Voice Therapy in Transgender Transitions

Published: September 30th, 2014

Category: UAD Student Blog


The Netflix original series, Orange is the New Black (OITNB) shows the struggles Sophia Burset endures as a male-to-female transgender woman. OINTB’s prison hairdresser, Sophia, has a character arc that delves into her family’s gradual acceptance of her transition. Her actress, Laverne Cox has endured similar struggles in her own life. One priority for a transitioning transgender individual is to inconspicuously live as their target gender. Sometimes when people transition from male to female or female to male, they look to a speech-language pathologist to assist them in sounding like the target gender.

The journey of transitioning gender can be long and painful, and involves multiple surgeries, hormone therapy, and emotional struggles. Individuals who undergo this long process have described their voice as the last obstacle before completing their transition. Perception of voice gives off an abundance of information about the speaker’s age, masculinity/femininity, and mood. Even infants can distinguish traits based on the speaker’s voice.

Voice therapy for transgender individuals mainly targets adjusting fundamental frequency (pitch) and resonance. The goal for male to female transgender speakers is to increase the fundamental frequency and perceived pitch, while the goal for female to male transgender speakers is to decrease the fundamental frequency and perceived pitch. Resonance is changed by modifying tongue position and lip spreading.

However, the increase in pitch alone isn’t enough to elicit consistent perception as a female. Some features such as intonation pattern, non-verbal communication, and language choice can affect perception. Characteristics of female non-verbal communication include more varied facial expressions, more hand gestures, and more head nodding during conversation. Pragmatic aspects of discourse for females involve more expressive and emotional phrases. All of these details contribute to perception of gender and are important to include in therapy. Unfortunately, intonation pattern, non-verbal communication, and pragmatic aspects of disclosure are commonly overlooked in favor of adjusting frequency (pitch) and resonance.

What was once taboo has now become more socially acceptable and has infiltrated mainstream television like Orange is the New Black. The socially evolving world is altering the scope of practice for clinicians everywhere. Speech-language clinicians are poised to play a pivotal role in assisting transitioning individuals in finding their new voice.