Affirming care

LGBTQ+ Affirming Hearing Care in Westchester

What affirming care means inside an audiology clinic: chosen name in the chart, how speech testing is chosen and recorded, hearing after decades on HIV treatment, and hearing aids after voice training.

Read time: 8 min read

Two adults in unhurried conversation at a hearing care appointment

Most pages like this one say a practice is welcoming and stop there. Welcome is the floor, not the service. What follows is the specific, practical difference affirming care makes inside an audiology clinic: what goes in your chart, how the tests are chosen and recorded, and the two clinical situations where being LGBTQ+ genuinely changes what your audiologist should be doing. We have tried to be honest about the evidence throughout. Two of the four topics below are well studied. Two are not studied at all, and where that is the case we say so rather than dressing an educated guess as established practice.

The chart, and the New York wrinkle. Your chosen name and pronouns go in your record and are what the front desk and the clinicians use, including on reminder and follow-up calls. Where a legal name is required for insurance billing, it lives in the billing field and nowhere else. That sounds administrative because it is, but the consequence is not: being misnamed in a waiting room is among the most commonly cited reasons LGBTQ+ patients delay or avoid care, and delayed hearing care has a particular cost, because untreated hearing loss compounds while you wait. The New York wrinkle is worth knowing about. Since the Gender Recognition Act took effect on 21 December 2021, changing a name in this state no longer requires publishing notice in a newspaper, and since 24 June 2022 the DMV has issued driver licences with an X marker on self-attestation, without a doctor's letter. The practical result is that a New Yorker's licence can be correct while an insurance card issued under an older policy is not, or the reverse. That mismatch is now more common here than it used to be, not less. Tell us when you book and it is set up before you arrive, rather than negotiated at the desk in front of a full room.

“Welcome is the floor, not the service. The question is what happens at the front desk in November, not what colour the website goes in June.”

Speech testing, talkers, and what we write down. Here is a piece of clinical detail almost nobody explains. A speech-in-noise test is not one test. QuickSIN uses a female talker against four-talker babble; HINT and BKB-SIN use a male talker. Those are properties of the recordings, and the choice measurably changes the score, because the signal-to-noise ratio you need for fifty per cent correct is not the same across them. A result therefore only means something beside another result from the same test and the same recording. We record which test and which recording were used and keep it constant across your visits, so that a change in your score is a change in your hearing rather than a change in the disc. That is good practice for every patient. We raise it on this page because when a patient's voice or presentation is not what a clinician unthinkingly expects, an unexamined talker choice is exactly the sort of thing that quietly creeps in. There is no published guidance on speech audiometry for transgender and gender-diverse patients. We looked; the audiology literature on trans care is about clinical culture rather than test procedure. In the absence of guidance, consistency is what protects you. One clarification while we are here: standard speech testing uses recorded talkers or the clinician's voice, never yours. Your own voice enters into it only when we are checking occlusion, which is two sections down.

Hearing and long-term HIV treatment. This one is genuinely established, and it is more interesting than the version usually repeated. A large cohort study published in JAMA Otolaryngology-Head & Neck Surgery, drawing on the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study, found that adults living with HIV had measurably poorer hearing thresholds than HIV-negative comparators, on the order of ten decibels on average, at both low and high frequencies. The American Academy of Audiology's position is that several large studies now point consistently toward an association. What makes it worth understanding rather than merely knowing is the part usually left out: in that study the difference was not explained by white blood cell count, viral load, duration of antiretroviral therapy, or adherence. The common assumption that it is simply the medication is not what the data showed.

The reason this matters more in New York than almost anywhere else is demographic. New York State Department of Health figures put more than 104,000 New Yorkers living with diagnosed HIV in 2022, and 57 per cent of them were aged 50 or older. That is a majority, and it is the age band where age-related hearing loss arrives on its own. Many in it were treated in the 1980s and 1990s with the older nucleoside analogues, zidovudine, stavudine and didanosine, which carry historical ototoxicity signals of their own. For someone on a modern regimen the honest position is that an association exists and the mechanism is not settled. What we do about it is unglamorous and useful: get a baseline audiogram and repeat it, so that change is measured against your own history rather than against a population average. That is the same advice we would give anyone with a known risk factor, and it is worth more than a theory about why.

