This review covers recent research findings that demonstrate the effectiveness of speech pathology intervention in enabling male-to-female transsexual individuals to portray their gender identity through speech. Research reports that extend our understanding of communication characteristics that contribute to perceptions of sex in male-to-female transsexuals are identified. Current issues related to the measurement of therapy effectiveness are also presented. Recent findings Earlier studies confirmed that an increase in voice pitch is achievable for many transsexuals. However, it is now accepted that pitch is not the sole contributor to perceptions of gender. Recently, modification of vocal resonance has been shown to increase perceptions of a speaker as female. There is evidence that encouraging precise articulation results in increased perceptions of the speaker as female. Evidence for the contribution of voice quality and loudness to perceptions of gender is inconclusive. Speech rate does not appear to contribute significantly to gender perceptions. Ecologically valid measures of the individual's vocal functioning and its impact on everyday life in clinical assessment of male-to-female transsexuals are needed to provide meaningful measures of therapy outcome. Summary There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender. It is essential to include the perspective of the individual when evaluating therapy outcome.