Transgender voice therapy

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 and voice resonance. Other characteristics that have been explored include intonation patterns, voice quality, loudness, speech rate, speech-sound articulation and duration. == Voice masculinization ==

Voice modifications for transgender men typically involve the lowering of the speaking fundamental frequency. 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. Overdevelopment of vocal folds in an undescended, small larynx can result in a condition named "entrapped vocality" with permanent hoarseness, and lack of passing. 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. == Gender perception in voice ==

In the case of AI vocal gender identification examples, key features noted to effect gender perception included fundamental frequency and formant frequency as well as further source related measures including cepstral peak prominence (a rough measure of harmonicity in voice with low values indicating a higher likelihood of dysphonia) and rolloff in energy between the first and second harmonics. A 2020 study in the International Journal of General Medicine noted other factors being involved in gender perception, saying: "a minimum F0 value of 180 Hz required for a voice to be perceived as feminine". Vocal gender presentation can be assigned by speakers even as things like fundamental frequency stay the same, especially where we see formant frequencies changing, which is noted as important for gender presentation alongside fundamental frequency. == Transgender voice surgery ==

Surgical procedures may be undertaken by transgender individuals, particularly transgender women, to alter their vocal pitch and quality when voice therapy alone does not achieve desired results. These surgeries modify the vocal folds and laryngeal structures to raise or lower pitch, improve resonance, and contribute to a voice that better aligns with a person’s gender identity. Various surgical techniques exist, including cricothyroid approximation, Wendler glottoplasty, feminization laryngoplasty, and laser-assisted procedures. While effective for some, these surgeries carry potential risks and complications and are generally considered after voice therapy. == Therapeutic techniques ==

Therapy may take place in an individual or group setting. The most common focus in transgender voice therapy is pitch raising or lowering; however, other gender markers may be more important for an individual to work on. Lowering pitch A lack of training on how to use their new voice may cause some transgender men to have increased muscle tension. Informational erasure and institutional erasure were identified in a 2009 Canadian study of health care for transgender people as being the most prominent barriers to care. During adolescence, there is an increase of both vocal tract size and vocal fold length, especially for those assigned male at birth, which affects the voice and pitch. Because of these physical changes and hormonal changes, it is difficult to focus on pitch. Previous studies have shown that therapy shaped from adult therapy can be effective. == Disagreement over Genderfluid voice ==

The clinical viability of training a bimodal or genderfluid voice is a subject of disagreement. A person may want to have both a masculine and a feminine voice in their vocal repertoire, possibly to fit with their own genderfluid identity, or to read as a different gender in different contexts. Most current transgender speech and voice protocols do not support bimodal speech as a treatment goal. This is based on the clinical concern that such inconsistent use reduces the opportunities for practice, and that switching voice patterns may be too difficult for some clients. However, Davies, Papp and Antoni (2015) reference the ability of actors to use different accents and dialects, and people to learn different languages as a sign that training a genderfluid voice may be a viable treatment goal. ==See also==