affirming voice care services, I would say the general like definition I would give is that gender affirming voice care is often elective, or should really always be elective and consensual and involves us modifying a number of things, whether it's pitch, intonation, resonance, prosody, as well as articulation and can be can be expand to other communicative aspects if the provider and the client desire. So we could talk about like gestural communication, or optimizing the voice and communication for the workplace versus being in community spaces, oftentimes, we'll even want to have access to more than one or more than two voice configurations and so Oh, that's so interesting.

Yeah, so it can be very much client led and client specific in terms of what does somebody want to do with their voice what makes them feel the most confident and aligned and a lot of times there can be an issue of, you know, safety.

Ruchi Kapila 09:56 
So, yeah, I mean, it's definitely specific to the person that I'm working with. I hope that helps.

Mai Ling Chan 10:03 
Yes. And so for our listener, I'm assuming that the listeners are also new to this field because I feel like it's been growing and there's just so much more support.

It's so much more richer than it used to be. And if you could just shed a light a little bit on how your work does interface with Transgender Awareness Month.

Ruchi Kapila 10:23 
I mean, I would say everything.

I hold space for clients who are also trans and gender nonconforming all the time in my practice. So for me, like November is another month where I'm also aware of the trans experience, but that's kind of a year round thing for me. I would say that we don't get, I don't know, the best way for me to say it is I think working with trans community and being a trans non -binary person has really facilitated changing my clinical practice overall.

And so in many ways, like I owe trans community so much for reframing how I think about speech language pathology practices as a whole. And I think even if somebody doesn't work with a majority trans population, like I do when I'm focusing on gender affirming voice, I think the message that I want to share with people who are listening is that like all of us are likely to interact with somebody who is trans or gender nonconforming at some point in our career.

Ruchi Kapila 11:30 
And we can learn to make our like practices more inclusive in our services, more client centered as we should with members of community. I think when we're working on making services accessible and safer and more appropriate for the people who are in communities that are not being fully supported right now or experience a lot of accessibility in terms of healthcare and other avenues of services. When we are seeking to serve those communities we actually learn how to serve the rest of our communities better.

That's always been my experience.

So I think that's what lands with me the most.

Mai Ling Chan 12:14 
Yeah. You mentioned safe twice, and that reminded me that while I was in India recently, I had the absolute honor to go around and do some presenting at different speech language pathology universities in Southern India. And while I was waiting, I was sitting outside the department and I saw an old news clipping that they had put up there.

And it said something like, does having a feminine voice restrict you from your employment? And that was really interesting. And it was talking about how you can have speech therapy services, but it was older. And it was probably about, I want to say like eight or nine years ago that I saw that.

Yeah.

And it just made me think of you. And I don't know if you remember, I took a picture and sent it to you. I was like, I'm here.

I'm thinking of you because we need you. And this brings me to, I know that you have been growing into this leadership position, Ruchi, and it's been just so beautiful to watch you.

Mai Ling Chan 13:07 
And so I go back to, back in 2021, I did reach out to you to see if you would join me in my anthology, become an exceptional SLP leader. And at that point, you just weren't ready to be so public and to be the voice of this very, very new space.

And so I was hoping that you could share with us a little bit of what your journey has been and how you have come into this beautiful leadership role.

Ruchi Kapila 13:30 
Yeah, I mean, I would say from like, you know, a few years ago that lots of things have changed.

I'm glad you asked about it. I think a lot of things in terms of like coming to terms with like neurodivergence, I don't think I was like 100% there in terms of understanding how being like, you know, autistic and being an ADHD -er and there being a big component of self -diagnosis at that time was so impactful. I think that was really early in my career development.

So even though I had established my voice practice in 2020, I hadn't completely, you know, had this stable history of like, oh, I've been doing this for so long, or I feel like I've built so much experience at this time. That took time as well. And so I think I was in such a period of development, and you know, I think it's really common for people in the field to experience imposter syndrome that I was like, I don't know, I don't know what I'm leading yet.

Ruchi Kapila 14:29 
You know, I didn't have a fully formed idea of what I would end up becoming a few years later. And you know, I think even as I stand now, I recognize that like, leadership is something that I've, you know, taken part in, you know, in various different arenas.

