Hi! I’m Nicole Gress. I’m a speech-language pathologist and trans voice coach. I help trans, non-binary, and gender-questioning folks find a voice that aligns with their identity.
Early on in my career in gender-affirming voice, I worked at both a San Francisco hospital and private practice with trans and non-binary clients. Being employed by those institutions dictated the type of interactions I could have with my patients. Working within a traditional healthcare system through the traditional medical model dictated that my patient contact be limited to “billable hours” only.
What is the traditional medical model?
Well if you’ve ever been treated in the US, you’re likely familiar with it. It starts with an appointment with your general practitioner, followed by a referral to a specialist. Then you see the specialist for an evaluation and create a plan of treatment that’s carried out through weekly appointments. Think of psychotherapy or physical therapy or, more to the point, voice therapy. I’ll take you through the typical flow of a trans person seeking to explore their voice through the traditional medical model next.
Meet Grace (name changed).
Grace was a dedicated client of mine who started working with me within weeks of being hired at Pinterest. Grace got a referral from her GP, and we met for our initial evaluation. At that evaluation we discussed her goals for her voice, she shared some YouTube clips of an anime character whose voice she admired, and we discussed our plan for her voice transition. Pinterest had very inclusive gender-affirming healthcare benefits, and she was informed that her insurance plan covered voice therapy. It seemed as though everything would be covered, so we moved ahead with scheduling.
Grace scheduled a weekly appointment to see me for 40 minutes every Wednesday at 4 pm. Each week, Grace would sit across from me and I’d introduce a new structure or function of her voice that we were going to explore changing to align with her identity. We’d talk about the anatomy and physiology of her voice, and I’d demonstrate some exercises and techniques I wanted her to practice throughout the week. Grace did great with these exercises in the clinic and felt confident she’d be able to recreate that success at home. Before leaving, I’d send her off with a printout of her exercises she’d place in her hot pink banana printed folder and instructions on how to keep her voice healthy as she practiced.
7 days later
at 4 pm, Grace would sit across from me and share how she did over the past week and present a list of questions that had come up when practicing. More often than not, these questions were imperative to have clarity around to ensure she wasn’t doing the exercises wrong, and causing harm or creating bad habits with her voice.
Eventually, Grace shared that although she could execute her voice exercises almost perfectly in our sessions, practicing at home was difficult. That’s because she lacked a place to “carry over” her skills outside the clinic. Grace worked from home and lived alone (with her cat, Algebra) so she had very few opportunities to use her transitioning voice for practice, and Algebra didn’t talk back. Though she was very self-motivated, she struggled as she was practicing throughout the week without access to me, her clinician for questions and feedback.
Over time, this inability to get feedback or coaching on her practice, and lack of an affirming friend or roommate to use her transitioning voice with greatly restricted how fast she could progress through her voice work.
After just 6 months, Grace’s insurance company decided she should have followed some arbitrary schedule and by now be almost done with her voice work. Her insurance dictated the number and frequency of sessions they would cover, and after just 24 weeks, her benefits started being denied.
Grace’s experience isn’t unique.
Gender-affirming voice therapy within the confines of the traditional medical model is inherently flawed.
When the number and frequency of sessions one “should” be entitled to is restricted, a pressurized environment that breeds self-judgment and doubt if someone fails to accomplish their goals within the prescribed time is created. Simultaneously, the provider’s hands are tied through denied reimbursement for the amount of support one actually requires to habitually alter such an integral part of the physiology as the voice.
Even if given approval for unlimited weekly lessons, one-to-one lessons in a traditional medical model take an average of one and a half to three years. If forced to pay out of pocket, those sessions can cost up to $30,000.
After working within the traditional medical model for 3 years, I noticed a pattern in my clients.
- They were frustrated by how long it took to find what they identified as their unique, authentic voice.
- They felt abandoned while practicing on their own without feedback.
- They often ran out of coverage, money, or motivation before finding their desired sound.
Faced daily with these frustrations amongst other roadblocks, I began to envision a future with a single goal in mind: to demedicalize voice transition and create a new model and approach that centers community needs. A place where people like Grace, who are struggling with finding their voice and want high-quality, accessible, affordable care, can find it.
I knew there was no way I could create what I envisioned within the institutions that were employing me—creating something outside the box required full autonomy, and a little rebellion.
And so, in 2020, I quit.
I quit my clinical job, quit my hospital job, quit my old way of doing things, and started asking the question: “How can we do this faster, smarter, and cheaper while centering the trans community?”
With community the driving force behind my new vision for trans voice, I began to spend time in the spaces where trans and non-binary folks were changing their voices online. I put in countless hours on the r/transvoice subreddit, in discord servers, in meetings with community-based organizations, and talking to individuals who had struggled to find their voices.
I listened to their stories and learned the pain points and roadblocks they were hitting on their voice journey.
Finally, I decided I wanted to CREATE a place.
A place where anyone, gender questioning, trans, non-binary, or even cis can go to explore and create the voice that aligns with their self.
And thus Undead Voice Lab was born!
Undead Voice Lab is an online gender-inclusive platform for voice transition. It’s a place where people like Grace can sign up for a year-long membership.
Once a member, you’re part of the family.
Through Undead Voice Lab you’ll find not only community but the coaching and support not possible through the traditional medical model.
The majority of a member’s time is spent in online video courses where they learn how to control every aspect of the voice. They can move at their own pace and access lessons every day through their computer or the course app.
We meet twice a month for small group coaching calls where we work through each member’s unique struggles, and I help coach them through their roadblocks.
On a day-to-day basis, members keep in contact with me and hundreds of their peers through our private community platform. If someone has difficulty following through, they can join a small group for weekly practice sessions, or one of our online DnD groups where they can explore their transitioning voice while embodying a character.
For a behind-the-scenes look into Undead Voice Lab check out this 6-minute walkthrough. If you want the reader’s digest version, here are the highlights:
Price: UVL costs as low as $39/week (annual payment) or $49/week (monthly payment) *individual course offerings coming this Fall.
Timing: Full voice transition takes an average of 9 months (with most of the big wins happening in the first 6).
Content: Take it at your own pace with a series of 9 online courses
Coaching: Coaching calls happen twice a month
Community: The private online community space hosts weekly practice groups, and guest speakers pop by for workshops on things like voice acting, singing, and overcoming voice dysphoria.
What became of Grace?
After taking a break from voice work for a few months, Grace was browsing the r/transvoice subreddit one day and came across one of my weekly trans voice video tips. She scheduled a free voice consult where we chatted about her goals for her voice, what kind of budget she had for voice work, and by the end of the call, she was on-boarded into Undead Voice Lab. She has since graduated with full control over her voice, transitioned socially, and got a second cat (Calculus) to keep her and Algebra entertained.
So what’s next?
If you’re curious about exploring what your voice can do, or have hit a plateau and need some guidance, here’s a few different ways I can be of help. Choose your own adventure:
Take the quiz to see which of Undead Voice’s resources fits your goals and budget.
- If you’re lost and don’t know where to go next on your voice journey, grab a spot on my calendar for a quick (free) voice consult.
- If you’re interested in joining Undead Voice Lab, enrollment is open now. You can learn more about the full program and sign up here.
No two voices are alike. No two voice transitions are alike. There is only one you and we’re excited to celebrate that.
Social Links:
This piece was originally scheduled to run in March as part of a series on voice transition. Check out:
