This expert lecture by 2 laryngologists, each with over 30 years of experience, focuses on the knowledge needed by otolaryngologists to help guide transgender individuals through the process of aligning patterns of voice and communication with gender. Recent changes in societal understanding and acceptance of diversity have led to an increase in the number of individuals able to express that their gender at birth does not align with their gender identity. Therefore, now more than ever, a significant number of individuals who have gone through puberty based on their assigned gender at birth are openly seeking assistance to better align their current presentation with their gender. Since gender identity is heavily predicated on both physical appearance and style of communication, otolaryngologists are frequently asked to help patients with this transition. This newly identified need has led to a practice gap as most practicing otolaryngologists were not trained in this currently relevant topic. Comprehensive otolaryngologists and laryngologists should be familiar with the state of practice to help guide their patients through this process. They must understand the effects of behavioral alteration on gender perception as well as the state-of-the-art surgical advances that are now available to aid transgender individuals. Using didactic and case presentation format, the purpose of this course is to present characteristics of voice and communication that listeners use to infer gender of the speaker, to present how behavioral interventions can be used to align voice and communication with gender in a sustainable manner, and to present advances/developments in surgical practice that have allowed reliable pitch alteration.