Vol. 13 No.


Spring/Summer 1999 p. 10




By Lynn Gold, MA CCC

"I feel I am a woman but if I can only speak with a man's voice my whole identity is shattered." This collision of physical and vocal presentations was described by a highly talented and intelligent middle-aged appearing woman, and is faced by most male-to-female (M-T-F) transsexuals like her, going through their transition. Because hormone treatment for male-to-female transsexuals cannot feminize their voices, as testosterone virilizes the female-to-male larynx, I have treated only the M-T-F transsexual and will focus primarily on this population. They are some of my favorite clients, highly motivated and quite courageous.

Prerequisites of voice professionals: A skilled voice coach can provide valuable instruction to transgendered clients, especially in attaining flexibility within the head voice, the soprano range, while maintaining relaxed laryngeal and oral postures. But as I have also recommended to speech pathologists working with the M-T-F transsexuals, the professional should have a solid background in voice physiology and training, in transgender issues as described below, and in dealing with the psychodynamics that impact the whole person, not just her speech and voice.

Gender Dysphoria: Jan Eder, Ph.D., describes treatment of the transsexual client as a process of phases that one travels through to get to the other gender side. We are working with a much broader spectrum than a speech and voice change. The transgendered client needs to express herself in verbal and nonverbal communication as her "true gender." Her self esteem has often been battered over a lifetime before we see her, which isn't usually until her middle decades, so emotional support is very important. She suffers a conflict of gender identity, described by Los Gatos sexologist Dr. Millie Brown in True Selves. Understanding Transsexualism, as the "...deeply held conviction and deeply felt inner awareness that we belong to one gender or the other." The transsexual client experiences a profound "gender dysphoria" because gender identity doesn't match her body. Her chromosomes, hormones, sexual organs, and gender-related messages and expectations of society conflict with her sense of herself as female, even as a child.

Medical Treatment: Impulsive hormonal or surgical treatment are usually prevented because of the widespread adoption of the 1979 Harry Benjamin Guidelines for Standards of Care, named after one of the first physicians treating this population. They contain built- in time restraints and safeguards to include intensive counseling before hormone treatments and at least a year of full-time living as the identified gender before optional sexual reassignment surgery. During that time, M-T-F transsexuals might receive electrolysis, facial plastic surgery, breast augmentation, and make-up, hair, movement, and voice instruction. Dr. Brown suggests they must "rebuild themselves psychologically, socially, and interpersonally by integrating elements of their old self into the new one." They have little, if any, life experience as females even though recent research indicates a biological basis, or brain difference, that probably dictates their perception of themselves as females.

Voice Surgery: Hormone therapy effects growth and masculinization of the female-to-male larynx. However, once a man's larynx and throat have reached adult size they won't easily produce the vocal tone or resonance of the smaller female larynx. There are several types of vocal cord and laryngeal surgeries available to raise vocal pitch in a M-T-F transsexual patient but with mixed results. Most surgeries attempt to permanently stretch the vocal cords. I have heard some transsexual post- surgical voices which are acceptable, but many have become less flexible and, therefore, less responsive to voice therapy, when needed.

Voice Therapy

In therapy, increase of fundamental frequency is a controversial goal, some concerned that it can be potentially damaging, as cautioned by Colton and Casper in their text. Oates and Dacakis' study discusses male and female speech markers and defines frequency ranges of approximately two octaves for both males (65 Hz to 262 Hz) and females (128 Hz to 523 Hz) in their 20's. There is an octave of overlap between the two ranges, between C3 ( 128 Hz) and C4 (262 Hz). Within this over- lapping octave I find most my transsexual clients able to function for conversational speech, their head voices reaching even higher into the female pitch range. In fact, Dr. Betty McMicken of City of Hope and I analyzed voice samples of my clients and those of Carol Freidenberg in San Francisco. We included clients male or androgynous voices and their feminine "head" voices. We also included voice samples of Robin WilliamslMrs. Doubtfire, Dustin Hoffman/Tootsie, and Melanie Phillips, an actor whose videotape describes the techniques she used to acquire her M-T-F feminine voice. All of the most feminine of these voices approached or even surpassed the Oates study's female mean frequency and were comparable to the female pitch range, although their vocal expressiveness often extended below that range, not surprisingly.

I find that practicing a soprano "head voice" can be effective in raising pitch while avoiding the thin falsetto and vocal strain. Playful experimentation with a "Queen Mother" dialect or role playing as Julia Child often elicit the head voice in a new client, allowing her to release inhibitions and anxieties. We then warble high and low within head voice to build flexibility and control in head register. Gradual adjustments from the British speech and voice pattern to the more natural speech and prosody of American English usually transitions the client to a rather natural feminine voice.

I tape record this transition for my clients' self evaluation, goal setting, and home practice. Otherwise, the client is aware only of the overdone, playful voices rather than the evolved feminine voice. It's quite pleasant and acceptable on playback but imperceptible to the speaker while she is producing it. We might then select a phrase or two from this transition voice to use as a model or goal for voice development. My clients enjoy maintaining practice recordings of our exercises, especially if their voices and voice transitions are included on the tape. A written list of instructions compares poorly to a recording. With that audio sample, clients can more easily replicate the experience of the office session, hear their own vocal output and reflect on it, and carry a piece of me with them. Most of us are facilitated in carryover from practice if we can conjure up the image of our teacher or therapist demonstrating the goal behavior. Reliving the experience provides that fuller, sensory and somatic experience obtained within the therapeutic session.

