Voice and communication are critical in maintaining quality of life, especially in the transgender and gender-diverse population. Perception of vocal gender relies on a number of cues including not only vocal pitch, but also intonation, word choice, loudness and stress patterns, resonance, and voice quality. Surgeries have been developed for pitch elevation; however, pitch elevation alone is insufficient and accounts for only a small percentage of variance in the perception of speaker gender. An interdisciplinary approach with speech-language pathology is essential to address the behavioral changes necessary in creating a voice that is reliably identified as female. Nonetheless, voice surgery has been shown to be a safe and effective way to improve voice-related quality of life. This chapter focuses on the voice care of transgender women.