Demonstrators carrying the transgender flag protest near the U.S. Supreme Court in Washington during arguments on cases about gender discrimination protections in 2019. File Photo by Kevin Dietsch/UPI | License Photo
SALT LAKE CITY, July 8 (UPI) -- A decision by Brigham Young University to stop providing gender-affirming services to transgender clients at its speech-language clinic has sparked an accreditation review and a debate over whether the move was ethical.
The university, which is located in Provo, Utah, and operated by The Church of Jesus Christ of Latter-day Saints, discontinued the services earlier this year. Transgender clients use the vocal training to make their voices reflect their gender identity.
BYU determined that providing the services was not consistent with guidelines that tell church leaders to "counsel against social transition," according to C. Shane Reese, the university's academic vice president. The church describes social transitioning as including changing dress or grooming or changing a name or pronouns to present oneself as other than his or her birth sex.
The master's program in speech-language pathology is accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, a semi-autonomous body of the American Speech-Language-Hearing Association. The CCA launched an investigation in the spring to determine if the program remains in compliance with the standard for accreditation.
ASHA, a national professional and credentialing organization, says ending gender-affirming services for transgender clients "is in direct opposition" to the practice expected of its members.
"ASHA recognizes gender-affirming voice and communication services for transgender and gender diverse populations within the speech-language pathology scope of practice," the association says in a statement posted on its website. "Transgender individuals who attempt to modify their voice without a trained speech-language pathologist, risk permanent damage to their vocal cords; and without appropriate services are an increased risk for related mental health challenges."
The association alleges clinic employees are being directed "to act in a manner contrary to their responsibilities under the ASHA Code of Ethics." It cites a section that says, "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 dialect.
"Therefore, BYU is putting its certified speech-language pathologists in an untenable position," the statement says.
In its statement, ASHA also alleges BYU's decision does not align with the LDS Church's policies and points to a section of the faith's general handbook that says members and nonmembers who identify as transgender should be treated with "sensitivity, kindness, compassion and an abundance of Christ-like love."
ASHA urges the university to reverse its decision and restore the services for transgender clients.
BYU representatives did not respond to a half-dozen calls and emails seeking comment.
Carri Jenkins, assistant to the president for university communications, provided a statement to The Salt Lake Tribune.
"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," the statement says. "BYU clinical-personnel have offered to assist with the coordination between the students and these providers."
Because it is owned by a church, BYU has religious exemptions under Title IX, a federal law that prohibits sex discrimination in schools. Title IX does not apply to an educational institution that is controlled by a religious organization when application of the law would be inconsistent with its religious tenets.
In a letter responding to the ASHA statement, Reese said the university made a "narrow and religious mission-based decision" to discontinue providing gender-affirming services, but it is continuing to offer assistance with the other communication services it provides to everyone, regardless of gender identity or expression.
"ASHA does not require all clinics and all clinicians to provide the full range of speech-language-hearing services," the letter says. "It does prohibit a clinician from refusing services 'based on an individual's gender identity/expression that are not related directly to gender transition.'"
BYU students have not been refused services that are unrelated to gender transition such as treatment for voice disorders and post-stroke cognitive-communication disorder, the letter says.
In addition, Reese says he "respectfully disagrees" with ASHA's assertion that the decision to discontinue certain services does not align with LDS Church guidelines.
He notes the organization quoted only two portions of the relevant part of the handbook. ASHA did not acknowledge the provisions that directly address social transitioning, which include that church leaders should advise those who socially transition that they will experience some church membership restrictions, he says.
And Reese quotes this section from the Council on Academic Accreditation's handbook:
"The accreditation process involves evaluating programs in light of their own mission, goals and education models -- judging the degree to which a program has achieved those goals and objectives. Therefore, the CAA does not explicitly prescribe the processes by which the program's outcomes should be reached; rather, it evaluates a program's success in achieving outcomes and goals that are consistent with its stated mission (including religious mission, if relevant)."
Support from providers
A transgender client who had been going to the BYU clinic for about a year and a half spoke to UPI on the condition of anonymity. She said the voice therapy was very helpful.
"The whole time I was there, everyone was nice and affirming," she said. "Everyone I directly interacted with was wonderful."
The client said her voice gives her a lot of social anxiety and voice therapy is an important part of her transition.
"When I look one way and then I open my mouth and I sound another way, it can make people stare or it can make people uncomfortable around me," she said. "I'll refrain from asking questions in class because I'm worried about drawing attention to myself. Just having more assistance with fitting in better is a big deal."
The client said the therapy also helps with the internal discomfort she feels "with my voice not sounding like what's in my head."
"It's kind of distressing," she said. "It's like I've taken over someone else's body. Sometimes it takes my brain a second to register that that's me talking when I hear myself on a recording."
The discontinuation of the gender-affirming services was a blow, the client said.
"I'm still not to the point where I'm able to use the voice I was working on in my daily life," she said. "One of the big focuses of the practice that we were working on at the time it was canceled was trying to increase the stamina, making that my habitual voice."
When word spread about the cancellation, ASHA issued its statement and the accreditation investigation began. A discussion on social media included accusations that the university's action was discriminatory and transphobic. One poster countered in a tweet that the gender-affirming services were not medically necessary and the cancellation was not transphobic.
Speech-language pathologists in private practice from around Utah offered to provide services for the students, the client said. In addition, the University of Utah in Salt Lake City and Rocky Mountain University, a private school in Provo, agreed to provide services at their clinics to the students.
The client is getting services at the Rocky Mountain program at no charge. The BYU clinic also was free.
"I didn't feel anyone was going to hear about it outside of the people who were directly affected, so I was really surprised by how supportive people were," the client said. "It turned into this big issue."
Knowing people cared about what happened makes her feel less alone, she said.
"You can feel really alone when you're a queer student at BYU," she said.
Key to success
Celia Hooper, who was a clinical speech-language pathology professor at the University of North Carolina at Greensboro, said stopping the services conflicts with ethical practices.
Speech therapy is a critical part of gender-affirmation services because people often are successful at looking like the right gender but don't sound like it, Hooper told UPI.
"If you look like a woman but you sound like a man, people think you're a man in drag and that's not what you want to be," she said. "Your communication skills, speech and language and non-verbal, really are you. I've had clients say, 'It gave me my soul back.'"
Hooper, who retired in 2020, has worked with male-to-female transitioning people beginning in the late 1970s. Then, most clients were over 30 years old and would sneak in the back door.
"They spent years of agony because it was so shameful to society," Hooper said. "Many of them worked on changing from male to female or female to male on their own or through a network of people who had been through it. There was a real underground network."
Sometimes the steps they took to transition were "not so evidence-based" and by the time the clients got to a speech-language pathologist, they had to undo a lot of habits, she said.
"Every new client, at least adults, comes in thinking, 'All I have to do is make the pitch of my voice higher and I'll sound like a woman,'" Hooper said. "We have to explain your communication is your pitch, your resonance, your word choice. We do try to raise the pitch of your voice slightly. You can do it, but you have to be very careful and not create pathology, a vocal nodule, or hurt somebody's voice. You've got to know what you're doing."