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BYU cancels care for transgender clients receiving voice therapy at its speech clinic

The private religious school says gender-affirming care conflicted with LDS Church handbook guidelines against “social transitioning.”

(Leah Hogsten | The Salt Lake Tribune) A Brigham Young University student wears a rainbow heart pin on March 11, 2020. The private religious school decided in February 2022 that transgender clients seeking gender-affirming speech therapy will no longer be able to get services at the campus' clinic.

She has been receiving voice therapy at Brigham Young University for more than a year. But as of this week, the private religious school is refusing to serve her.

And it’s because she is transgender.

The client came into the campus speech clinic on Monday for her regular appointment, she said, and was informed that it would be her last.

The staff told her that the administration at the school, which is operated by The Church of Jesus Christ of Latter-day Saints, has decided to end all gender-affirming speech therapies because providing them doesn’t align with the faith’s policies. Transgender clients often use those services to help match the tone and pitch of their voice to their gender identity.

“The program was so helpful and had been relieving a lot of my anxiety around who I am,” the client said. “So to just be kicked out like this is really painful.”

The Salt Lake Tribune has agreed not to name the client, who remains a student at BYU, as she fears further repercussions for speaking out about being transgender. Her enrollment at the school was verified.

She is one of three transgender clients at the clinic who are now scrambling to connect with new speech providers.

The client said several staff and students were crying when she came in.

The director of the clinic said she couldn’t comment and referred questions to the university spokesperson. The receptionist at the clinic also said faculty would not comment for this story.

Carri Jenkins, the spokesperson for BYU, did not answer questions about the new policy at the speech clinic, though she provided a brief statement.

“Although the Department of Communication Disorders is no longer providing gender-affirming voice and communication services, it has made the three students impacted by this change aware of other providers,” she said. “BYU clinical personnel have offered to assist with the coordination between the students and these providers.”

The client who spoke to The Tribune said the decision feels like the latest in a string of events at the school targeting the LGBTQ community.

“It’s one thing after another,” the client said. “It’s destabilizing and makes you worry about what’s coming next. Losing this therapy is especially hard.”

The decision about the speech clinic has also touched off a debate in the field about when an institution’s stance on social issues might interfere with its ability to provide clinical services — without discrimination.

Professionals in communication across the country have weighed in, expressing concern on social media. One professor from Kentucky said it was an “ethical injustice” to deny speech services to transgender individuals. Another called it “transphobic policy.”

A graduate student is collecting signatures for a petition to the American Speech-Language-Hearing Association, which oversees and accredits university speech programs, including BYU’s.

The church handbook

As a private church-funded university, BYU has religious exemptions that allow it to ignore federal laws prohibiting gender-based discrimination. Those include the ability to enforce its own preferences while recruiting and admitting students and giving out financial aid.

It also has an exemption specifically for “health and insurance benefits and services” that applies to its campus clinics. That means BYU can choose to deny care, if it wants, based on a person’s identity.

In a note to faculty shared with The Tribune, school leaders cited the exemptions and said that providing gender-affirming speech therapy to transgender clients violated the LDS Church’s policies that guide the institution. They pointed to the faith’s handbook, which states that gender is an “eternal identity.”

While LGBTQ members are welcomed at church, the guidelines state, same-sex romantic partnerships are forbidden. And leaders are told to counsel against both sex reassignment surgery and “social transitioning” for transgender members.

Social transitioning is defined by the church as: “changing dress or grooming, or changing a name or pronouns, to present oneself as other than his or her biological sex at birth.”

Those who go against that can face discipline.

BYU’s note to faculty said speech therapy to help an individual align their voice to a sex not assigned at birth would be considered by the school to be a part of transitioning. And it will not assist in that process.

But speech therapy is not expressly listed as part of the handbook’s description on transitioning that would not be allowed.

And the church, for instance, does grant exceptions for transgender individuals to receive hormone therapy if it is prescribed “to ease gender dysphoria or reduce suicidal thoughts.”

National studies have shown that gender-affirming speech services also can alleviate pain and difficulties when a person’s appearance or mannerisms don’t match the gender they feel.

It is considered medical care, just the same as other speech therapies to help with stuttering or voice disorders.

A code of ethics

One student in the communication program said the change has been deeply upsetting and has roiled the department. Communication classes were canceled Wednesday as students processed the change.

The clinic, where graduate students work to learn how to work in pathology, has served transgender individuals since fall 2020 among its roughly 70 clients. Most speech therapy programs in the country offer that service.

“It’s part of the knowledge base that we should have,” said the student, who The Tribune agreed not to identity because they feared discipline for criticizing the school. “It prepares us for our work. To not have that is just a huge gap.”

Now there is concern that dropping services only for transgender clients could threaten the program’s accreditation. (Transgender clients can still come for other language therapies, just not those related to gender.)

The Code of Ethics from the American Speech-Language-Hearing Association, which approves BYU’s program, states: “Individuals shall not discriminate in the delivery of professional services or in the conduct of research and scholarly activities on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialects.”

