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Transgender Voice Services: What does it involve? (Hint: MORE than just pitch!)

Updated: Jun 21, 2020

When treating the transgender population it is different than other voice clients we may see. Why? Because for one, it's elective. These individuals are choosing to be there. But two, there is no "disorder" or actual impairment to the voice in most cases. We are simply changing one's voice.

What are the components of transgender voice therapy? I am going to give a few examples for possible targets for a Male to Female transition:

  • Pitch (This is the most obvious one)- likely the goal is to increase the pitch which can be done in a gradual and healthy way that does not cause straining to reach the higher pitch ever

  • Resonance- this is one of the most important features of distinction between male and female voices. Increasing frontward resonance is always a goal to increase the perception of femininity of a voice, even with a lower baseline pitch.

  • Airflow - perhaps increasing breathiness or targeting more efficient breath use to increase perception of feminine voice (if that is the goal)

  • Intonation patterns- we can increase use of intonation, increase patterns of female intonation (avoiding pitch drop at the ends of words or sentences)

  • Articulation of sounds (clearly articulating each sound)

  • Speech characteristics (i.e. Elongation of vowels)

  • Language

    • For Male to Female we would want to increase indirect language use, use of qualifiers ("rather", "sort of"), hedges ("If I'm correct..."), tags ("don't you think?"), and intensifies ("so" or "such")

    • Target different conversational topics, directness of language, elaboration during conversation (these all differ generally from males to females culturally)

    • Non-verbal communication - Hair touching, increased eye contact, crossing legs, posture associated with female behaviors)

  • Non-speech vocalizations - we want to also target automatic vocalizations like coughing or laughing to be in a pattern representative of the gender

What other components should be a part of treatment:

  • Counseling- providing a safe, supportive, culturally sensitive, and encouraging environment for this difficult process

  • Education - providing education on normal voicing, targets, and efficient voice patterns to reach goals. Education on at-home carryover work

Other factors to consider:

  • Patient's readiness to commit to process of therapy

  • Patient's readiness for change

  • What are their support systems outside therapy

  • Point in transition

  • Preferred pronouns

  • Model voice? High pitch, low pitch, somewhere in the middle/more neutral? Does desired voice differ depending on speaking context?

  • Acknowledge any road blocks to change and seek outside professionals (i.e. social workers, counselors) when needed

  • Discuss and decide on therapy only or therapy in combination with surgery from otolaryngologist

  • Goals set should always be collaborative and with patient's specific goals in mind

  • Progress should always be continually discussed and goals/methods altered as necessary

  • Recognize that it's a process and will take hard work and commitment on both ends!

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