Transgender voice therapy

Transgender voice therapy refers to modifying the voice so that it better corresponds to an individual’s gender identity. Transgender voice therapy is often part of the gender transitioning process, allowing an individual to learn to alter the voice so that they are more likely to be perceived as their desired gender. For those with gender dysphoria, voice therapy can be part of their gender-affirmative care. Transgender voice therapy can be divided into voice masculinization and voice feminization. In voice therapy, pitch, prosody, and resonance are focal points. Additional aspects of therapy may include voice quality, articulation, and vocal speed. Should an individual want to go beyond what voice therapy can offer, vocal surgery is an option for more permanent results. If an individual experiences distress because their voice does not match their gender identity, they could experience voice or vocal dysphoria.

Background

Transgender voice therapy can be an integral component of gender-affirmative care and the transitioning process because the voice is a gender signifier. When someone hears an individual’s voice, assumptions are made as to whether they are male or female. The assumptions are based on established social constructs of what it means to be a man or woman. For example, a masculine voice would be low and gravely, while a feminine voice would be higher-pitched and lighter. Voice therapy is not a required component for gender transitioning; however, for some people, it is necessary for their happiness.

Vocal masculinization is the process by which a person’s voice takes on more masculine characteristics. For those taking testosterone, the lowering of the voice often occurs because the larynx is very sensitive, and the testosterone consumed thickens and expands vocal folds. Thus, trans men who undergo hormone therapy may experience vocal changes, including voice lowering, even before they intentionally begin vocal therapy. Vocal feminization is the process by which a person’s voice takes on more feminine characteristics, most often, an increase in pitch. However, unlike testosterone, estrogen does not impact one’s pitch. To encourage vocal changes, doctors and therapists rely more on language therapists and vocal exercises. However, only a limited number of speech and language therapists are specifically trained in transgender vocal care. Trans women may opt for vocal therapy that retrains individuals on how to speak, placing emphasis on pitch and other characteristics. Trans men may also benefit from this type of therapy.

Vocal or laryngeal surgery is less common but a potential option for those who do not achieve the desired vocal changes from their transgender voice therapy. For voice feminization, individuals may explore anterior glottal web formation or cricothyroid approximation. In these surgeries, the vocal cords are shortened or made more tense, respectively. The result is not only the ability to speak at a higher pitch, but also the inability to speak at a lower one. For voice masculinization, thyroplasty type II can lower pitch by decreasing vocal fold tension. Female vocalization surgery, specifically, comes with its own set of risks. The surgery may create too high of a voice or place strain on the voice. Not every transgender man or woman seeks to alter their pitch or change it dramatically, however. For some, speaking at a more neutral or mid-range pitch is sufficient. This eliminates the need for surgery and is less committal, as masculinization surgeries and most feminization surgeries are permanent.

Overview

Although transgender voice therapy is frequently discussed in terms of masculinization and feminization categories that focus on changes in vocal pitch, additional areas can be explored and worked on to get an individual’s voice to where they would like it to be. Prosody refers to stress points, loudness or intonation, and the overall rhythm of a person’s voice, while vocal resonance points to the perceived vibrations that come from speaking. Vibrations are typically situated near the front of the mouth, near the lips, or in the back of the throat or chest. Medical professionals work with individuals to determine what type of resonance best fits them. Changing how one speaks is not a quick process, and individuals must practice their new skills until the voice is trained to speak in the new way, so it comes as close to second nature as possible.

Other aspects of voice therapy include voice inflections, breath support, articulation, and speed. Those involved with transgender vocal therapy may be encouraged to explore music or voice lessons that work on breathing techniques and articulation. Individuals are encouraged to be open and honest with their speech therapist to determine what they hope to achieve through vocal therapy. Those seeking a voice that will more likely be perceived as masculine will typically work on a deeper resonance, intentionally emphasizing words and including more immediate starts and stops. This is in addition to the lower pitch. Those hoping to have a voice that is perceived as feminine will work on achieving a higher pitch with a bright resonance. Instead of isolated starts and stops, sentences and words will be more fluid and melodic. In some cases, dramatic changes in pitch are not the sought-after goal. Instead, individuals are happier with a more neutral-sounding voice. In this instance, the voice allows someone to “pass” as either male or female without being overly committed either way. This can be particularly useful for those individuals who present themselves as both male or female, depending on the situation.

Bibliography

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“Gender-Affirming Voice and Communication Change for Transgender and Gender Diverse People.” American Speech-Language-Hearing Association, www.asha.org/public/speech/disorders/voice-and-communication-change-for-transgender-people/. Accessed 22 Aug. 2022.

Lagos, Danya. “Hearing Gender: Voice-Based Gender Classification Processes and Transgender Health Inequality.” American Sociological Review, 10 Sept. 2019, journals.sagepub.com/doi/10.1177/0003122419872504. Accessed 21 Aug. 2022.

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