Voice therapy for transgender – male to female transition hormonal imbalance in females

Most people have never even heard of voice therapy in the transgender arena or really in most other areas as well. This is a new area in Speech Language Pathology and is up and coming because of the recent evidence involved that has proven the effectiveness of its results.

First we must try to think about the differences in men vs women in regards to areas of voice, language, and nonverbal communication. There are many differences in communication and the individual needs to really define communication in regards to men vs women in evidence based case studies.

• Pitch– Pitch can be defined as the high or low tones in the sound. While having a higher pitch is usually associated with feminine voice; this area has been proven in some studies to not be as important with some women to create a more positive perception of a more feminized voice.


The clinician usually tries to raise the pitch to be gender appropriate in regards to create a healthy and realistic/consistent perception for the client while maintaining a healthy laryngeal mechanism.

• Resonance– So, what is resonance? Resonance is typical of being defined as how the different cavities of the vocal areas are either being vibrated/amplified to change the sound to your own unique quality. These different vocal areas are called “resonators”, and are the mouth, throat, chest, and nasal cavities. While trying to work with the resonators one can decrease/increase the power of their voice by training their ability to work with vocal resonance. It is worth noting, that these vocal resonators are anatomical areas which cannot be changed unless by surgical means. These areas have been used in the singing industry for a sufficient amount of time. One example, of using the resonator as one aspect of tg therapy is to bring the focus of the voice more up into the upper head area versus the chest in order to lessen the deeper chest resonation. Many areas are used in voice therapy for the transgendered client but the ability to learn this technique of feminine resonance has been one of the harder areas for the client. It has been quoted as “ hearing the voice” ( Miller 1996 ), as well as the ability to feel the vibrations.

• Intonation (the rhythm of speech)- As said earlier, pitch and intonation are one of the final goals in maintaining the client’s own positive perception of their speech. However, one must consider that intonation is mostly perceived equally in both genders. Intonation is the melody and rising and falling of the message of the speaker, which can alter the meaning of the delivery. While also, adding more impact and other areas of “maybe” gender qualities to the listener. Intonation and pitch can be part of the same goal in certain instances. There is evidence that gender differences have been documented in intonation; Such as women using more intonation more often and men tend to be more flat.

• Volume– Volume and rate have been distinguished differently in genders. Studies have been done diagnostically ( decibels ) and culturally while trying to describe appropriateness of the target gender. Conversational speech has been averaged at around 50 decibels and research in voice intensity has been supported as male intensity to be at a greater volume than female speakers. Decibel measurements have not been extremely precise when comparing each study but on average there is a 2-3 decibel range consistent for both genders.

• Rate– Rate is usually defined as the number of syllables/words in a segment of a certain target time, which typically includes pauses and speed of uninterrupted articulation variances. Articulation is defined as the actual production of the sounds made by the articulators ( lips, tongue, teeth, etc ). In different studies, it has been apparent that male participants spoke at a faster rate. “While female subjects spoke more slowly, quietly, dysfluently , and with a higher pitch” ( Addington 1968, page 341 )

• Articulation– Differences in articulation of genders is usually a perceptive area and is not normally focused on unless the client feels it is needed. There is normative information on gender differences such as substitution of sounds, prolonged vowels, speech sound production differences, and simplification of sounds. This is an area where the SLP can provide information and the client can decide if this is an area to focus.

In a case study recently published by McCready, Campbell, Crutchley, and Edwards (2010), it presented how voice, language, and non-verbal communication ( Example: Woman use more hand gestures ) helped in effective treatment for the transgender client. For example, in therapy the SLP focused on female language characteristics/behaviors to include; inclusive pronouns ( example : 1st person=we , us , ours ), tag questions ( Example= “ Am I right?”, “ You agree?” ), tentative language ( (Example; more cautious statements vs more assertive/confident ), more descriptive adjectives, adverbs, and just more overall communication which involved apologies, nurturing, and giving more personal information. The nonverbal behaviors focused on were more smiling/head nodding, fluid hand/arm gestures, more responsiveness, and being closer to the listener during communication. According to the study, when implementing these strategies along with voice therapy, it provided positive results towards the transgendered client; which then resulted in a better perceived outlook of the client’s own communication in regards to what their priorities where for their target gender.

Voice therapy for the transgender client is an emotional journey for the clinician and client. There needs to be a boundary of professionalism in regards to empathy from the clinician’s perspective and trust from the client. Each client is very different from the next because of anatomical structures, voice production, and target goals that are appropriate for their own confidence in their journey for transition to a more feminine voice.

There are surgical options to consider, but in my professional/personal opinion, this should only been done when exhausted all other resources. While there have been positive results from these procedures there are always life-long negative implications that may happen. So, please consult, research, and understand all dangers in anything that can harm your vocal chords.

A professional Speech Pathologist can provide diagnostic baselines and chart progress throughout all facets of the overall communication process. The areas of your voice are based and compared to average norms as well to show where you stand in the general population in regards to evidence based studies.