Gender Affirming Voice Modification

We offer Gender Affirming Voice Modification Training to people of all ages. Our Licensed Speech Pathologist Clinicians have over 35 years of experience in providing excellent therapeutic care in a variety of areas. 

FIND THE VOICE THAT IS IN YOUR HEART!

Our voice and communication style plays an integral role in how we perceive and express our identity. Regardless of your unique gender identity, having a voice that truly matches and aligns with your authentic self is critical for overall well-being, happiness, and confidence.

For some transgender individuals, their voice may not align with their gender identity and gender expression, causing possible feelings of discomfort or dysphoria. This can affect a person’s quality of life, self-esteem, and fear of being misgendered.

While not all transgender individuals may wish to modify their voice, gender-affirming voice training, also known as transgender voice therapy, can help those who do.

Our clinical team has specialized interest and training in evaluating and working with transgender patients to provide behavioral vocal interventions. Much about voice that identifies gender relates to word choice, phrase structure, and intonation patterns. As with all evaluations related to voice and interpersonal communication, the assessment begins when you walk through the door. People are often unaware of habitual communication patterns. These habitual patterns convey more about gender perception than vocal pitch or quality alone. Therefore, pragmatics (social communication patterns) will be evaluated during the initial visit. In addition, vocal pitch, quality and resonance along with orofacial structure and musculature will be assessed.

As an interdisciplinary team (patient, family, physician, speech pathologist) we will identify areas to target to help you reach your voice and communication goals. This usually begins with behavioral intervention targeting communication patterns and easily accessible pitch range that allow the patient to produce an efficient voice that is more in line with their gender identity. Once these behaviors have been maximized then consideration can be given to surgery to alter pitch. The need for surgery is rare however, as most patients can achieve a gender authentic voice without surgical intervention, and with just Gender Affirming Voice Modification Therapy alone.

The way a person speaks can play an important role in how they express themselves. Voice and communication training can be helpful when aspects of a person’s voice and the way they speak do not match their gender identity or gender expression, according to the American Speech-Language-Hearing Association’s (ASHA) resource on voice and communication services for transgender and gender diverse populations.External link:open_in_new

This can include individuals who identify as transgender, non-binary, gender nonconforming or other gender identities.

Among transgender people, transgender women are more likely to seek gender affirming voice and communication training. 

(Source: clevelandclinic.org)

Gender Affirming Voice Modification Therapy, otherwise referred to as transgender voice modification, is training that allows you to use your voice in alignment with your gender. Voice Therapy can help you improve your voice, manage a voice disorder, or prevent or heal from a vocal cord injury. Gender Affirming Voice Modification Therapy is a highly specialized form of voice therapy.

Gender Affirming Voice Modification Therapy is a form of gender-affirming care. Voice therapy can help you raise or lower your vocal pitch (how high or low your voice sounds) and shape your resonance (sound) to express yourself the way you would like. It’s an alternative to surgery, which changes your voice by modifying your vocal cord structure.

Your experience and perception of your voice, including your desire to change it, is profoundly personal. There isn’t a “right” or “wrong” way to sound like your gender.

Most transgender people seek voice therapy because they feel there’s a mismatch between their voice qualities and how they - or others - perceive their gender. Biological sex characteristics determine vocal pitch. People assigned male at birth (AMAB) tend to have larger and longer vocal cords. As a result, they have lower, or “deeper,” voices than people assigned female at birth (AFAB). These differences don’t often cause distress if you’re cisgender, which means that your sex assigned at birth matches your gender.

These biological characteristics can lead to misgendering and psychological distress (gender incongruence) if you’re transgender, which means your gender doesn’t match your sex assigned at birth. Having your gender misrecognized by others may even be dangerous if you’re in a hostile, transphobic environment.

You may decide to receive voice therapy if you think that changing your voice will allow you to express your gender more authentically.

Voice therapy may be a part of gender-affirming care if you’re a transgender woman or a nonbinary person assigned male at birth (AMAB) who feels that your voice doesn’t adequately express your gender. Transgender women seek voice therapy more often than any other trans-identified population.

