Laryngoplasty

Voice therapy or voice training refers to any non-surgical technique used to improve or modify the human voice. 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. Voice therapy or voice training refers to any non-surgical technique used to improve or modify the human voice. 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. Voice feminization is the desired goal of changing a perceived male sounding voice to a female sounding voice. The term voice feminization is used to describe the desired outcome of surgical techniques, speech therapy, self-help programs and any 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. Having voice and speech characteristics be in agreement with one's gender identity is important to transgender individuals, whether their goal be feminization or masculinization. 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. 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'. Many transgender men also choose not to take testosterone, and use voice masculinization as an alternative way to deepen their voices. Voice feminization refers to the voice change from male to female. It is considered an essential part of care for transgender women. Transgender women 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 and voice resonance, can help in that effect. Fundamental frequency, also called 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 towards femininity, can vary from person to person, and many clients are not satisfied with only a change in fundamental frequency. The efficacy of treatment should therefore be evaluated, not only by acoustic characteristics, but also using the transgender person’s perception of the voice and its femininity. 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, loudness, speech rate, speech-sound articulation and duration. Voice modifications for transgender males typically involve the lowering of the speaking fundamental frequency. Voice therapy is generally not required for transgender men as the effects of testosterone on the larynx result in a deeper pitch. However, testosterone therapy does not always deepen the voice to the person's desired level, and others choose to not undergo hormone replacement therapy (female-to-male) at all. Voice masculinization therapy can help to further lower the pitch of transgender males and address voice problems associated with hormone therapy. Another option for female-to-male clients who wish to further lower their speaking pitch is to undergo vocal surgery (see Surgical Techniques for more details). A speech-language pathologist (SLP) may be involved in aiding the female-to-male client achieve their desired voice goals, while usually prioritizing the overall health of the voice. Therapy techniques may involve finding the client's most comfortable pitch range, using breath support and relaxation exercises, introducing voice strengthening warm-ups, stabilizing posture and increasing chest resonance. While hormone replacement therapy and gender reassignment surgery can cause a more feminine outward appearance for trans women, they do little to alter the pitch of the voice or to make the voice sound more feminine. The existing vocal structure can be surgically altered to raise vocal pitch by shortening the vocal folds, decreasing the whole mass of the folds, or by increasing the tension of the folds. Trans women can undergo surgery to raise their vocal pitch as measured by fundamental frequency (F0), to increase their pitch range and to remove access to lower frequency ranges in their voice. The current pitch-raising vocal surgeries include: