Gender-Affirming Voice Therapy: How to Change Your Voice
If you are transgender or gender non-conforming, you may want to consider gender-affirming voice therapy to help change the sound of your voice. This type of therapy can be an important part of your gender transition. Transgender voice therapy can help you learn how to use your voice to match your gender identity.
Several factors can affect the sound of your voice, including pitch, resonance, breath support, and vocal fry. Gender-affirming voice therapy can help you learn how to control these factors to produce a voice that is more in line with your gender identity. This article will discuss the basics of transgender voice and communication training and how you can get started!
Benefits Of Gender-Affirming Voice Therapy
Impact of Hormone Replacement Therapy on the Voice
The Role of Phonosurgery in Voice Modification
How Gender-Affirming Voice Training Works
Typical Target Areas for Voice and Communication Therapy
What to Expect: Your Evaluation with A Speech-Language Pathologist
What to Expect During Gender Affirming Voice Training
The Importance of Vocal Health
Benefits Of Gender-Affirming Voice Therapy
Gender-affirming voice therapy can have several benefits for transgender and non-binary individuals. Some of the potential benefits include:
improved communication with others
increased confidence and self-esteem
improved mental health and well-being
increased ability to express gender identity
Gender-affirming voice therapy can also help reduce the stress and anxiety associated with gender dysphoria. Gender dysphoria is the experience of discomfort or distress that is caused by a mismatch between a person's gender identity and the sex assigned at birth.
Speech-language pathologists can adjust and fine-tune a person's voice production and communication patterns to allow each individual to find their most authentic voice. This process can help lessen the negative effects of gender dysphoria and improve mental health and well-being.
For some transgender individuals, the goal of voice therapy may be to sound more masculine or feminine. For others, the goal may be to sound androgynous or neutral. The main objective of transgender voice therapy is to help the individual feel comfortable and confident in their own skin- to sound like themselves.
Impact of Hormone Replacement Therapy on the Voice
Hormone replacement therapy (HRT) is a common treatment for gender dysphoria. Testosterone and estrogen are forms of hormone replacement therapy (HRT). HRT can have a significant impact on the voice, and it is important to consult with your doctor and a speech-language pathologist before starting hormone therapy.
Testosterone, the masculinizing hormone, thickens the vocal cords and increases the size of the Adam's apple. These changes can result in a deeper, more resonant voice.
Estrogen and progesterone, the feminizing hormones, don't modify the voice of transgender women, so voice therapy is most often recommended as the first line of treatment by both speech pathologists and laryngologists.
It is important to note that HRT will not immediately result in the desired changes to the voice. It can take several months, or even years, for the full effects of HRT on the voice to be realized.
That's why transgender males may choose to work with a voice specialist. A speech-language pathologist can suggest ways to change voice and communication behaviors to align with the person's gender identity. This may include altering the resonance and modifying intonation, volume, and articulation.
The Role of Phonosurgery in Voice Modification
Phonosurgery is another option that may be considered for transgender individuals who wish to modify their voices. Phonosurgery is a type of surgery performed on the larynx or voice box.
There are two main types of phonosurgery:
- Laryngeal masculinization surgery (LMS)
- Laryngeal feminization surgery (LFS)
Laryngeal masculinization surgery is a type of phonosurgery performed on transgender men. The goal of this surgery is to make the voice sound more masculine. This can be achieved by deepening the voice, changing the pitch, or making other changes to the larynx.
Voice masculinization surgery is performed less often than voice feminization surgery. The surgical procedure often used for voice masculinization is thyroplasty type III.
Laryngeal feminization surgery is a type of phonosurgery performed on transgender women. The goal of this surgery is to make the voice sound more feminine. This can be achieved by making changes to the larynx to change the pitch.
There are two primary surgical options used most frequently for vocal feminization. They are anterior glottal web formation and cricothyriod approximation.
Phonosurgery is performed by a qualified ENT surgeon and requires a hospital stay.
It is important to note that phonosurgery is considered to be a permanent change. This means that it is impossible to reverse the surgery's effects.
How Gender-Affirming Voice Training Works
A person's voice and speaking style are as unique as a fingerprint. Although two people may have voices that sound similar, no two voices are exactly alike.
Speech pathologists can help transgender and non-binary people to develop a healthy, sustainable voice that affirms their gender identity and individuality.
Gender-affirming voice training begins with a thorough assessment by a speech-language pathologist. During the evaluation, the therapist will work towards establishing a communication program that is based on an individual's personal wishes and goals.
Speech therapy entails lots of training, real-life practice ideas, objective feedback, and a wide range of resources to help clients achieve their own communication objectives.
Gender-affirming voice training is typically conducted by a speech therapist who has experience working with transgender individuals.
Typical Target Areas for Voice and Communication Therapy
Many different techniques can be used in transgender voice therapy, and the process can be tailored to meet each person's individual needs. Each of these techniques can be used alone or in combination with other techniques to help individuals achieve the desired results.
Some of the most common techniques used in transgender voice therapy include:
Pitch
The pitch of the voice is how high or low the voice sounds. Voice pitch is determined by how fast the vocal folds are vibrating. The higher the rate of vibration, the higher the vocal pitch will be.
Speech therapists can help alter the speaking pitch of the voice to sound higher or lower. While the vocal pitch is the first sound identifier for gender, it isn't the only thing to consider.
Resonance Adjustment
Voice resonance involves changing how the voice resonates in the body to match the individual's gender identity. Resonance is a fluent path to a natural sound. Resonance training helps voices to stay healthy. Resonance training also helps modify voices that are unnaturally high or low, too light or too heavy.
Intonation & Stress
Intonation and stress involve the rise and fall of pitch and prosody. Varying intonation and stress is a significant way to sound expressive.
A feminine approach to intonation might involve more overall pitch movement, while a masculine approach may involve more downward intonation than upward.
Speech Skills
Articulation, speech rate, loudness level, or voice projection are elements of speech that can be addressed during gender-affirming voice therapy. Voice projection training involves teaching individuals how to project their voices in a way that matches their gender identity.
Trans-feminine clients may want to work towards shaping a quieter voice, while trans-masculine may want to learn to develop a louder voice.
Body Language & Communication Style
The focus of nonverbal communication training should always be on the naturalness that is comfortable and desired by each client. Nonverbal communication may include gestures, facial expressions, eye contact, and posture.
Breath Support
This technique involves teaching individuals how to use their breath to support their voices.
What to Expect: Your Evaluation with A Speech-Language Pathologist
The first step in transgender voice therapy is for the speech-language pathologist and the individual to assess where they are starting from. This includes taking a detailed medical history, discussing current gender identity and expression, and setting personal goals for therapy.
The speech-language pathologist will also perform a perceptual voice assessment. This involves having the individual read aloud from a list of words and phrases. The therapist then listens to the recordings and rates them on factors such as pitch, quality, breath support, and vocal fry (a creaky or raspy sound).
Next, the therapist will assess the individual's vocal range and pitch. This is done by having the person sing a series of notes on a scale.
The therapist then uses a computer program to analyze the recordings and determine the person's average fundamental frequency (F0). The F0 is a measure of pitch and is affected by testosterone levels in the body.
Based on the results of the assessments, the therapist will develop a treatment plan that may include one or more of the following:
pitch and resonance correction exercises
breath support and vocal hygiene education
voice amplification strategies
relaxation and stress management techniques
If the voice sound is raspy or hoarse, then an ear, nose, and throat doctor (ENT) evaluation may be recommended to rule out any voice disorders.
What to Expect During Gender Affirming Voice Training
Gender-affirming voice training is usually done in individual sessions, but group therapy may be an option in some cases. The number of sessions needed will depend on the individual's goals and progress. Therapy aims to help you develop a comfortable and authentic voice.
At the start of communication skills training for gender-affirming voice care, the communication coach will inquire about the client's specific voice-specific expectations and set up functional and measurable goals.
During the first few sessions of transgender voice therapy (voice feminization or masculinization), the therapist will introduce you to techniques to improve your breath support and projection. The therapist may also work with you on pitch correction and resonance adjustment as you progress in therapy. Communication goals may evolve as training continues.
