Hair Removal, Voice Therapy and Fertility Services

Dr. Paula Amato.
Dr. Paula Amato, an expert in fertility, includes transgender care among her focus areas.

Gender-diverse patients will find expert providers and the latest therapies for hair removal, voice and communication therapy, and fertility at OHSU. We offer:

  • Voice and communication therapy supported by our research
  • Hair-removal experts who treat hundreds of gender-diverse patients a year
  • Advanced hair-removal technology
  • The latest fertility treatments provided by nationally recognized experts
  • Gender-neutral clinics

Vocal surgery: Learn about this option. We recommend vocal surgery only after voice therapy.

Hair removal

We offer experience, expertise and the latest equipment.

Surgical preparation: If you are having hair removed to prepare for surgery, your hair-removal specialist will coordinate with your surgeon. You will also want to ask which type of hair removal the surgeon recommends for your type of surgery.


Electrolysis is FDA-approved for permanent hair removal. Our licensed electrologist at the Plastic and Reconstructive Surgery Clinic treats about 100 transgender patients a year.

A thin needle is inserted into each hair follicle. A small amount of electric current destroys the cells that grow hair. The hair is then removed with tweezers. Electrolysis can be used on all hair colors and skin types.

We have expertise in all three kinds of electrolysis:

  • Galvanic: A chemical reaction destroys the follicle.
  • Thermolysis: Heat destroys the follicle.
  • Blend: A combination of galvanic and thermolysis is used.

During treatment: You may feel heat and mild stinging. Discomfort is usually minimal, and settings can be adjusted.

After treatment: You may have redness for about a day.

Sessions: How often and how long someone needs treatment varies greatly. It depends on the amount of hair, the size of the area being treated, the hair’s growth cycle, and sensitivity. Patients need multiple treatments, though as often as once a week and for up to an hour. Some have up to 100 visits a year, and may need treatment for more than a year. You may not need follow-up treatments.

Laser hair removal

Our Dermatology Clinic uses the newest LightSheer DUET Laser, which is FDA-approved for permanent hair reduction.

  • It’s faster and less painful than many other laser treatments.
  • Although people with darker hair and lighter skin are the best candidates for laser treatment, this laser can successfully treat hair on darker skin.
  • Our specialist has more than a dozen years of experience in hair removal and treats more than 700 transgender patients a year.

An intense beam of light is passed over your skin. The laser beam heats areas of high pigmentation, damaging or destroying hair follicles. Hair falls out in the days and weeks afterward, and the follicles eventually stop growing hair. Lasers can treat large areas at one time.

Laser hair removal provides permanent hair reduction, but some regrowth is possible. Our patients see about 80-90% of hair permanently removed.

Before treatment: Avoid exposing the treatment area to direct sun.

During treatment: You will wear goggles to protect your eyes from the light. The area to be treated may be shaved, and a numbing cream may be applied. You will probably feel some stinging.

After treatment: Avoid exposing your treated area to direct sun immediately afterward. Redness and swelling are common but usually last only a day or two.

Sessions: You will need multiple treatments. Hair grows in phases, and the laser affects hair only in the active growing phase. Other factors include the area being treated, skin color, and hair color and coarseness. Most patients have six to seven treatments, with four to six weeks between each one. Many have follow-up treatments every six to 12 months.

A smiling transgender woman sitting on a therapist's couch.

Voice and communication therapy

Clinic: Our Northwest Clinic for Voice and Swallowing offers therapy to alter your voice and movements so you can express yourself the way you want. This can help you project your gender identity and protect your vocal cords from potential harm. Our speech-language pathologists treat as many as 50 gender-diverse patients a year.

Standards of care: We follow World Professional Association for Transgender Health (WPATH) standards.

A speech-language pathologist can train you to develop authentic ways of expressing yourself. Voice training may include:

  • How your voice sounds
  • The rhythm of your speech
  • The words and phrases you use

Communication therapy can teach you new ways to sit, stand and use your hands. If you are transitioning, training can help you overcome physical changes such as vocal instability from testosterone therapy.

Treatments: Our therapies train you to talk and act naturally without straining your vocal cords and muscles. Your new voice and traits will become second nature.

You will have a comprehensive voice and communication assessment before we recommend a training program. Your evaluation may include:

  • Your medical history
  • Your transition goals and how you prefer to communicate
  • A stimulability test, which assesses your speech sounds
  • Recording and analyzing your voice
  • Looking at your voice box if:
    • Your voice sounds abnormal
    • You have a history of voice problems
    • You have risk factors such a job that requires a lot of talking

Our voice training includes:

  • Pitch and tone
  • Loudness
  • Vocal quality
  • Speaking rate
  • Speech sounds
  • Grammar

Our communication training includes:

  • Gestures
  • Facial expressions
  • Body language

Sessions: You typically have a 45-minute session every week for at least six months. You also practice daily at home. How long your training lasts may depend on your vocal health, your goals and the frequency of your training.

OHSU offers vocal surgery to raise pitch. We require that patients have vocal therapy first, though. Some patients achieve their desired voice through therapy alone.

We recommend that patients seeking voice therapy to lower pitch be evaluated by a speech-language pathologist and sometimes by an ear, nose and throat specialist (otolaryngologist).

This is because our research has found that testosterone therapy isn’t fully effective for about one in five patients. These patients may have vocal fatigue or voices that are too high or soft. Testosterone therapy also doesn’t change body language and other forms of expression.

Fertility and reproduction

We will discuss fertility with you before you begin any treatment such as hormone therapy or surgery. Some treatments can make it difficult or impossible to have biological children if you haven’t taken steps in advance.

Our Fertility Clinic, a national leader in fertility research, offers the broadest and most advanced medical treatments available. We treat transgender and gender-nonbinary patients in a gender-neutral space separate from the Center for Women’s Health.

Our treatments

We offer a range of treatments, including:

Fertility preservation:

  • Sperm banking
  • Egg freezing
  • Embryo freezing

Fertility services:

  • Intrauterine insemination
  • In-vitro fertilization

Learn more about fertility options

For patients

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Other questions and concerns

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