Many transgender men and women experience gender dysphoria distress. Many seek help to reduce this. A particular group, who identify as transsexual and have a firm belief their sex at birth is the opposite of their gender identity, frequently request help to transition to a gender presentation that matches their gender identity and experience. This commonly includes genital re-assignment surgery, cross-sex hormone therapy, voice and communication training, and social care.
One of the primary ways people express their gender is through their voice. Female-sounding voices, for example, are generally perceived as being higher pitched, slightly breathier and with more varied inflection than male-sounding voices.
Voice change approaches Many transsexual women and men seek specialised services to assist them to feminise or masculinise their voices. Female-to-male men are fortunate in that their gender transition involves cross-sex hormone testosterone therapy that normally results in considerable masculinisation of the voice through increasing the size of the vocal cords and consequently lowering the pitch. Although the lower pitch achieved through testosterone therapy may be sufficient for them to be perceived as male speakers, that is not always the case.
Some will require voice training from a speech pathologist to help them access their altered pitch range, to habituate their new pitch into everyday speech and to masculinise their voice quality, resonance and intonation patterns. Male-to-female women, in contrast, do not benefit vocally from cross-sex hormone therapy with oestrogens. Oestrogen therapy cannot feminise the voice in male-to-female women. Many therefore request voice feminisation training from a speech pathologist who is skilled in voice assessment and training for transsexual individuals.
The aim of voice training is to assist the woman to modify her voice so it becomes congruent with her gender identity and the altered voice sounds authentic to others. Male-to-female voice transition before and after. Laryngeal surgery surgery on the voice box may also assist male-to-female women and female-to-male men achieve a more gender-conforming voice. More extensive surgery to the framework of the larynx and the pharynx throat can also enlarge the cavities of the larynx and the vocal tract above the larynx so that the voice sounds more masculine.
For female-to-male men, surgical voice masculinisation involves reducing the tension on the vocal cords so they vibrate at a lower rate.
While voice feminisation and masculinisation surgery is available worldwide, it is not routinely offered. This is because, although such surgeries can result in substantial pitch change, research shows outcomes are variable.
Some are left with a gender-incongruent voice. Laryngeal surgery can also lead to unwanted side-effects, such as poor voice quality, vocal fatigue, difficulty projecting the voice and reduced ability to vary the pitch of the voice in both speaking and singing.
However, surgical procedures are being refined. Training goals typically focus on increasing pitch into the average range for non-transsexual women. Other goals include decreasing vocal effort and loudness, and increasing breathiness allowing a small amount of air escape between the vocal cords.
Voice training usually involves about ten individual sessions of 40 minutes to one hour supplemented by a small number of group sessions.
This training aims to maximise transfer of the new voice into everyday communication and to facilitate compliance with the relatively demanding vocal practice regime. The practice is not painful, but can be tiring. The fatigue is mainly mental — the person has to consciously control their voice whenever they talk, especially early in the training process. Voice training methods include imitation of female voice models, instruction on how to alter the position of the larynx in the neck, the tightness of the vocal cord muscles, the rates and ranges of movement of the vocal cords, lips, tongue and jaw, and exercises that promote increased vocal flexibility.
Specialised apps such as Sonneta Voice Monitor are now available, so users can monitor their own development. Ongoing and extensive practice of the new voice skills outside of voice training sessions is essential.
Although there were very few reports on the effectiveness of voice training for male-to-female women prior to , evidence of the effectiveness has increased rapidly over the last 15 years. Further studies are required to reach unequivocal conclusions. Virtually every client is satisfied with their voice outcomes.