If you’re AMAB, the hormone testosterone causes physical changes that deepen your voice during puberty. Your vocal cords thicken, and muscles in your throat and voice box (larynx) get bigger.

These biological changes drop your voice frequency, or pitch. These physical changes are irreversible without surgery. Suppressing testosterone and taking estrogen as part of hormone therapy won’t change your pitch.

Voice therapy can train you to use your voice muscles to adjust pitch so that your voice sounds higher. Generally, vocal pitches greater than 160 Hz are perceived as feminine. The range is from 160 to 315 Hz and above, with 220 Hz as the average pitch.

Voice therapy may also include learning other vocal qualities. For example, you may develop:

• More pitch variability: Adjusting your pitch so you’re speaking across the highs and lows of your vocal range more frequently.
• Resonance: Shaping your sound to stay more forward and using different registration, which relies more on the vocal muscles in your head (light quality) instead of your chest (heavy, boomy quality).

Voice therapy for transgender men and possibly for nonbinary people assigned female at birth (AFAB) focuses on lowering pitch. Generally, vocal pitches between 95 to 175 Hz (with an average of approximately 120 Hz) are perceived as masculine.

Unlike feminizing hormone therapy, taking testosterone as part of masculinizing hormone therapy changes your pitch. Testosterone changes your vocal cords and speaking muscles similarly to people AMAB people during puberty, naturally lowering your voice.

Still, hormone therapy may not lower your voice to a pitch you’re comfortable with. In this case, you may also need voice therapy. Voice therapy can also help you adapt to changes in your vocal cords that result from taking testosterone. For example, your vocal cords may get bigger, but your voice box may not get bigger proportionally. This can lead to muscle tension and vocal problems that voice therapy can address.

Voice problems that may result from hormone therapy include:

• Hoarseness and voice fatigue.
• Vocal instability (cracks or a buzzing sound when you talk).
• Trouble getting loud or projecting your voice.
• Sounding younger than your age.

You may receive masculinizing voice therapy because you’d like to lower your voice but don’t want to take testosterone.

Part of therapy may also include learning other vocal qualities. For example, you may develop:

• Less pitch variability: Staying in a narrower pitch range, so your voice has less pitch variability.
• Greater intensity: Speaking louder with changes in rhythm and rate of speech.

Gender-ambiguous voices fall within the range of approximately 155 to 187 Hz. You may wish to target this range if you’re nonbinary or uncomfortable having a vocal pitch that others associate with specific genders.

This type of therapy trains you to switch between pitches to control when you sound more feminine (higher pitch) or masculine (lower pitch). Voice training can help you find the voice qualities that accurately reflect your gender and also may allow for the flexibility that your voice requires.

(source:Expresable) Gender-affirming voice training, or transgender voice therapy, can include a wide variety of vocal and communication aspects. These include pitch, resonance, intonation, articulation, nonverbal communication, language, and vocabulary use.

There is a wide range of feminine and masculine vocal qualities. You may be looking for MTF (male to female) or FTM (female to male) voice training. Your focus may be on voice feminization or voice masculinization. Or you may want a gender-expansive voice, so you can modify your voice depending on context and the gender identity you present across settings. 

The key is to listen to and understand your own inner voice. Accessing your authentic voice means understanding who you are, whether that's transfeminine, transmasculine, nonbinary, gender nonconforming, genderqueer, bi-gender, agender, cisgender, or something else! Behavioral voice change is intended to help you find the ideal range that feels most natural to your authentic self. Each session is individualized to your goals. Your voice specialist will only target those areas which feel authentic to you.

When you work with a speech therapist specializing in voice modification, there are many aspects of your verbal and nonverbal communication that can be explored to better align your voice and identity. These may include:

• Pitch: How high or low your voice sounds, which is impacted by the number of vibrations your vocal cords produce
• Resonance: The quality of the sound your voice makes
• Intonation: How your voice rises and falls during speech--in other words, the melodic or rhythmic quality of your voice
• Rate of speech: How quickly or slowly you talk
• Volume: How loud or soft your voice sounds
• Nonverbal vocalizations: Sounds you produce that aren’t speech, such as laughing or coughing

In addition to voice qualities, there are other components of your communication that you may wish to alter. These can include how clearly you articulate certain sounds or words, your vocabulary and word choice, and certain social pragmatics that you follow during conversational exchanges.

