Voice therapy (transgender)

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Voice therapy or voice training refers to any non-surgical technique used to improve or modify the human voice.[1][2] Because voice is a gender cue, trans people may frequently undertake voice therapy as a part of gender transition in order to make their voices sound more like what is typical of their gender, and therefore increase their readability as that gender in society. Crossdressers may also desire to undertake voice therapy.


Voice feminization is the desired goal of changing a perceived male sounding voice to a perceived female sounding voice. The term voice feminization is used to describe what the desired outcome of surgical techniques, speech therapy, self-help programs and a general litany of other techniques to acquire a female-sounding voice. The methods used for voice feminization vary from professional techniques used for vocal training, speech therapy by trained speech pathologists and several Pitch altering surgeries.

Vocal sound is produced by air traveling upwards from the lungs through the opening of the larynx called the glottis where the vocal folds vibrate and phonation or voicing occurs. The vibrating vocal folds produce a sound that is modified by chambers (like rooms) of the throat and mouth creating resonance frequencies. The size of the chambers directly affects these frequencies. As the size of the chambers increase the deeper (or lower) the formant frequencies become. These chambers play a very important role in the perception of the timbre (rich, nasal, flat) of the voice. The articulators (tongue, lips, jaw, and soft palate etc.) shape the sound into recognizable speech. Then it is the prosodic features (speaking rate, inflection, pauses) which makes unique speech patterns.

There are several frequencies or harmonics produced at the lips. The fundamental frequency (F0) or the number of times per second that the vocal folds vibrate (in hertz), the conversational fundamental frequency is approximately 200 Hz for adult women and 125 Hz for adult men. Many of the voice feminization techniques, including those of surgeons, focus on the fundamental frequency but do little to address how the sound is modified by the articulators or prosodic features. Speech therapists and professional voice coaches offer training in both changing the fundamental frequency and how to change the perception of voice quality.[citation needed]

Voice masculinization is the opposite of voice feminization, being the change of a voice from feminine to masculine. Voice masculinization is not generally required for transgender men as the masculinising effects of testosterone on the larynx are usually sufficient to produce a masculine voice.[3] However, Alexandros N.Constansis has stated that "Apart from being unfair to transmen, is also overtly simplistic" and cites Davies and Goldberg in saying that "testosterone doesn’t always drop pitch low enough for FTMs to be perceived as male".[4]

Differences between male and female voices[edit]

Like other gendered characteristics, considerable overlap exists between male and female vocal characteristics, especially the psychological ones.

Transgender women who go through puberty before transition will usually develop voices characteristic of males. Hormone therapy does not alter a trans woman's voice once it has masculinized;[5] therefore, trans women who intend to pass as cisgender need to have help with vocal training to feminize their voices.

Vocal training is done formally with the help of several types of professionals and privately by the use of self-help resources including audio or video tapes programs, books, information garnered from websites or chat groups that shares this particular interest. Some trans women, such as Lynn Conway, have feminized their voices with no assistance.

The advantage of going through a speech pathologist instead of many of the other professionals that offer training or trying to learn on your own with self-help programs is that vocal cords can easily become irritated and even develop callous-like growths called vocal fold nodules as the result of incorrect use of the voice and from modifying one’s voice too quickly. Individuals who participate in a voice feminization program are trained to self-monitor and become more aware of their vocal quality. They learn to recognize where and how they produce sound, how they are resonating that sound, and how they physically carry themselves and their voice. Related aspects of communication are also addressed including: breathing patterns, gender related non-verbal communication and vocal hygiene.

Some transwomen find voice training to be difficult, while others consider it unnecessary. While most trans women would prefer to have completely feminine voices, many are unable to achieve this goal. Some transwomen have masculine voices, and many have peculiar female voices that may draw attention.

Voice scientists, speech pathologists, language pathologists and ENT physicians (otolaryngology) organize voice production into five components.[citation needed] They are:

In training for a feminine voice, all five components are usually included.

Vocal surgeries[edit]

While hormone replacement therapy and gender reassignment surgery can cause a more feminine outward appearance, they do little to alter the pitch or sound of the voice. The existing vocal structure can be surgically altered using procedures that include

  • Cricothyroid approximation (CTA) (is the most common)
  • Laryngoplasty
  • Thyrohyoid approximation
  • Laryngeal reduction surgery (surgical shortening of the vocal cords)
  • Laser assisted voice adjustment (LAVA)

There was, until recently, limited evidence as to the efficacy of these surgeries in raising the fundamental frequency over the course of several years. However, since the late 1990s, surgeons performing CTA and other 'voice' procedures at Charing Cross hospital, (Hammersmith, London), have conducted long-term follow-up studies indicating "high" levels of patient satisfaction with both surgical and social health outcomes. All of these modes of 'voice surgery' may or may not have an effect on resonance or other vocal characteristics. Many in the transsexual community have previously been led to regard voice surgery as 'inadvisable', while others regard a socially acceptable standard of feminine speech to be indispensable (and further surgery an acceptable risk). Anecdotal evidence has suggested that (CTA) voice surgery can be expected to raise pitch above female norms in the immediate post-operative period (when sutures are used to create the adjusted 'approximation'); however the (more modern) use of titanium clips avoids this problem, maintaining a correct and even tension on the vocal folds, in the immediate and longer term. Of course, laryngeal surgery carries risks and some patients experience 'raspiness', or, much more rarely, complete loss of voice.[citation needed] There is current research to replace the larynx using stem cells that will have all of the characteristics of a female.[citation needed]


While many trans women wish to sing like cisgender women, it will require a lot of training for one to achieve a feminine-sounding voice. This is why most prepubescent males who begin hormone replacement therapy have a higher chance of retaining this quality. See castrato for more information.

See also[edit]


  1. ^ Laver, John (1984). Principles of Phonetics. Cambridge University Press. ISBN 978-0-521-45031-7. 
  2. ^ Benninger, Michael (1994). Vocal Arts Medicine: The Care and Prevention of Professional Voice Disorders. Thieme Medical Publishers, Inc. ISBN 978-0-86577-439-1. 
  3. ^ Abitbol, J.; B. Abitbol; P. Abitbol (September 1999). "Sex hormones and the female voice". J. Voice. Mosby. 13 (3): 424–446. doi:10.1016/S0892-1997(99)80048-4. PMID 10498059. 
  4. ^ Constansis, A. (2008). "The Changing Female-To-Male (FTM) Voice". Radical Musicology. 3. Retrieved 2009-09-21. 
  5. ^ James, Andrea (March 2007). "Hormonal therapy for women in transition". TS Roadmap. Retrieved 2007-03-16.