And I think, you know, it's complicated. But I think in SLP work, we are often told in our graduate program trainings and in our clinical fellowships and early on in our career that we need to fake it till we make it. And I think for the leadership thing, I had to see myself become that thing before I could, you know, kind of hold on to that title.

And also it's something that's like, to some extent, I feel like leadership is something that's kind of bestowed upon us. Like people call us this, you know, doing work where we've developed, like we've demonstrated or developed some sort of leadership through service or through teaching or through presentation or through writing and being a more public representative.

Ruchi Kapila 15:34 
And that's happened. But you know, I think part of it is like you, you know, you came to me and you're like, Hey, I see this in you.

And I think, you know, now I'm at a point where I'm like, Okay, I can acknowledge that. I mean, I think at that time, like, I think, you know, maybe maybe there was a part of me that was just like, I think Mei Ling sees potential.

It's not like, but maybe it's not 100% cooked yet. And so I think, I think the biggest advice I have around like navigating around leadership or being like, when am I ready is to kind of just do I mean, it's something that I've learned from my now spouse, Blake was he was just like, do the work. You know, it's not about, it's not about what people say or how people rate things.

It's really about your dedication and you have knowing your own reasons and, you know, leading with, you know, with your mind, but also with your heart into the work.

Ruchi Kapila 16:32 
And so I feel like I've mostly been pretty dedicated to that over the last few years. And I'm happy that I got to that place.

Mai Ling Chan 16:40 
That's beautiful.

That's fantastic. If you're like me, you can't get enough of books, podcasts, blogs, and other ways to find out how to create, grow, and scale. That's why I brought together 43 disability -focused leaders to give you more of what you're looking for. You will hear their stories in three best -selling books, which focus on general offerings, augmentative and alternative communication, and speech -language pathology. I invite you to search for Becoming an Exceptional Leader on Amazon, so you can learn intimate start -up pearls of wisdom and keep growing your brilliant idea. Now, let's get back to our amazing interview.

This whole community, I feel, of speech pathologists who are focusing in this area has started to grow. Have you seen that also in the work that you're doing?

Ruchi Kapila 17:29 
Absolutely. I mean, I think even in seeing the educational opportunities that Trans Voice Initiative has allowed, as well as some of the collaboration we've had with other trans and gender -unconforming SLPs in terms of doing, you know, live trainings for this work, we've seen people coming into part -time private practice or applying for positions where they're able to work on this in either a general outpatient like capacity or in a voice and swallowing sort of specific role at a clinic. So we're definitely seeing that change as well as like the diversity of offerings in terms of people getting to learn about what gender -affirming voice is.

There's always huge social media demonstrations and discussions about what this work can look like or where to receive these services. And we've, a number of us have been, you know, like I think I was interviewed on NPR this year and AC Goldberg was on, kind of had an interview on one of the Today sort of blogs and I think Kevin Dorman was like interviewed for CNN.

Ruchi Kapila 18:41 
So like we've had a number of people just, you know, being interested probably also because of the anti -trans legislation in certain states that like, you know, where there is a push to kind of just really talk about what gender -affirming voice care looks like so that people can be better informed about what's impacted as well as understanding, you know, who is like a candidate for these services, which is, you know, basically I would say basically anybody who, you know, wants to change their voice as a candidate to at least, you know, come in, get assessed. And I think just having that, having that awareness and people also being concerned about, you know, wanting to have access to services has been, I think, a big push in the direction of people wanting to provide these services as well.

Mai Ling Chan 19:30 
Excellent. Yes, where there's a need, right? So you touched on the trans voice initiative. Can you share with us a little bit about this?

Ruchi Kapila 19:36 
Yeah, Transphoresis Initiative, I believe we started in 2020. And we were just like a coalition of speech language pathologists, I think, wind fasting when it was one of our early founding members, who helped us kind of coordinate.

And there's a number of us who are involved either in healthcare settings, university settings, clinical settings, private practices across the United States. And we are all trans and gender nonconforming speech language pathologists who are organizing to basically bring this work into community hands as much as possible. So being able to train other SLPs and SLP students who are also in the TGNC community to provide these services for other people in community. Part of this is because the lack of access there are a lot I mean, there are limited voice and upper airway clinical fellowships, as well as fellowships where people can learn about gender affirming voice.