The therapist may also give the individual exercises to practice at home. These may include vocal warm-ups, breath support exercises, pitch correction exercises, and relaxation techniques.
You may be given information packets and audio and video decks of female and male voice speakers. You may be asked to keep a log or journal of your voice and the changes you are experiencing.
It is important to remember that everyone's journey is different. There is no right or wrong transgender voice therapy program. The goal is to find the approach that works best for you and helps you to feel more comfortable and confident in your voice.
Transgender voice therapy can be an important step in the gender transition process. If you are considering transgender voice therapy, a certified speech-language pathologist can help you assess your goals and create a treatment plan that is right for you.
The Importance of Vocal Health
The ultimate goal of communication skills training is to ensure long-term vocal health.
Vocal hygiene modifications are an essential component of the program. Vocal hygiene is used to describe good habits that you can use to support a healthy and strong voice throughout your life.
Just as brushing your teeth daily can help protect your teeth as you age, vocal hygiene can help you preserve the quality of your voice as you age. Hydration is of utmost importance.
In addition to vocal hygiene, breath support, and abdominal breathing should be included in your training. Abdominal breathing provides more support for voicing and allows you to speak more loudly with less effort and strain on the vocal folds.
If the muscles surrounding your vocal folds are tight, your speech coach may teach you self-massage, stretching, and range-of-motion exercises for the head, neck, shoulders, and jaw.
How Long Does it Take to Improve?
Transgender voice therapy is an individualized process, and the length of time required to reach goals varies from person to person.
Some individuals may only need a few sessions, while others may require ongoing therapy for an extended period of time.
Therapy usually consists of a series of one-on-one sessions. Meetings are typically held weekly and last 30-45 minutes. Attending appointments regularly is necessary for improvement.
To maximize outcomes, you will also need to practice at home. This involves following your speech pathologist’s direction and repeating the exercises they provide.
Be patient and diligent with your practice if you want to see results from therapy. It is also important to consider how often you can use your new habitual voice. Changes can vary from person to person, so don't get discouraged if you don't see results right away.
Gender-Affirming Voice Therapy: The Bottom Line
Transgender voice therapy can be an incredibly beneficial process for transgender individuals. Clients from all stages of transition benefit from training.
Finding a therapist you trust and feel comfortable with is the most important thing. Transgender voice therapy can be an empowering and life-changing experience!
When seeking out a Transgender Voice Therapist, be sure to look for someone who:
is experienced in working with the transgender community
uses a gender-affirming approach
makes you feel comfortable and respected
Connected Speech Pathology
At Connected Speech Pathology, our services are delivered exclusively through telepractice via our secure online video platform. We have experience working with transgender women, transgender men, non-binary people, and a wide range of individuals along the gender spectrum.
We are committed to providing affirming and supportive care to all of our clients. We would be honored to work with you on your journey!
If you are a transgender or non-binary individual interested in exploring gender-affirming voice therapy, please contact us today to schedule an appointment.
With the help of a therapist, you can achieve your goals for your voice!
Learn more about our Transgender Voice Therapy Services
About the Author
Allison Geller is a speech-language pathologist (SLP) and the owner of Connected Speech Pathology. She obtained her Bachelor’s and Master’s degrees from the University of Florida in Speech-Language Pathology. Allison has practiced speech therapy in a number of settings including telepractice, acute care, outpatient rehabilitation, and private practice. She has worked extensively with individuals across the lifespan including toddlers, preschoolers, school-aged children, and adults. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including receptive/expressive language disorders, articulation disorders, voice disorders, fluency disorders, brain injury, and swallowing disorders.
Allison served as the clinical coordinator of research in aphasia in the Neurological Institute at Columbia University Medical Center in New York. She is on the Board of Directors for the Corporate Speech Pathology Network (CORSPAN), a Lee Silverman Voice Treatment (LSVT) certified clinician, and a proud Family Empowerment Scholarship/Step-Up For Students provider. Allison is passionate about delivering high quality-effective treatment remotely because it’s convenient and easy to access. What sets us apart from other online speech therapy options is—Allison takes great care to hire the very best SLPs from all over the country.
