Addressing the incongruence between voice, communication, and gender is a critical aspect of the gender transition for gender-diverse individuals, particularly when this incongruence is great. Resonance, pitch, intonation, intensity, and voice quality are all highly associated with gender and culture. Alteration and/or modulation of gender-related voice and communication-associated dysphoria may improve mental health and quality of life. Multidisciplinary evaluation by voice sub-specialized speech-language pathologists and laryngologists is needed. Thorough evaluation includes case history, instrumental evaluation of the laryngeal anatomy and physiology, acoustic and aerodynamic voice measures, and assessments of stimulability for vocal change. This information informs shared therapeutic goal setting and ultimately guides the development of a behavioral treatment plan for voice therapy. Voice and communication therapy includes education and counseling to explore voice, identity, and sense of self and seeks to direct therapeutic techniques necessary to guide the individual towards a voice that reflects gender identity.