Ruchi Kapila 20:40 
And there's also limited like clinical opportunities, even at the university level. And while there has been a great boom of like university clinics providing gender affirming voice services or transgender voice services, that's not every single university and not students going to have act like just because of the numbers, not everybody's going to have that experience. So we wanted to be able to mentor specifically TGNC SLPs and SLP students, so that if they didn't have that opportunity to for mentorship for training, that their perspectives, especially being in community can be elevated. And so there's there's an understanding that by being in community, there is a sense of cultural responsiveness and sensitivity, which I think can be one of the challenging things for allies to to learn to a satisfactory level in terms of providing the service, though I have plenty of cisgender allies who do.

Ruchi Kapila 21:31 
But I think what the idea is that if we can support these folks in terms of learning how to provide gender affirming voice services, and they can go out into the world in various settings and be able to provide these services, that gender affirming voice care can continue to get better and better, as well as more responsive to community needs, if that representation is there.

Mai Ling Chan 21:52 
Wow. So for our listener, the speech language pathology profession is so wide. You go from birth to death, you can go from feeding, swallowing, speaking, cognition, just all of these area articulation, which is the classic one that people know. And then there's AAC, which is augmentative alternative communication. And so now I feel this is another really important niche area that you can go into, which could be part of your suite of services, or you could be an area that you choose to really dive in and do your private practice around.

And so this is really interesting because I feel like this area is really starting to grow.

And Ruchi, again, is right there, providing education. You also use the term vocologist, and I used it because it was in your bio. Can you share a little bit about why you're using this terminology?

Ruchi Kapila 22:42 
Vocologist is kind of a recognition that all SLPs are not necessarily voice specialists, for one thing. Exactly.

I know that there are talks about there being potentially board certification for voice in upper airway. I don't really have news about that or information about that, but a vocologist typically studies voice science as well as information about voice habilitation. Oftentimes there'll be information regarding singing voice habilitation and rehabilitation, but a vocologist can be many things. A vocologist could be a voice teacher, a voice coach, a voice scientist who's not necessarily an SLP.

It can be an SLP as well, and vocologists are often under an umbrella. Pan American Vocology Association is like the common organization that I know that is releasing PAVA -recognized vocologists who take an exam and also demonstrate that they've done a certain amount of education or publication work to be recognized by the organization.

Ruchi Kapila 23:54 
People can become a vocologist whether they go through PAVA or through other, I would say commensurate training. A lot of that is about a lot of people working together to keep voices healthy, whether it's for singing voice, acting voice, if somebody is a podcaster, for example, like yourself, or another professional voice user, and for everyday folks as well. Basically, it's somebody who can work with voices where there is a voice disorder involved, but also people who just have preventative voice needs or they're wanting to optimize their voice for whatever work or activities of daily living involve voicing and vacation. I think there's an understanding that vocologists, we all work together in an interdisciplinary care team. I should also add that laryngologists and ENTs can also be vocologists. I did not want to leave them out.

They should.

Mai Ling Chan 24:50 
Yes, and that brings me perfectly to the next thing was that I really wanted to publicly thank you for assisting myself and my husband. This is not a HIPAA violation because he did give me approval to talk about what he went through recently and I did touch on it on a previous episode where he was experiencing increasing difficulty speaking and fatiguing towards the end of the day and really like over speaking and his neck muscles were hurting.

So it was going on for a period of months.

We ended up, I reached out to Ruchi and I was like, what do you think? And she she is an expert in voice for years, you know, and so Ruchi immediately said, these are these are the people you need to speak with connecting me with some people in right here in Phoenix, Arizona, where I am.

Mai Ling Chan 25:35 
And I loved that they were even people that I knew but I did not know had gone into focusing more in the voice area. So that was amazing.

And then moving through the process of going through the scope visually, being able to see, you know, that there was some growth on there and going through surgery and then going through voice rehab. So all of that Ruchi was right there with us.

And so I just wanted to thank you again for just giving us that hand holding and I just the professional information and recommendations you gave were excellent and prepared us.

Ruchi Kapila 26:09 
Of course, absolutely.

I mean, voice changes can be really scary or unexpected. And it's really important to have people in your team or people that you can connect with that you can ask for help. And I think that was one of the great moments of a lot of us coming together and kind of getting people from forums to kind of share where you'd be able to get services best. And it was a great opportunity for a bunch of us to get together to help address this issue. So, you know, I appreciate you feeling comfortable enough to reach out and everything.