Hearing aids after voice training or voice surgery. If your voice has changed substantially, through training, through surgery, or through testosterone, and you wear hearing aids, three things are worth checking. We should be upfront that none of them rests on published evidence: there is no literature on this and no manufacturer guidance, so what follows is reasoning from documented mechanisms, clearly labelled as such. First, own-voice processing. Some hearing aids are trained during fitting to recognise your voice. Signia's implementation builds a spatial model of the path from your mouth to the microphones and states plainly that detection rests on spatial cues rather than on the sound quality of your voice, remaining reliable when the voice is raised, hoarse, or speaking another language. That mechanism argues a change in pitch or resonance should not defeat it. Signia does not address voice change anywhere in its documentation, so treat that as a documented silence rather than a reassurance. Second, occlusion, the boom or blocked feeling of your own voice. The occlusion effect is concentrated below one kilohertz and varies strongly with the vowel being spoken, so a lower fundamental frequency puts proportionally more of your own voice into exactly that region. It is reasonable to predict that occlusion may feel worse after masculinisation and better after feminisation. No study has tested that. It is a reason to re-check, not a finding.

Third, and this is the one that matters most: real-ear verification will not catch any of it. Verification uses a standardised international speech signal built from six talkers, deliberately independent of your voice. That is precisely why your fitting stays valid through a voice change, and precisely why an own-voice complaint will not appear on the measurement. The check has to be a conversation and a re-fit, not a printout. If your voice has changed since your aids were fitted, book a check and say so when you book.

What we do not claim. We are a general audiology practice, not a specialist gender clinic, and we have no specific training in gender-affirming care beyond keeping current with an audiology literature that is, on these topics, thin. We do not provide voice therapy. That is a speech-language pathology specialty, and if you need it we will say so and point you elsewhere rather than improvise. For community support, referrals and local programming, The LOFT LGBTQ+ Community Center at 252 Bryant Avenue in White Plains has served Westchester and the Hudson Valley since 1983 and is a better first call than we are for anything outside hearing. What we can offer is competent hearing care from clinicians who will use your name, choose and record your tests carefully, know why a baseline matters after decades on HIV treatment, and take an own-voice complaint seriously instead of pointing at a verification screen. Our offices are in Harrison and Somers. Call (914) 949-0034 and tell us anything you would like us to know before you arrive.

Common questions

Will you use my chosen name?

Yes, in your record, at the desk, and on reminder and follow-up calls. A legal name is stored only where insurance billing requires it. If your ID and your insurance card do not agree, which is increasingly common in New York since the Gender Recognition Act simplified name and gender marker changes, tell us when you book and it will be set up before you arrive.

Does HIV or antiretroviral therapy cause hearing loss?

Large cohort studies consistently find poorer hearing thresholds in adults living with HIV, around ten decibels on average in the JAMA Otolaryngology study. But that study did not find the difference explained by viral load, duration of treatment or adherence, so the simple version in which the medication is the cause is not what the evidence showed. The older nucleoside analogues such as zidovudine and stavudine do carry historical ototoxicity signals. The practical answer is a baseline audiogram, repeated, so change is measured against your own history. This matters here in particular: 57 per cent of the more than 104,000 New Yorkers living with diagnosed HIV in 2022 were 50 or older.

My voice has changed. Do my hearing aids need refitting?

Possibly, and it is worth a check. Own-voice detection in the aids that use it appears to rely on the spatial path from your mouth to the microphones rather than on the sound of your voice, so it should survive a change, though no manufacturer addresses voice change directly. Occlusion is the more likely complaint, because it sits in the low frequencies where a lowered voice puts more energy. Real-ear verification will not show any of this, since it uses a standard signal rather than your voice, so the check is a conversation and a re-fit.

Do you offer voice therapy?

No. Voice training and voice feminisation or masculinisation are speech-language pathology, not audiology, and we will not improvise them. If you need that, we will tell you so and help you find the right professional.

Is there research on audiology care for transgender patients?

Very little. Two tutorials appeared in the American Journal of Audiology in 2023, both concerned with clinical culture and terminology rather than test procedure. There is no published guidance on speech audiometry for trans and gender-diverse patients, and nothing at all on hearing aid fitting after a voice change. We would rather tell you the gap exists than write around it.

Where is the nearest LGBTQ+ community centre?

The LOFT LGBTQ+ Community Center, at 252 Bryant Avenue in White Plains, has served Westchester and the Hudson Valley since 1983 and runs Westchester Pride among other programming. For anything outside hearing care, it is a better first call than we are.