Clinical speech reveals identity through both spoken identifiers and voice, yet its pauses, delivery, and speaker roles can also carry useful clinical evidence. Protecting that speech therefore requires more than preserving its words. We present AegisVox, a factorized framework that assigns consistent surrogate voices and edits identifier-bearing turns using document-consistent replacements. Across 390 public simulated or non-patient conversations totaling 63.6 hours, a matched comparison of two speech renderers separates replacement realization from retained identifiers, speaker linkage, and clinical preservation. Text-to-speech rendering realizes 535/601 planned replacements versus 453/601 for the codec-based speech editor. However, similar aggregate clinical preservation conceals more model-labeled contradictions, and conversation-wide speaker scores conceal greater edited-speech linkage under a score-direction sensitivity analysis. Fresh transcription of original audio provides a reference for interpreting the clinical measurement chain; an independent judge tests sensitivity to model-based assessment. Better replacement realization can therefore coexist with worse clinical or speaker-linkage measurements. AegisVox supports use-specific evaluation of those tradeoffs, not a guarantee of identifier removal or clinical safety.

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