Voice is a complex marker for gender and pivotal to the gender reassignment process. The goal of the transgender patient is to achieve a voice and communication style that is congruent with their gender identity. Voice and speech therapy are fundamental for successful transition. Phonosurgery, to adjust pitch, can be an important adjunct to relieve the patient from active pitch elevation of voice to free them to focus on the other adjustments needed and learned through behavioral training with speech and voice therapy. The authors review current management options for transgender patients with difficulties in voice and communication style.