Yawn-Sigh: We want to prevent the vocal strain of laryngeal elevation and squeeze which is too often employed by speakers or singers unfamiliar with more effective techniques for raising their pitch. So we simultaneously employ the resonance and laryngeal stretch of a Yawn-Sigh as described by Dr. Daniel Boone. The full-bodied Queen Mother voice that I model for my M-T-F clients employs that Yawn-Sigh expansion and resonance, providing foundation to the head voice. It helps prevent vocal strain by expanding the throat and lowering the larynx, counteracting the anxious larynx's nature to "rise and sphinct," according to Dr. Arnold Aronson of Mayo Clinic. Alfred Lavorato, Ph.D., of Los Angeles developed the "Barney Rubble" voice as a therapeutic tool after observing the widely expanded throat of a voice-over artist. Through fiberoptic lens he observed the stretched and relaxed muscles of the larynx and throat during the cartoon character's dialogue. Ironically, this yawn throat not only enriches the head voice with expanded resonance, avoiding a thin falsetto, it also creates the rich resonance and deeper pitch in the chest register that the female-to-male transsexual might desire. The laryngeal muscles naturally stretch and larynx lowers, vocal cords relaxing, expanding mass width, and vibrating slower for a lower pitch and deeper resonance in a wider, more relaxed throat chamber. This healthier expanded resonance of the Yawn-Sigh voice better serves a speaker seeking a deeper voice than does an attempt to merely lower the pitch, which can elicit muscle strain.

Larynx Manipulation: I also use laryngeal manipulation as described by Dr. Arnie Aronson and Dr. J. Lieberman, to detect excessive laryngeal tension, to reduce it if present, and to instruct my client to do likewise.

Speech Markers of a Female Speaker: Other speech and language cues have been identified in the Oates' study and others as occurring more frequently in females than in males. These markers tend to be ill-defined, yet are consciously or unconsciously used by a listener to assign gender to a speaker, especially when other factors such as her name or her appearance are not observable or are ambiguous. Usually five markers must be judged as feminine before a person is determined to be female rather than male. Markers include, among others:

1. Higher fundamental frequency.
2. Higher functional intonation range and pitch variability.
3. More vocal expression with variety of pitch, stress, and duration patterns.
4. Some rising intonation after declarative sentences, suggesting uncertainty.
5. Occasional breathy phrases and overall slightly breathier voice.
6. Tag questions for consensus; e.g., "Don't you think? "Okay?"
7. More modals (can, will, may, must).
8. Light, yet precise articulation.
9. Wider range of qualifiers; e.g., "Such a little , quite cute, really , rather violent."
10. Compound polite requests; e.g., "Would you ..... please?"

Nonverbal Markers: Feminine nonverbal visual markers include maintaining eye contact, attending to other speaker's nonverbal cues, using more hand, arm, and upper body gestures, sitting closer and occasionally touching the listener. Judith Challoner, Speech Therapist of the Gender Identity Clinic in Middlesex, England, strives for a convincing voice in a confident, unselfconscious speaker, finding the client's attitude about her voice is most essential to success as a speaker. The same recommendation should apply to female-to-male speakers. Likewise, he will wish to use more orders and directives, fewer qualifiers, shallower expressive range, and firm rather than breathy voice quality.

A coach or teacher in the theater arts could aptly employ these markers when coaching a M-T-F transsexual client or group. Of course, as with any characteristic or behavior, each of these markers or gender cues has the potential of becoming stereotypical and irritating if overdone. From our more objective perspective, we can guide our client to enhancing her self expression as an authentic woman, with care that she doesn't overact otherwise subtle behaviors, destroying her authenticity.

Most of my M-T-F clients have enthusiastically described the advantage in interpersonal relations they have experienced when they practice their feminine communication style. They find people respond more readily and cooperatively when they ask questions, seek accord within a group, and listen more actively, than when they previously gave orders and directives. An M-T-F photographer whom I treated found female models responded faster and more effectively to her supportive comments and suggestions as a woman than they had years previously to the abrupt directives she'd given when still a man. Similar viewpoints are expressed by multiple sources, including Kate Bornstein and Melanie Phillips.

Prognosis: I've sound that success with feminization of speech and voice are enhanced by three factors. The M-T-F transsexual who is most likely to succeed is described below: 1. She "dresses up" for voice sessions, or she is already living full time as a female and is more motivated to practice vocal techniques consistently. 2. She has talents or experience in the performing arts, stage or music, therefore is likely to have a more discriminating ear and vocal flexibility. 3. She is playful and is willing to try on "the mask of the imitator." She allows herself to experiment with unusual voices I model for her and uses them in therapy and in practice, initially, as one would wear a mask. Because her new voice does not "sound like her," it won't feel authentic and she won't "wear" or practice it unless she does so as if wearing a mask or costume. If she believes that her new voice is pleasant and acceptable, she must trust that she will eventually be able to adopt the new voice as her own. When the client can incorporate the new feminine voice and speech markers, verbal and nonverbal, as part of her true self, she is able to cross with greater success into her identified gender.

References: Available upon request from the VASTA Newsletter editor, preferably by e-mail.