Transgender Voice Therapy and Surgery
Overview
Gender-affirming voice treatments, including therapy and surgery, support transgender and gender-diverse individuals in changing their voice to better match their gender. These methods can affect vocal features like pitch, resonance, and overall sound. Adjustments may also include nonverbal communication, such as facial expressions, eye contact, and hand movements.
Options for Voice Care:
| Type | Focus |
|---|---|
| Feminization Therapy | Raises vocal pitch and adjusts tone |
| Masculinization Therapy | Lowers pitch and deepens quality |
Each individual’s needs are different. Professionals help set personal goals and plans that are safe for vocal health. They give advice on how to avoid overusing the voice or causing harm as a person practices new ways of speaking. Changing one’s voice and communication style can feel unfamiliar at first. It often takes patience and practice to find a style that feels right.
Reasons for Gender-Affirming Voice Care
Gender-affirming voice care helps people match their voices to their gender identity. Many seek this care to lessen feelings of gender dysphoria or vocal dysphoria that come from a mismatch between their voice and how they view themselves. Common reasons include:
- Reducing stress caused by having a voice that does not fit their gender identity.
- Improving personal comfort in speaking.
- Lowering the risk of bullying, harassment, or other safety issues.
Some people are comfortable with their voices and decide not to pursue therapy or surgery.
Possible Complications
Changing how someone produces and uses their voice over time can put stress on the vocal cords. If exercises or techniques are not done carefully, a person might notice vocal tiredness or discomfort. Working with a speech-language expert often helps to reduce these problems.
Voice surgeries aimed at raising pitch, like voice feminization surgery, can make the voice higher but may also shrink the range of notes the person can use. Loudness may drop, which can make it tough to yell or project the voice in a noisy place. The risk exists that the pitch ends up too high or still too low after surgery.
Some people may find their voice becomes rough, hoarse, weak, or breathy, making conversation more challenging. Voice masculinization surgery is less common and works by making the vocal cords looser to lower the pitch. It may change how the voice sounds overall and usually cannot be undone.
| Risk | Possible Impact |
|---|---|
| Vocal Fatigue | Tiredness, discomfort after speaking or singing. |
| Permanence | Most changes cannot be reversed. |
| Quality Changes | Hoarse, breathy, or strained voice. |
| Pitch Concerns | Voice may become too high, too low, or lack flexibility. |
| Reduced Loudness | Harder to shout or communicate in loud settings. |
Professional support helps guard against many problems. Vocal health remains important before, during, and after any voice change process.
Steps to Get Ready
Start preparation by asking a healthcare provider for a referral to a speech-language pathologist with training in transgender and gender-diverse communication. Set clear goals for how you want your voice and communication to change.
If you are unsure about these goals, the specialist can guide you through your options. Vocal hygiene is a key part of getting ready. Drink plenty of water, avoid shouting, and do not smoke to keep your voice healthy. Hydration helps protect the vocal cords. Some professionals may suggest vocal function exercises.
Check insurance requirements before starting, as some plans may cover therapy but have specific rules. Otolaryngology specialists may use assessments, such as stroboscopy or videostroboscopy, to examine your vocal cords.
What You Might Experience
Gender-related voice training helps people adjust how they speak to better match their gender identity or goals. This can mean making the voice sound more feminine, masculine, or somewhere in-between.
Specially trained speech-language pathologists who are experienced in transgender voice care and gender-affirming voice support lead the process. The main areas often addressed in sessions include:
- Vocal Pitch: Pitch is how high or low a person’s voice sounds. Training may help someone reach a pitch that feels comfortable and matches their gender presentation.
- Typical feminine voices have a pitch above 165 hertz (Hz).
- Masculine voices usually fall below 165 Hz.
Various techniques, such as vocal exercises, feedback apps, and musical tools, help practice and measure changes in pitch.
Resonance & Placement: Resonance is how sound vibrates in the throat, mouth, and nasal passages. Working on resonance helps the voice sound brighter or deeper.
- A brighter, more forward resonance is often linked with a more feminine sound.
- A deeper, chest-focused resonance is associated with masculine voices.
Prosody (Rhythm & Melody): Prosody refers to the flow of speech, including rhythm, emphasis, melody, and emotion in the voice.
- Masculine voices may use louder stress to show meaning, while feminine voices often use changes in pitch or melody.
- Practicing with a specialist can help develop these patterns.