It's important to seek care from a specialist in the area of gender-affirming voice care, as modifying your voice can be vocally fatiguing. Vocal health and hygiene is an important consideration for anyone seeking to change aspects of their voice. For many people beginning the journey to transform their voice, they may think simply adjusting the pitch or volume will help them sound more feminine or masculine. This is not necessarily true. A certified speech-language pathologist can provide techniques and warmups to prevent vocal fatigue or strain and to help you find a voice you can use for a whole lifetime! A professional can help you find your voice in a healthy, safe, and productive way.

When you begin working with a speech therapist who specializes in gender-affirming vocal training, the first step is an assessment. This assessment seeks to uncover your existing communication profile, and establish your voice and communication goals.

An assessment may include several components, including:

• Examination of oral-motor skills: Oral-motor functioning is how the muscles in your face and throat, including your lips, jaw, and tongue, coordinate movement to produce speech. Your speech therapist may begin by examining this coordination to see how these muscles work together to produce desired sounds.
• Voice evaluation: Your speech therapist may use a variety of tests and exercises to examine your current voice profile. This includes your voice’s existing pitch and pitch range, intonation, volume, resonance, and intensity. This also includes your respiration and breathing habits, which affect the “power” behind your voice.
• Communication skills: In addition to your voice, there are many other verbal and nonverbal communication behaviors that we use during conversation. This style of communication can be adjusted to take on more feminine or masculine qualities.
• Goals: Gender-affirming vocal training will look different for every individual. This is because your existing vocal profile and your desired outcome will be used in developing a unique training program tailored to your needs. Your speech therapist will take the time to clearly understand your goals and the desired voice and communication style that best matches your identity.

You’ll meet regularly with a voice specialist, such as a speech therapist (speech-language pathologist). Treatment success will depend on your choice of provider. It’s essential to carefully vet the healthcare provider you work with so you choose someone who understands and respects your treatment needs as a transgender person.

You’ll meet with a healthcare provider to decide on voice therapy goals, and you’ll make a plan to achieve them. To start, your provider will analyze your voice, including how you use your breath, vocal cords and other speaking muscles. They’ll note your baseline voice pitch. This starting point will help them determine how much change is needed to reach your target pitch.

They’ll also ensure your voice is healthy, so you don’t risk injury during therapy.

You’ll meet regularly with a provider on a timeline that makes sense for your goals. Many programs involve multiple sessions over 4-6 months, but there’s no standard timeline. You’ll connect on your progress throughout therapy and modify training as needed.

Adjusting your pitch will likely be a primary focus during therapy. Still, the specific training you receive depends on your unique goals. You may develop skills in:

• Pitch modification: Lowering or raising your pitch. You’ll start with a slight pitch change before gradually progressing to higher or lower pitches. You may begin with vowel sounds before gradually progressing to words, phrases, sentences and conversations in your desired pitch.
• Vocal hygiene: Practicing good habits to keep your vocal cords healthy and free from injury. This includes doing vocal warm-ups, practicing good posture, and performing breathing and relaxation exercises.
• Articulation: Using your speaking muscles to form sounds in a way that accurately reflects your gender identity. This may mean lightening the constriction between your lips, tongue and teeth/palate or even using greater intensity, depending on your goals.
• Resonance: Using the air-filled cavities in your throat, mouth and nose to color the sounds your vocal cords make. Working on your resonance can help create a unique tone that feels authentic to you. Training may involve learning how to control your vocal muscles better to anchor sounds in your chest (chest voice) or in your head (head voice).
• Prosody: Modifying the tone and emphasis you place on sounds, words and phrases, creating a rhythmic quality (or flow) to your speech.
• Word choice: Choosing words that reflect gendered ways of speaking.
• Pragmatics: Adjusting your communication style to fit changing social situations.
• Nonverbal communication: Using visual cues like body language and facial expressions to convey messages without speaking.

