Transgender voice therapy

Transgender voice therapy is any non-surgical vocal therapy technique used to improve or modify the human voice to relieve gender dysphoria by aligning a patient's voice with their gender identity. Because voice is a social cue to a person's sex and gender, transgender people may frequently undertake voice training or therapy as a part of gender transitioning in order to make their voices sound more typical of their gender, and therefore increase their likelihood of being perceived as that gender. Having voice and speech characteristics align with one's gender identity is often important to transgender individuals, whether their goal be feminization, neutralization or masculinization. Voice therapy can be seen as an act of gender- and identity-affirming care, in order to reduce gender dysphoria and gender incongruence, improve the self-reported wellbeing and health of transgender people, and alleviate concerns over an individual being recognized as transgender.

Voice feminization refers to the perception of voice change from masculine to feminine. It is considered an essential part of care for transfeminine people. Transfeminine people trying to feminize their voice represent the largest group seeking speech therapy services, therefore, most studies regarding transgender voice have focused on voice feminization, as opposed to voice masculinization.

Therapy has been shown to be effective in voice feminization, and the modification of certain voice characteristics, such as fundamental frequency, vocal weight and voice resonance, can help in that effect. Fundamental frequency, closely related to pitch, was initially thought to be the characteristic most effective in voice feminization. Raising the fundamental frequency can help towards voice feminization. However, each person might have different perspectives regarding speech and voice, and therefore the salient characteristics, and their relative impact on femininity, can vary from person to person, and many people are not satisfied with only a change in fundamental frequency.

What is considered a feminine or a masculine voice varies depending on age, region, and cultural norms. The changes with the greatest effects towards feminization, based on current evidence, are fundamental frequency, vocal weight and voice resonance. Other characteristics that have been explored include intonation patterns, loudness, speech rate, speech-sound articulation and duration.

Voice modifications for transgender men typically involve the lowering of the speaking fundamental frequency. Voice therapy is generally not required for transgender men as the effects of testosterone on the larynx result in a deeper pitch. However, testosterone replacement therapy does not always deepen the voice to the person's desired level, and others choose to not undergo masculinizing hormone therapy at all. Voice masculinization therapy can help to further lower the pitch of transgender men and address voice problems associated with hormone therapy.

In testosterone replacement therapy vocal folds change faster than larynx. Overdevelopment of vocal folds in an undescended, small larynx can result in a condition named "entrapped vocality" with permanent hoarseness, and lack of passing.

Larynx length can be controlled via exercise, making lowering the larynx a useful tool for transgender men in obtaining a passing voice. Other areas that transgender men may benefit from training are embouchure and maintaining high CQ (closed quotient, a quotient of how long the vocal folds are touching to how long the cycle of vibration lasts), responsible for "heavy" or "buzzy" voice quality.

A speech-language pathologist (SLP) may be involved in aiding transmaculine people to achieve their desired voice goals, while usually prioritizing the overall health of the voice. Therapy techniques may involve finding a person's most comfortable pitch range, using breath support and relaxation exercises, introducing voice strengthening warm-ups, stabilizing posture and increasing chest resonance.