Voice Quality & Articulation: People may focus on clarity and how sounds are formed, which can affect how gendered the speech sounds. Exercises may also help with breath control, inflection, and softening or strengthening the voice as desired.
Other aspects of communication addressed:
Nonverbal Communication: Specialists also work on posture, gestures, facial expressions, and eye contact. These cues can impact how someone’s gender is read in conversation.
Technology and Feedback: Computer programs and mobile apps allow people to hear their voice, see real-time measurements, and track their improvement over time.
Ear Training: Learning to listen to, and recognize subtle differences in one’s voice helps set goals and notice progress more easily.
| Voice Feature | Feminization Focus | Masculinization Focus |
|---|---|---|
| Pitch | Raise above 165 Hz | Lower below 165 Hz |
| Resonance | Forward/nasal | Chest/throaty |
| Prosody | Wider melody, pitch changes | More monotone, stress on loudness |
| Articulation | Precise, lighter | Stronger, heavier |
| Breathing/Inflection | Softer airflow, breathiness | Firmer, shorter phrasing |
- Schedule and Structure: Sessions often last between 20 and 40 minutes, and can be individual or in group settings. The number and frequency of sessions are based on each person’s specific goals and needs.
- Benefits of Gender-Related Voice Training:
- Builds confidence with everyday speaking
- Helps align self-expression with gender identity
- Can reduce discomfort (sometimes called voice dysphoria)
- Provides tools and information for voice care and vocal health
- Preparation for Surgery: Before any surgical steps, voice therapy is usually recommended, both to prepare for changes and to support the best possible voice outcome after surgery.
Medical Procedures for Voice Change
Some people may choose surgical options to permanently change their voice pitch if therapy alone does not meet their goals. Trained specialists, such as laryngologists or laryngeal surgeons, perform voice surgery.
Raising Voice Pitch (For Feminization):
Surgery options for increasing voice pitch include:
- Anterior Vocal Fold Web:
- Surgeons create a small web of scar tissue at the front of the vocal cords.
- The web shortens the cords, making it harder to produce low-pitched sounds and raising the overall pitch.
- This technique narrows the airway slightly, so it may not suit people who use their voice heavily in singing or professional speech.
- Cricothyroid Approximation (CTA):
- Surgeons tighten the vocal cords by bringing voice box structures closer together.
- This results in a higher baseline pitch and less ability to lower pitch.
- Some studies have found the results can fade over time, so it’s not always a permanent solution.
Lowering Pitch (for Masculinization):
- Thyroplasty Type 3:
- Surgeons relax the vocal cords, which lowers the pitch.
- This surgery is less common than feminization surgeries because hormone therapy often achieves the lower pitch many want.
- It may be an option if hormones do not provide enough deepening of the voice.
Other Surgical Techniques:
- Surgeons may also use procedures like laser-assisted voice adjustment (LAVA) or vocal fold shortening.
- Some people choose tracheal shave to reduce the Adam’s apple while feminizing the voice.
Before and After Surgery
Healthcare teams — including surgeons, mental health professionals, and speech specialists — often guide people through the decision process. They help explain benefits, risks, and what results to expect.
Post-surgical voice therapy supports better healing, helps adjust to the new sound, and addresses areas like resonance, articulation, or inflection that surgery alone cannot change.
| Surgery Type | Purpose | Main Outcome | Suitability |
|---|---|---|---|
| Anterior Vocal Fold Web (Wendler) | Feminization | Raises pitch, limits low notes | Not ideal for singers |
| Cricothyroid Approximation | Feminization | Raises pitch, but may fade over time | Some, not permanent |
| Thyroplasty Type 3 | Masculinization | Lowers pitch | Less commonly needed |
| Laser-assisted techniques | Span options | Alters vocal cords as needed | Case by case |
- Surgery changes the physical features of the vocal cords to adjust pitch.
- Voice therapy remains important before and after surgery for best and lasting results.
Results
People who choose gender-affirming voice therapy or surgery often experience changes with time and work. Different treatments produce different results. Practicing voice exercises and following a specialist’s advice play important roles in progress. Common outcomes include:
- Improved comfort with speaking voice.
- Increased confidence in daily communication.
- Better alignment of voice and gender identity.
Many find that support from trusted people and regular sessions with a speech-language specialist help them reach their goals. Voice changes occur gradually and may require ongoing effort. Each person’s journey is unique, and patience is important as results appear over weeks or months.