Mai Ling Chan 26:42 
Yeah. And actually now you're reminding me is the speech language pathologist we ended up working with saw your post that was just a generic inquiry, you know, just saying, Hey, you know, I'm wondering about this. And they were like, Oh, this is fantastic.

Like I can tie this all together. So, you know, again, for our listener, reaching out for help is it's so powerful, whether it's within your profession across professions, you know, everyone is here to help each other. And we firsthand just witnessed that an entire community coming together that, you know, I didn't, I really did not know was so strong and powerful because I was not, you know, in that specific area of speech pathology. So, okay, what else are you working on right now?

Oh, so much.

Ruchi Kapila 27:21 
Okay, so, you know, I have a number of talks that we're doing at ASHA this year. I'm talking about AAC and voice considerations with Karina Seychow from Golden Oak Speech Therapy. She's doing her PhD at KU.

And so that will be a really awesome like cross -disciplinary talk we're doing with Jenny Cleary who's at Kaiser Permanente and of Explore Voice Studios. We're going to be doing our Embracing the Grade talk which we did at Kasia previously, but this is about, you know, just kind of going through some case scenarios with regard to gender -affirming voice because sometimes we'll get into the descriptive mode but not necessarily get to show people functionally how we navigate things with clients and particularly if they're singing voice examples. So I'm really excited about the fun.

Mai Ling Chan 28:10 
That sounds fantastic. And just for the listener, ASHA is the American Speaks Language Hearing Association conference, and it will be in Seattle, Washington in December of 2024. And then CASHA, she was referring to, is the California Speech and Hearing Association. So Richie really has some wonderful platforms.

And I do love that you're going to be sharing not just the details about it, but I guess this is a little visual and functional example.

Ruchi Kapila 28:34 
Absolutely, yeah, I mean, and I, you know, we have a, we have a whole group of phonetics folks that we're presenting with and names are escaping me right now but I'll share all the information with mailing whenever we're out. And then Kevin Dorman from Prismatic Speech Services and I are coordinating on this gender voice training that's going to be at the UNSHITS next January, so that's 25th and 26th. So registration is open for that still, and we should be following up with an offering in April as well and so I'll keep you posted with details on that. So there'll be plenty of opportunities to talk about gender affirming voice as well as other speech language pathology related considerations for voice and I'm always happy to chat about phonetics too, so.

Mai Ling Chan 29:26 
I love it.

I love it. So when you're talking about all of this voice training, I'm thinking adults, where are you at with the children?

Ruchi Kapila 29:32 
Where am I at with children? I have seen pediatric voice clients before, and I think this is like, it's definitely when it comes to working with kids, it's very dependent on the kid, the family, the situation, in terms of if they're amenable to strategies, whether and what makes the most sense at a given time. So I definitely am open to and have worked with a number of kids over the years, but I think it's all dependent on, you know, I think awareness, as well as a sense of like agency with their voice and being able to participate in, you know, voice exercises, even if they're play -based. I know that there are a ton of people who work with a lot of pediatric voice, and so I'm hoping to continue to develop that as it goes.

Mai Ling Chan 30:22 
available.

That's great. Sounds like a very interesting space. For sure.

Fantastic. Okay, well how can we continue to support you and follow what you're up to?

Ruchi Kapila 30:30 
You know on tiktok and instagram and facebook i'm at Kapila Voice and you can always check out my website kapilah voice calm Where i will eventually commit to an email list and all of that stuff Yeah, i mean i think that'd be great and if anybody is At asha or comes out to see and ships please say hello to me feel free to reach out If you have questions and yeah i would love i would love to hear from all of you I'm really appreciative of getting to be here and to connect with you and so it's nice to be able to bring more people in To talk about voice especially in these like subspecialty areas

Mai Ling Chan 31:11 
Excellent. Thank you again, Ruchi, so much for all the work that you're doing and helping us to come into this new community and understand more. Thank you. We hope you enjoyed this episode and invite you to leave us a review on Apple Podcasts and Spotify and share the show with people you think will find value from it. This helps the show a lot. Or have a great guest referral. Reach out to us at xleaders at gmail .com. 

James Berges 31:36 
And if you want exclusive tips on becoming an exceptional leader, deliver straight to your inbox, just go to ExceptionalLeaders .com and sign up for our mailing list. Thanks for listening.