What Is Gender-Affirming Voice Care?
Vocal congruence, or the idea that a person’s voice and speech accurately reflect who they are, can positively impact quality of life, mental health, and personal safety (Kennedy & Thibeault, 2020; Ziltzer et al., 2023). Gender-affirming voice training helps transgender and gender diverse individuals establish vocal congruence and find a voice quality and communication style that fits who they are.
At the Sean Parker Institute for the Voice, we take an individualized and person-centered approach to gender-affirming voice care. Our multidisciplinary team of physicians and voice therapists offers a variety of options for gender-affirming voice care, from surgical procedures to voice training and therapy.
Gender-Affirming Voice Training
As part of gender-affirming voice training, our team of specialized speech pathologists provides evidence-based tools to help you establish a voice that fits you. We target all aspects of voice and communication, including pitch, resonance, intonation, volume, speech rate, articulation, syntax, and nonverbal features. Goals and training techniques are selected based on the specific needs of each client.
Patients have the option to self-refer to our voice therapists for gender-affirming voice training or to see our voice therapists and physicians together for a multidisciplinary consultation before beginning their voice training.
Effects of Hormone Replacement Therapy on the Voice
Many patients undergo hormone replacement therapy in conjunction with endocrinology. For transgender men, testosterone (androgen) lowers the pitch of the voice. Individuals taking testosterone (sometimes called “T”) typically experience lowering of their vocal pitch after taking T for approximately 3 months, with the majority of pitch lowering occurring between 6 and 9 months (Irwig et al., 2017). For transgender women, estrogen therapy typically does not alter the pitch of the voice.
Gender-Affirming Voice Surgery
Patients may also choose to undergo surgical interventions to help reach their goals. Surgical procedures focus primarily on alteration of pitch, and includes pitch-raising surgeries, pitch-lowering surgeries, and tracheal shave procedures. Surgical intervention may also include pre- and post-voice therapy to maximize behavioral changes and facilitate optimal surgical outcomes (Nolan et al., 2019; Coleman et al., 2022).
Pitch-raising surgeries:
- Wendler glottoplasty (minimally-invasive, endoscopic)
- Laser-assisted voice adjustment (LAVA) (minimally-invasive, endoscopic)
- Type IV “tensioning” thyroplasty
- Cricothyroid approximation
Reduction thyrochondroplasty (also called feminization chondrolaryngoplasty, tracheal shave, thyroid cartilage shave, or “Adam’s apple reduction”) reduces the outward appearance of the thyroid notch in the front of the neck, often called the “Adam’s apple.” This may be combined with pitch-raising surgery or other facial feminization procedures.- Now available with scarless approach
Pitch-lowering surgery may be completed if satisfactory outcomes aren’t reached with hormone therapy for transmasculine patients.- Type III “relaxation” thyroplasty
Current Research and Technology
As an institute, we are actively engaged in research on maximizing the use of technology to further individuals’ goals in gender-affirming voice training. Our multidisciplinary team has been collaborating with members of the trans community to develop Attuned Voice, a free mobile application for gender-affirming voice care using evidence-based practices in speech language pathology. Thanks to the generous support of the Dalio Center for Health Justice, we have created a functional prototype which we hope will empower members of the trans community by providing accessible, inclusive, and high-quality educational materials to find their true voice in a manner that is safe for their voice health and efficient for their time and resources.
We will soon be seeking community members for beta testing, so be on the lookout on our social media @AttunedVoice and @SeanParkerVoiceInstitute for more details coming soon!
Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., Nieder, T. O., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International journal of transgender health, 23(Suppl 1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644
Kennedy E, Thibeault SL. Voice-Gender Incongruence and Voice Health Information-Seeking Behaviors in the Transgender Community. Am J Speech Lang Pathol. 2020 Aug 4;29(3):1563-1573. doi: 10.1044/2020_AJSLP-19-00188. Epub 2020 Jun 15. PMID: 32539455.
Nolan, I. T., Morrison, S. D., Arowojolu, O., Crowe, C. S., Massie, J. P., Adler, R. K., Chaiet, S. R., & Francis, D. O. (2019). The Role of Voice Therapy and Phonosurgery in Transgender Vocal Feminization. The Journal of craniofacial surgery, 30(5), 1368–1375. https://doi.org/10.1097/SCS.0000000000005132
Ziltzer RS, Lett E, Su-Genyk P, et al. Needs Assessment of Gender-Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria. Otolaryngology–Head and Neck Surgery 2023.
