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Voice therapy (transgender)

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Voice therapy or voice training refers to any non-surgical technique used to improve or modify the human voice.[1][2] 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 perceived 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.[3]

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.[4] However, Alexandros N. Constansis has stated that "apart from being unfair to transmen, [this assumption] 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".[5] Many transgender men also choose not to take testosterone, and use voice masculinization as an alternative way to deepen their voices.

Overview Edit

Vocal sound is produced by air traveling upwards from the lungs through the opening of the larynx called the glottis where the vocal folds vibrate and phonation or voicing occurs. The vibrating vocal folds produce a sound that is modified by chambers (like rooms) of the throat and mouth creating resonance frequencies. The size of the chambers directly affects these frequencies. As the size of the chambers increase the deeper (or lower) the formant frequencies become. These chambers play a very important role in the perception of the timbre (rich, nasal, flat) of the voice. The articulators (tongue, lips, jaw, and soft palate etc.) shape the sound into recognizable speech. Then it is the prosodic features (speaking rate, inflection, pauses) which make unique speech patterns.

There are several frequencies or harmonics produced at the lips. The fundamental frequency (F0) or the number of times per second that the vocal folds vibrate (in hertz), is approximately in the 120–520 Hz range for adult women and in the 60–260 Hz range for adult men.[6] Many of the voice feminization techniques, including those of surgeons, focus on the fundamental frequency but do little to address how the sound is modified by the articulators or prosodic features. Speech therapists and professional voice coaches offer training to alter the fundamental frequency and to change the perception of voice quality.[Citation needed]

Differences between male and female voicesEdit

Template:Original research section Like other gendered characteristics, considerable overlap exists between male and female vocal characteristics, especially the psychological ones.

Transgender women who go through puberty before transition will usually develop voices characteristic of males. Hormone therapy does not alter a trans woman's voice once it has masculinized;[7] therefore, some trans women who intend to pass as cisgender need to have help with vocal training to feminize their voices.

Vocal training is done formally with the help of several types of professionals and privately by the use of self-help resources including audio or video tapes, books and information garnered from websites or chat groups.

The advantage of going through a speech-language pathologist is that vocal cords can easily become irritated and even develop callous-like growths called vocal fold nodules as the result of incorrect use of the voice and from modifying one’s voice too quickly. Individuals who participate in a voice feminization program are trained to self-monitor and become more aware of their vocal quality. They learn to recognize where and how they produce sound, how they are resonating that sound, and how they physically carry themselves and their voice. Related aspects of communication are also addressed, including breathing patterns, gender related non-verbal communication and vocal hygiene.

Voice scientists, Speech-Language Pathologists and ENT physicians organize voice production into five components.[Citation needed] They are:

  • Respiration - power source
  • Phonation - sound source
  • Resonance - sound modifier
  • Articulation - speech modifier
  • Prosody - melodic aspects of speech

In training for a feminine voice, all five components are usually included.

Vocal surgeriesEdit

While hormone replacement therapy and gender reassignment surgery can cause a more feminine outward appearance, they do little to alter the pitch or sound of the voice. The existing vocal structure can be surgically altered using procedures that include

  • Cricothyroid approximation (CTA) (is the most common)
  • Laryngoplasty
  • Thyrohyoid approximation
  • Laryngeal reduction surgery (surgical shortening of the vocal cords)
  • Laser assisted voice adjustment (LAVA)

There was, until recently, limited evidence as to the efficacy of these surgeries in raising the fundamental frequency over the course of several years. However, since the late 1990s, surgeons performing CTA and other 'voice' procedures at Charing Cross hospital (Hammersmith, London), have conducted long-term follow-up studies indicating "high" levels of patient satisfaction with both surgical and social health outcomes.[8] All of these modes of 'voice surgery' may or may not have an effect on resonance or other vocal characteristics. Many in the transsexual community have previously been led to regard voice surgery as 'inadvisable', while others regard a socially acceptable standard of feminine speech to be indispensable (and further surgery an acceptable risk). Anecdotal evidence has suggested that (CTA) voice surgery can be expected to raise pitch above female norms in the immediate post-operative period (when sutures are used to create the adjusted 'approximation'); however the (more modern) use of titanium clips avoids this problem, maintaining a correct and even tension on the vocal folds, in the immediate and longer term. Of course, laryngeal surgery carries risks and some patients experience 'raspiness', or, much more rarely, complete loss of voice.[Citation needed] There is current research looking into replacing the larynx using stem cells that will have all of the characteristics of a female voice.[Citation needed]

See alsoEdit

References Edit

  1. Error on call to Template:cite book: Parameter title must be specifiedLaver, John (1984). . Cambridge University Press.
  2. Error on call to Template:cite book: Parameter title must be specifiedBenninger, Michael (1994). . Thieme Medical Publishers, Inc..
  3. MSc, Shelagh Davies; RSLP-C; Goldberg, Joshua M. (2006-09-01). "Clinical Aspects of Transgender Speech Feminization and Masculinization". International Journal of Transgenderism 9 (3-4): 167–196. Error: Bad DOI specifiedTemplate:Namespace detect showall. ISSN 1553-2739. http://dx.doi.org/10.1300/J485v09n03_08. 
  4. Abitbol, J.; B. Abitbol; P. Abitbol (September 1999). "Sex hormones and the female voice". J. Voice (Mosby) 13 (3): 424–446. Error: Bad DOI specifiedTemplate:Namespace detect showall. PMID 10498059. 
  5. Constansis, A. (2008). "The Changing Female-To-Male (FTM) Voice". Radical Musicology 3. http://www.radical-musicology.org.uk/2008/Constansis.htm. Retrieved 2009-09-21. 
  6. Error on call to Template:cite book: Parameter title must be specified pp. 610. Pearson (July 21, 1997).
  7. Andrea James (March 2007). Hormonal therapy for women in transition. TS Roadmap. Retrieved on 2007-03-16.
  8. Matai, Vandana; Cheesman, Anthony D.; Clarke, Peter M. (2003-06-01). "Cricothyroid approximation and thyroid chondroplasty: a patient survey". Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery 128 (6): 841–847. ISSN 0194-5998. PMID 12825036. http://www.ncbi.nlm.nih.gov/pubmed/12825036. 
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