Voice therapy, also known as transgender speech therapy, gender affirming voice therapy, or transgender communication therapy, can be a way for transgender, non-binary, and gender-expansive people to alter the tone and pitch of their voice if their voice causes them gender dysphoria, or discomfort. In addition to verbal and non-verbal communication changes, trans and non-binary people can use voice therapy to increase confidence and self-satisfaction in their communication style. Although voice therapy is often used by binary-identifying transgender people, non-binary people can tailor voice therapy to their own specific goals based on what feels affirming and important to them. 

Our voice identifies our gender in the word choices we make, the phrase structures we use, and our intonation patterns.  Our voice is an important part of who we are and what we reveal about ourselves to the world.   We use our voice to communicate, and it is also fundamental to how we express ourselves and establish our identities with others. In the transgender community, when a person’s voice doesn’t correspond with gender expression and identity, it can be greatly distressing. 

Many aspects of vocalization and communication are highly relevant to gender identity, and many transgender individuals find themselves struggling with the chasm between how they identify and how they sound when interacting with the world. This makes speech-language therapy just as important as hormone therapy and other interventions when making the transition in how one identifies with their gender. 

How Can Speech Therapy Help?

Voice therapy uses non-surgical interventions in speech therapy sessions to change key components of verbal and non-verbal communication that can help a trans, non-binary, or gender-expansive person be audibly and visually affirmed in their gender. With the help of a speech-language therapist, communication therapy can help reduce how much a trans person is misgendered by altering the gender cues that are given off in everyday speech. Voice or speech therapy sessions help trans-spectrum individuals masculinize or feminize their voice and communication style to affirm their gender identity. 

Everyone who has decided to undergo voice therapy starts off in a unique place with specific goals and desired outcomes. There are many people who discuss and offer guidance for transgender voice and speech therapy on YouTube and other online platforms. Online platforms might be a helpful place to start, but finding a provider who can tailor voice therapy interventions to an individual’s needs is the best place to start.

There is the potential for transgender individuals to cause damage to their vocal folds if they try to push out sounds that their voices can’t make, so the work of speech-language therapists includes identifying any underlying vocal pathologies, education on proper vocal care, and overseeing the process of making gradual and subtle voice changes over time. 

It should be noted that testosterone as a method of hormone replacement therapy (HRT) is more likely to change the pitch of someone’s voice than estrogen. This is because the masculinizing effects of testosterone usually impact the vocal cords enough to drop the pitch of the voice to gender-affirming levels, while estrogen often does not significantly impact someone’s voice. However, the impact that hormones can have on the voice is dependent on many variables, including the age that someone started HRT, the pitch of the voice to begin with, how long someone has taken HRT, and other factors. That being said, HRT does not always impact someone’s voice, and there are voice therapy techniques that can be used to masculinize and feminize the voice.

Balancing the psychological and physical aspects of an individual in gender transition is critical to achieving confidence and an overall sense of well being and satisfaction. A 2006 International Journal of Transgenderism study found that altering the aspects of voice and communication related to gender can improve mental health and quality of life for those making a transition. Speech-language therapists consider the whole person, bringing a unique level of understanding of both the psychological and physiological implications of gender transition, and can provide therapy at any point during transition, or even in the years following.

Assessment 

Before providing services to their transgender individuals, speech-language therapists perform an assessment, which involves collecting a case history and medical history and assessing the client’s current voice, language and communication. Speech-language therapists will determine if their clients are currently trying to change their voice’s pitch and intensity. If so, they can work to change the behavior to ensure clients avoid damaging their vocal folds. Individuals can achieve a gender authentic voice when working with a speech therapist.

As a part of the assessment and  treatment process, the speech-language therapist will help the individual to become aware of their habitual communication patterns. These habitual patterns convey more about gender perception than vocal pitch or quality alone. Therefore, social communication patterns, such as eye contact, facial expressions and posturing, also need to be assessed in speech therapy sessions, along with vocal pitch, quality and resonance, and the size of the voice box.

Treatment

After assessment of the individual’s of voice and communication (verbal and non-verbal), target areas are identified to help the person reach their voice and communication goals. This process begins with behavioral intervention, targeting communication patterns, and identifying and achieving an easily accessible pitch range. This allows the individual to produce an efficient voice that is more in line with their gender identity. 

Speech therapists address the following aspects of communication when assessing and providing gender affirming voice and communication therapy to transgender spectrum clients. Areas of focus in gender affirming voice therapy include:

  • Articulation
  • Volume and intensity
  • Pitch
  • Intonation and stress patterns
  • Breath support
  • Resonance
  • Speaking rate
  • Language
  • Pragmatics
  • Vocal health

Treatment with clients seeking an authentic gender affirming voice is always individualized and dependent upon the outcome of the assessment. The voice and communication therapies and techniques provided by speech therapists are often provided alongside medical/surgical interventions and hormone therapy. However, most people find that voice therapy is all that is needed to find their most authentic voice.

Voice Feminization – The components of voice production in voice feminization include:

  • Pitch
  • Resonance
  • Intonation

Two common voice therapy techniques in voice feminization include flow phonation, which targets the exertion of airflow during voice production, and resonant voice therapy, which focuses on attaining comfortable phonation while experiencing a vibration of sound in the mouth.

Voice Masculinization – Far fewer transgender males seek voice and communication therapy than transgender females, likely because the desired change in pitch is often achieved through hormone therapy.

Flow phonation and resonant voice therapy are used in voice masculinization therapy. Flow phonation focuses on the balanced exhalation of airflow during talking to achieve a stronger voice, while resonant voice therapy focuses attaining easy phonation while experiencing a vibration of sound in the mouth.

Shifting pitch and resonance together are the two most important factors. Other areas from the list above that may or may not be targeted, depending on preferences, include, but are not limited to, intonation, non-verbal communication, posture, walking, sitting, articulation, vocabulary, grammar, and reflexive sounds (crying, burping or sneezing, or unintentional vocalizations made when air passes through closed vocal chords). Voice therapy can maximize ease and efficiency of voice in an accessible pitch range that is more congruent with one’s gender identity. 

What About Surgery?

Surgery only addresses pitch. Voice therapy helps to address resonance and other voice and speech targets, as well as ensuring clients have the tools to optimize post-surgery healing. 

We are here to help you find your true voice and feel comfortable in how your communication aligns with your gender identity.  Contact Vibe Speech Therapy to learn more about us and how we can help you.