What Is Voice Therapy for Transgender Individuals?

Can help transgender people present more comfortably

Voice therapy for transgender individuals helps them present their voice in a way that is better aligned with their gender identity. Transfeminine people, in particular, may experience significant dysphoria about the way their voice is perceived by others.

Voice therapy can help individuals retrain the pitch (highness or lowness, also referred to as frequency) of their voice and can also include vocal production techniques and mannerisms that are perceived as masculine or feminine.  This may make it easier for people to be correctly perceived as their affirmed gender.

Voice therapy can also help a person adjust to changes in their voice that occur as a result of gender-affirming hormone therapy.

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Meaning of Vocal Therapy for Transgender Individuals

Voices, and their varied characteristics, are closely associated with gender perception—both by the person speaking and by those who are listening.

As such, vocal therapy may be an important component of a successful social transition for transgender and gender diverse individuals whose voices are not perceived in a way that is congruent with their gender identity.

Vocal therapy, sometimes in combination with vocal cord surgery, can be an important tool to help some individuals present more comfortably as themselves.

When transgender individuals wish to address dysphoria that is related to their voice, the first recommended step is usually vocal therapy or vocal coaching.

  • Vocal therapy is primarily offered by speech-language pathologists. Speech-language pathologists are trained to work in conjunction with medical professionals to address medical and structural issues with the voice.
  • Vocal coaching may be offered by other types of professionals, including musicians and other performers trained in working with the voice. Vocal coaching may be a reasonable option for individuals whose goal is to address gendered vocal mannerisms and habits rather than more fundamental qualities of the voice such as pitch or hoarseness.

When looking for vocal therapy for transgender individuals, it is a good idea to work with an individual who has expertise in the transgender voice. This is both because such an experienced professional is more likely to be aware of specific vocal issues affected by gender-affirming hormone therapy and because they are likely to have experience in assessing the way voices are perceived as gendered by others in society.

Vocal therapy has been shown to have some effect in making the voices of transfeminine individuals sound more feminine. However, some individuals feel that they are not able to make their voices sufficiently feminine using therapy alone.

These individuals may pursue surgical procedures to shorten the vocal folds and directly increase vocal pitch. That said, it is important to note that pitch or frequency shifting alone may not sufficiently change the gendered perception of the voice.

Types of Vocal Therapy

The types of vocal therapy recommended for transgender individuals will vary depending on their goals. Usually, vocal therapy involves a combination of synchronous lessons in voice use with exercises that are to be performed at home between sessions.

Practice is important to help retrain a person's way of speaking so that it becomes instinctual rather than requiring conscious effort. Many aspects of vocal production are perceived in a gendered way, including breath support, resonance, and rate of speech, and may be amenable to vocal therapy.

Testosterone and Voice

Transmasculine individuals who take testosterone as part of their medical transition/gender affirmation will often find that the pitch of their voice drops significantly. This is due to the effects of testosterone on the vocal cords.

Testosterone exposure is associated with longer vocal folds and vocal-tract length. Research has shown that the perceived "maleness" of a voice is largely related to the length of the vocal folds.

The effects of testosterone on the voice are one reason why some transmasculine individuals are not interested in using testosterone to affirm their gender. Individuals who use their voice professionally, such as singers, may be concerned about the effects of gender affirming hormone therapy on their instrument.

This is a reasonable concern, and individuals should discuss the pros and cons of testosterone therapy with a physician. They may also wish to consider discussing their concerns with a speech and language pathologist or voice therapist who is experienced in working with the transgender voice.

Healthcare and Vocal Therapy

Vocal therapy is usually the first step for transgender individuals who wish to change the gendered perception of their voice. While some individuals may also be interested in pursuing surgical interventions to address their vocal dysphoria, a trial of vocal therapy is almost always recommended before surgery is offered.

When surgery is performed, vocal therapy is often still needed afterward in order to help the person retrain their voice to meet their goals.

A Word From Verywell

How we perceive people's voices is both individual and deeply culturally constructed. Traits that are considered feminine in one culture may be considered masculine in another, and vice versa. For many individuals, both cisgender and transgender, their voice is an important aspect of how they see themselves and how they are seen by others.

It is difficult to discuss vocal therapy for transgender individuals without acknowledging that many of the assumptions that lie behind it are deeply cissexist and heterosexist.

People should not be expected to adjust characteristics about themselves to conform to the expectations of others. However, for those transgender individuals who choose vocal therapy to affirm their gender, it is important that good options be available.

When seeking a gender-affirming voice therapist, it may be helpful to reach out to a local transgender support group or a clinic that provides medical or surgical gender affirmation. They may be able to help point you to a therapist in your area who has experience with the transgender voice.

In addition, a growing number of gender-affirming voice therapists are offering services via telehealth, which has significantly expanded the options available to people in areas with smaller transgender communities.

Voice therapy and voice surgery may be covered by some insurance companies. However, as with all health services, it is important to check with your insurance company before assuming that any costs will be covered. It may be necessary to pay out of pocket for your vocal therapy services.

8 Sources
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By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.