To be certified by the organization upon graduation, too, pathologists are supposed to be trained to work with every type of client and experience the different kinds of therapies, including gender-affirming services.

The American Speech-Language-Hearing Association released a statement Friday, saying BYU’s decision was “in direct opposition to practice expected” of accredited schools.

“BYU is putting its certified speech-language pathologists (CCC-SLPs) in an untenable position,” the statement said. “These employees are now being directed to act in a manner contrary to their responsibilities under the ASHA Code of Ethics.”

It urges BYU to restore gender-affirming therapies immediately.

(Steve Griffin | The Salt Lake Tribune) A transgender client works with computer software at Rocky Mountain University to help the consistency of her voice on Jan., 16, 2018. The program shows the pitch in her speech.

R.J. Risueño, a former BYU student who earned his undergraduate degree there, is now a licensed speech-language pathologist specifically working with transgender and gender non-conforming individuals in Arizona. He said he sees the decision at BYU as discriminatory.

“By denying services to transgender individuals, BYU is preventing their student clinicians to embrace a core component of the gospel of Jesus Christ: loving their neighbor,” he said. “In return, a community in need is left without access to essential services.”

But when Latter-day Saint Apostle Jeffrey Holland spoke at BYU last fall, he said the school and students should defend the tenets of the faith, specifically “marriage as the union of a man and a woman” — even if that costs the university some “professional associations and certifications.”

That speech is just one thing students point to with concern about how the school appears to be tightening its policies against the LGBTQ community.

BYU has also made stricter its rules on protesting after a group of students lit up the “Y” on the mountain above the school in rainbow colors to speak out against how those who are LGBTQ are treated.

Switching providers

Two schools in Utah with speech programs and clinics have agreed to take on BYU’s transgender clients. Those are the University of Utah in Salt Lake City and Rocky Mountain University, a private for-profit school in Provo.

“We will gladly accept anyone who was affected by BYU’s policy change,” said Dr. Brett Myers, director of clinical education in speech-language pathology at the U. He invites the clients impacted to email him directly at brett.myers@hsc.utah.edu, and he will put them on the schedule.

The U. has 25 transgender clients receiving gender-affirming speech therapy — making it one of the largest providers in the country. The school charges a small fee for services, while Rocky Mountain’s program is pro bono.

Wendy Chase, the director of clinical education and an assistant professor in the speech program at Rocky Mountain, said she is also happy to take on the BYU clients and “continue the work that’s already been done.”

Voice, she added, is often is the first clue a stranger uses to classify someone by gender. And if that person assumes wrong, it can derail a conversation and cause pain. The focus shifts away from what is being said to how it is being said, she noted.

Chase feels that is especially the case for transgender individuals. For some of her clients, the fear is that by not “passing” for a man or woman, they will receive unwanted attention or be discriminated against. One client, she said, told her about being physically assaulted after their voice didn’t match their gender expression.

(Steve Griffin | The Salt Lake Tribune) In this Jan. 16, 2018 photo, a transgender client works with students Timothy Baker and Abbey Lasek at a speech clinic at Rocky Mountain University to help the consistency of her voice in Provo, Utah.

The client from BYU who spoke to The Tribune said she is afraid to speak up in class. She doesn’t want to have people question her based on the sound of what she says, and it has impacted her education, she said.

She started to transition as a woman in spring 2020, dressing differently and changing her name. But she felt her voice betrayed her.

For individuals who transition from female to male, taking testosterone will typically lower their voice by expanding their vocal cords. But pitch doesn’t change much for individuals who, like the client, transition from male to female. Estrogen doesn’t have the same effect and can’t reverse the thickening of the vocal cords that happens when undergoing puberty as a boy.

This is where speech therapy can help.

A provider, like the U. or Rocky Mountain, will work with a client to help them change their pitch with practice in a natural way that won’t cause damage. They also help with other language cues.

Women, for instance, tend to gesture more with their hands, use more adjectives and make eye contact. So that is part of the “metalinguistic” learning process, too.

It can take anywhere from four months to two years to get to a pitch range that a person is more comfortable with. The female range is considered anything above 160 hertz. With some overlap, males are usually below 180 hertz.

“Communication — and how you want to communicate — is a human right,” Chase said.

Feeling silenced

Sue Robbins, a member of the Transgender Advisory Council of Equality Utah, said voice is important to transgender individuals.

“If we’re able to interact in society without people recognizing that we’re transgender all the time, it allows us to go about our activities as we are without discrimination,” she said. “Almost any transgender person has stories of being early on in their transition and being outed because of their voice.”

The transgender client who spoke to The Tribune said the change felt sudden, and she would have liked to at least have until the end of the semester. Now, she said, she is planning to call Rocky Mountain to continue her care.

“We were making a whole lot of process,” she said. “I was very confident with what we were doing.”

She said she felt like the clinic at BYU gave her a voice and then administrators took that away.

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