An important part of transgender voice therapy involves applying the skills you learn to real-world situations. Across settings, you’ll reflect on how you feel when using your voice across a range of purposes: speaking, laughing, singing, etc. You can share your response with your provider to adjust voice therapy to your needs.

Yes. Speech therapy can give you the tools to understand how your voice works. It can help you exercise more control over your voice so you can change how it sounds.

Still, there aren’t any guarantees regarding how much higher or lower your voice becomes during therapy. Many people reach their desired pitch, but it’s not possible in all cases. Much depends on the anatomy of your vocal cords and your ability to use them.

Voice therapy can help you change your voice without surgery. Most people who receive transgender voice therapy see it as a positive experience. In addition to helping you change your pitch, voice therapy can offer you the space to reflect on the vocal qualities that sound and feel true to you.

Your vocal cord anatomy may not allow the pitch adjustments you’d like to achieve. It’s important to remember that pitch is just one vocal quality people hear regarding gender. You can work closely with your provider on other aspects of your communication style to convey your gender.

If you’re unsatisfied with your results, talk with your healthcare provider about the possibility of surgery to change your voice.

Contact your provider if you notice signs of vocal cord strain, including:

• Hoarseness.
• Vocal fatigue.
• Pain when you speak.

It shouldn’t feel unpleasant to use your voice. Get guidance from your provider on whether you should adjust your therapy, rest your vocal cords or try other treatments.

You’ll need to continue vocal exercises to maintain the gains you make during vocal therapy. Over time and with consistent practice, you’ll gain better control over your voice muscles.

The effects of testosterone on your vocal cords are permanent, which means your voice will remain lower even if you stop taking testosterone. Whether you’re on hormone therapy or not, the voice exercises you learn in voice therapy can help you maintain better control of your voice.

GLOSSERY OF TERMS

Dysphonia

A voice quality that leads an individual to sound strained, tremorous, weak or rough.

Gender Affirmation

The process through which a person’s gender identity and gender expression are recognized and supported.

Gender Dysphoria

A diagnosis for individuals who experience significant distress or problems functioning due to an incongruence between their gender assigned at birth and their gender identity.

Gender Expression

The external presentation of someone’s gender. Signifiers of gender expression can include clothing, hairstyle, pronouns, voice, behaviors and other factors.

Gender Identity

A person’s internal sense of their true gender.

Gender Nonconforming

A person whose gender expression is not confined to the typical expectations of masculine or feminine. Someone who is gender nonconforming is not necessarily transgender, and the term is only applied to people who self-identify as such.

Non-Binary

When gender identity or expression do not fit entirely into the categories of man or woman. This term only applies to people who self-identify with it.

Non-Verbal Communication Skills

Cues that do not involve speech, such as eye contact, hand gestures and body language.

Transgender

Individuals whose gender identity or gender expression do not align with what is typically associated with the sex they were assigned at birth.

Transgender Man

Someone whose gender identity is male but who was assigned female at birth.

Transgender Woman

Someone whose gender identity is female but who was assigned male at birth.

Transition

The process of aligning one’s gender expression with their gender identity. This can include changing one’s name and pronouns, dressing differently, hormone therapy and surgery.

Verbal Communication Skills

The use of sounds and words to express one’s self, which can include aspects such as language choice and communication patterns.

Voice Feminization

Training to help transgender women adapt their voices and communication patterns.

Voice Masculinization

Training to help transgender men adapt their voices and communication patterns.

AFAB 

Assigned Female At Birth

AMAB

Assigned Male At Birth

ALL ASSESSMENT AND THERAPY SESSIONS ARE UTILIZE A TELEHEALTH SERVICE DELIVERY MODEL AND ARE PROVIDED FROM THE COMFORTS OF YOUR OWN HOME. 

NOTE:

Choosing an experienced Speech Pathologist who works with vocal therapy and transgender people will make the difference in your treatment success. Many healthcare providers can help you adjust your pitch. It’s important, though, to find a provider who can tailor treatment to the changes you’d like to hear so your voice expresses your gender. These changes may involve more than changing how high or low your voice is. You may not know what changes feel right inside of your body when you’re speaking without the guidance of a specialized provider who’s attuned to your needs. Work with a provider who understands how voice and gender identity are related.

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