For many transgender and gender-diverse individuals, voice is deeply tied to identity. The ability to use one’s voice in ways that feel authentic and aligned with one’s gender can shape everyday interactions, from ordering coffee to speaking up in a meeting. Yet practicing voice use outside the therapy room remains one of the hardest steps in gender-affirming voice training. The gap between a controlled clinical setting and the unpredictability of real social situations is wide, and crossing it takes courage.

A 2025 pilot RCT published in the Journal of Voice (Leyns et al.) is the first randomized controlled trial to use Therapy withVR in the context of gender-affirming voice care. The headline finding: the VR group showed a meaningful increase in willingness to communicate with strangers, while the control group’s scores stayed flat. You can read the full study summary with effect sizes and methodology in the Evidence Hub.

But numbers only tell part of the story. What I find most interesting about this study is what it reveals about the clinical challenge itself, and why VR might be uniquely suited to address it.

The transfer problem in voice work

If you work in gender-affirming voice care, you already know the pattern. An individual makes real progress on pitch, resonance, and intonation in your sessions. The therapy room feels safe. They can sustain their target voice for an entire conversation with you. And then they leave.

The moment they walk into a shop, join a video call, or meet someone new, the stakes change completely. The voice that felt confident and natural in your office suddenly feels exposed. Many individuals describe this as the hardest part: not learning the voice, but being willing to use it when it matters.

This is what the Leyns et al. study measured. Not acoustic outcomes, but willingness to communicate with strangers. That distinction matters. A voice that someone can produce but does not feel safe using is a voice that stays in the therapy room.

What makes VR different from role-play here

Gender-affirming voice training asks individuals to do something inherently vulnerable: to use a voice that may feel new or unfamiliar in front of other people. Traditional approaches often rely on role-play or homework assignments that ask individuals to practice in real settings. Both have limitations. Role-play rarely produces the same emotional and physiological responses as real social interaction. Practicing directly in public can feel overwhelming, particularly early in the process.

VR offers a middle path, and in this specific clinical context, the middle path matters more than usual. Consider the difference between these two scenarios:

Role-play: You ask your client to practice ordering coffee while you play the barista. You both know you are their clinician. The social evaluation they fear, someone hearing their voice and reacting, is absent. The practice is valuable, but it does not build the specific confidence they need.

VR: Your client stands in a virtual cafe. An unfamiliar avatar stands behind the counter, waiting. There are other avatars nearby. Your client has to speak. Their voice will be heard by “someone.” It is not real, but it is real enough that their nervous system responds. You are watching from your laptop, ready to simplify the scene if they become overwhelmed.

That second scenario is closer to what they will actually face, but you still have full control. You can adjust who is in the room, how the avatars react, whether there is background noise. If someone finds it difficult to use their voice with strangers but feels comfortable with familiar listeners, you can configure the scenario accordingly and gradually increase the challenge.

A growing evidence base

This pilot RCT is part of a growing research base around VR in speech and communication therapy. Additional evidence continues to emerge in the voice domain specifically. A 2026 study by Dasdogen and Hitchcock in the Journal of Voice found that the visual experience of being in a virtual environment influences voice production itself. Together, these studies point to VR as a tool that affects not only how individuals feel about communicating but potentially how they use their voice when they do.

What this means for your practice

For speech-language professionals working in gender-affirming voice care, the practical takeaway is this: if your clients are making progress in the therapy room but struggling to carry that progress into daily life, VR gives you a way to create the in-between step. Not replacing your expertise, not replacing the therapeutic relationship, but giving you a tool to create graded, controllable, and repeatable speaking situations that feel real enough to build genuine confidence.

Willingness to communicate is a prerequisite for everything that follows. You cannot generalize a voice you are not willing to use.

A note on privacy: no audio or video is ever recorded during sessions, and no identifiable client data needs to enter the system. If you are evaluating any technology for your practice, I put together a free checklist covering data privacy, informed consent, and more.

Further reading

If you work in gender-affirming voice care and want to explore how VR might support your practice, get in touch. I would be glad to show you the software and discuss how it might fit your work.