The intricacies of voices and hormone medication in transition

not just the ones in my head

I have talked in some of these episodes about transition generally and in some of them about things specifically. I will admit I don’t really have a roadmap to talk about things, I just really think about things that have popped into my head and then talk about them. And since I am talking about them, my voice is one of the things I think I want to talk about. Because voices are certainly one of the pieces of transition that one things about.

I have a lisp and I thought that would always be the thing about my voice I disliked the most.

It isn’t a very big one, and honestly it is kind of soothing to listen to (and if you don’t think it is, you can keep that to yourself thank you very much) and I have learned to speak very softly with it when I have the brain space to be aware of it. But of course, often my brain works faster than I can process so it sometimes gets away from me. So I lisp and it is there and that is life and how I speak and that is how things have always been.

That part of my voice is something I now use to my advantage. It is cute and can be used to feminize what otherwise is now a more masculine voice. Which is a bit strange because I never felt I had a particularly deep voice. But not thinking I had a very deep voice was something that I felt Before Transition.

Whoosh, now I think about my voice and the pitch and the tone and a bunch of words I didn’t know existed about voices a whole heck of a lot. Because my voice is a thing that gives people an impression of me and voices are yet another thing people look to to make a determination about whether or not people in front of them are men or women, ignoring the idea of non-binary or gender non-conforming people altogether.

Most of us don’t consciously do this, we are just trained to do this from the time we are born. We look for things like colors people wear and length of hair or hairstyles or style of clothing or way someone wears makeup or jewelry and make split second decisions on how we address people and how we act around them.

We all need to work on removing these snap judgements because they don’t actually tell us who people are, the people we are looking at tell us who they are. But that work is long and takes work and there are a lot of people who are not committed to doing that work. This is called radical acceptance. I know there is something I would love to have happen, but it is ok to acknowledge that that future is a work in process.

And so, there are little things that I do like to work on to make my own appearance more feminine. There are things I do for myself to take away some of the hurt that comes when I am constantly misgendered when I am out. And, my voice is currently one of those things.

Luckily for you, you are listening to my voice right now, so you have a pretty good indication of where my voice sits on the masculine versus feminine frequency. Generally, an adult woman's average range is from 165 to 255 Hz, while a man's is 85 to 155 Hz. So the higher the number the more, “quote unquote” feminine sounding your voice is. And again, I’m using this as a radical acceptance piece where this feminine and masculine exists only in a world where we see voices as assigned to men and women. Mine, naturally, falls within the masculine side of things. I fall somewhere around 157 or so and can go down to the 130s if I’m not focusing on keeping my voice higher. If I lose sight of what I’m doing completely I’ll come close to the 120s as well.

If I really really focus on things I can get into the 150s, but I can’t think as much about what I’m saying as where I’m keeping my voice. So here’s where practice on how I speak comes in.

Here’s a little thing about hormone replacement therapy on the feminization side of things—it does not alter your voice at all. I tried to do a little research on how these things play in a more medical way so that you have some of the words of professional trans support community words and not just mine.

Testosterone for HRT on the masculinization side of things, works wonders. As the good people at Mount Sinai Transgender Voice Care clinic explain, “voice masculinization is often achieved to a satisfactory level due to the effects of testosterone on the vocal fold mucosa. Most trans men develop a low enough pitch; hence, further intervention is not necessary.” This isn’t to say that taking testosterone relieves dysphoria entirely. There can be really difficult times for people transitioning in every way. And, taking testosterone doesn’t change ones voice overnight. The effects take time, and also presume ready and available access to HRT access and that it is affordable to you, two things that are never guaranteed to anyone.

For trans women and non-binary folks looking for a change in their voice, intervention is much more necessary. I can very much attest to this being the case.

The voice care clinic explains that their “voice therapists will help you make subtle changes to parts of your voice such as the resonance and breathiness. Speech changes may include speed, fluidity, inflection, and stresses within the sentence. Other things that can signal a male or female voice may also include attention, eye contact, head gestures, and timing or turn taking in a conversation.”

So this is the voice therapy portion of things. I’ll talk a bit more about this in a bit because this is the intervention I have been able to access so far in my transition and one I can speak to a bit more thoroughly. But first, a few other medical procedures they discuss.

“One of the most successful of these procedures is called the Wendler glottoplasty. This involves connecting the anterior 1/3 of your vocal folds with sutures. The remaining 2/3 then act as female length vocal folds, and yield a slightly higher pitch after healing.”

And also..

“The male larynx (voice box) has a more prominent Adam’s apple versus a woman’s larynx. This is called the laryngeal or thyroid prominence. Frequently, the thinner your neck, the more prominently this stands out. We perform a surgical procedure, the tracheal shave, which reduces the size of this area by carefully removing only that portion of the thyroid cartilage that is on the outside.”

Obviously, there is more risk and more cost associated with these procedures. And, the more you layer onto this, the less accessible these become. I haven’t looked further into these procedures (and honestly am not sure I will because the idea of someone touching my throat at all is absolutely horrifying to me, let alone performing surgery on it), but hopefully this information helps for you.

Now, back to voice therapy. My teacher as I would say is Renée Yoxon, who describes themselves as a gender affirming voice teacher. They support people in achieving whichever frequency they are looking to reach and offer coaching sessions and an online learning environment to do all of this in.

My parents gifted this to me a couple of Christmases ago and what I have enjoyed about this style of learning is that once you have it, you have access to it always. This is not to say that this is the style of learning for everyone, but for me, who does not love the idea of warming up my vocal chords in front of large groups, or even in front of groups of more than me, having access to instructional video has proven to be helpful.

But, you have to practice. And, you have to hold yourself accountable to going through the lessons and learning them and understanding them and feeling ok being awkward making sounds you’ve never made before and practicing breathing in a way you never have. It feels strange to make all these noises but it helps to remember that I am doing them to alter the way my voice projects.

And that really is the purpose of these gender affirming sessions. They don’t change the way your body is built and they don’t change the physical structure of your body, but they help you understand how to control what you already have access to to be able to change the way your voice sounds, and to do it in a way that is sustainable for all the different parts that make up speech.

I’ll admit that even years later I still struggle with it. While I think I have shifted the frequency of my voice up a little bit on average, I still need to focus completely if I want to have a noticeable difference in how high my voice is. That’s what it comes down to with voice therapy and altering voice through this method. It is more accessible, it is more affordable, but it is only as permanent as you are willing to practice it.

Yes, it is frustrating at time to have my voice to go back to lower frequency and catch myself doing it, but there is a chance then to remind myself to slow down and think more about what I am saying. And really, as someone who gets going and just talks a lot once they do so, slowing down and thinking about what I am saying is not a bad thing in the least.

Let’s take a minute to remember that voices are not gendered and hearing ones voice does not give you a tell. It is not the piece of information you need to know whether or not someone is a man or a woman, that piece of information can always only come from them. My voice is good, it is tiring to feel shame and embarrassment around everything. If you catch yourself thinking that someone’s voice doesn’t match their look or someone’s look doesn’t match their voice, try and consider that maybe your perception of voices doesn’t match the reality of gender. We can all give this a little work together.

I promise I’ll keep practicing my voice work and you’ll likely hear all of the practice come out all over this podcast. I am never more aware of it than when I’m recording an episode for you. So thank you for being a part of my practice group and for listening to the things I say. I hope you have a wonderful week and maybe use this little bit of information to think a little bit differently about transgender voices.