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Voice Therapy (Transgender)

Voice Feminization (Male-to-female)
Voice feminization refers to the voice change from male to female. It is considered essential part of care for transgender women. Transgender women trying to feminize their voice represent the largest gender noncomforming group seeking speech therapy services, therefore, most studies regarding transgender voice have focused on voice feminization, as opposed to voice masculinization.

Therapy has been shown to be effective in voice feminization, and the modification of certain voice characteristics, such as fundamental frequency and voice resonance can help in that effect.

Voice characteristics:

Fundamental frequency was initially thought to be the characteristic most effective in voice feminization. However, each person might have different perspectives regarding speech and voice, and therefore the salient characteristics, and their relative impact towards femininity, can vary from person to person, and many clients are not satisfied with only a change in fundamental frequency. The efficacy of treatment should therefore be evaluated, not only by acoustic characteristics, but also using the transgender person’s perception of the voice and its femininity.

What is considered a feminine or a masculine voice varies depending on age, region, and cultural norms. The changes with the greatest effects towards feminization, based on current evidence are:

Fundamental frequency: also called pitch. Specifically, raising the fundamental frequency helps towards voice feminization. However, there is no clear answer to how much this frequency should be raised in order for the voice to be perceived as female. The consensus in the literature is that the fundamental frequency should be raised from the cismale speaking range (around 100-140Hz) to either a gender neutral (145-175 Hz) or a cisfemale range (around 180-220Hz) ; however, different studies suggest different minimum fundamental frequency targets, such as 155 Hz, 160-165 Hz , or 180 Hz.

Voice resonance: the length of the vocal tract changes the resonance of the vocal tract, which in turns changes the pitch. The vocal tracts of cismen and ciswomen are different; cismen tend to have vocal tracts that are 10-20% larger, and therefore cismen have a lower vocal tract resonance than ciswomen. Modifying the length of a vocal tract results in a change in resonance and in pitch, as can be shown by saying the sound “sss” and protruding and retracting the lips. Transgender women can use techniques, such as retracting the lips, to shorten the vocal tract and sound more feminine.

Temporary: Pitch can also be altered through voice resonance modification. The length of the vocal tract affects the resonance of the vocal tract, which in turns affects the pitch. Cismen tend to have vocal tracts that are 10-20% larger than those of ciswomen, and therefore cismen have a lower vocal tract resonance, and a lower pitch, than ciswomen. Modifying the length of a vocal tract results in a change in resonance and in pitch, as can be shown by saying the sound “sss” and protruding and retracting the lips. Transgender women can use techniques, such as retracting the lips, to shorten the vocal tract and sound more feminine.

Other characteristics that have been explored include inflection patterns, loudness, speech rate, speech-sound articulation and duration.

Transition in childhood and adolescence:

Few studies have considered the potential repercussions of age on therapy. Currently, there is no consensus regarding speech therapy for adolescents. During adolescence, there is an increase of both vocal tract size and vocal fold length, especially for males, which affects the voice and pitch. Because of these physical changes and hormonal changes, it is difficult to focus on pitch. Previous studies have shown that therapy shaped from adult therapy can be effective.

Transition in aging populations:

Few studies have looked into the transition in the elderly. A survey has shown that many elderly members of the LGBT community do not disclose their LGBT status to their clinicians, including members that receive speech therapy; they choose not to disclose this information because they are afraid it would negatively affect their access to services.

Tentative References

Carew, L., Dacakis, G., & Oates, J. (2007). The effectiveness of oral resonance therapy on the perception of femininity of voice in male-to-female transsexuals. Journal of Voice, 21(5), 591-603.

Davies, S., & Goldberg, J. M. (2006). Clinical aspects of transgender speech feminization and masculinization. International Journal of Transgenderism,9(3-4), 167-196.

Davies, S., Papp, V. G., & Antoni, C. (2015). Voice and communication change for gender nonconforming individuals: giving voice to the person inside. International Journal of Transgenderism, 16(3), 117-159.

Gelfer, M. P. (1999). Voice treatment for the male-to-female transgendered client. American Journal of Speech-Language Pathology, 8(3), 201-208.

Gorham-Rowan, M., & Morris, R. (2006). Aerodynamic analysis of male-to-female transgender voice. Journal of Voice, 20(2), 251-262.

Hancock, A., & Helenius, L. (2012). Adolescent male-to-female transgender voice and communication therapy. Journal of Communication Disorders,45(5), 313-324.

McNeill, E. J., Wilson, J. A., Clark, S., & Deakin, J. (2008). Perception of voice in the transgender client. Journal of Voice, 22(6), 727-733.

Wolfe, V. I., Ratusnik, D. L., Smith, F. H., & Northrop, G. (1990). Intonation and fundamental frequency in male-to-female transsexuals. Journal of Speech and Hearing Disorders, 55(1), 43-50.