Common Questions About Gender Affirming Voice Therapy

Your voice is an integral part of who you are. Finding your authentic voice can be an important key to unlocking your true self-expression. Gender affirming voice training, also known as transgender voice therapy, can help you do just that.

There is no “one size fits all” approach to voice training, and no ideal “female” or “male” voice. Here, we answer some of the common questions we receive about gender affirming voice training and how it can help people match their voice with their authentic self.

What is gender affirming voice training? 

Gender affirming voice training is also referred to as transgender voice therapy, or transgender voice and communication training. This form of speech therapy is a holistic, nonsurgical intervention to modify a person’s voice and communication style. The goal is to align a person’s voice with their authentic gender identity and expression. Speech-language pathologists, also known as speech therapists, provide expertise in safely modifying the voice. 

The goal is to align a person’s voice with their authentic gender identity and expression.

The structure of each voice therapy session depends on your personal goals. Your therapist will begin with individualized voice exercises to help you safely access your new target pitch and resonance (or voice quality). They will then guide you through exploring a variety of voice and speech characteristics to find your true voice. Keep reading to learn more about what happens during transgender voice therapy sessions. 

Why is gender affirming voice training important?

When we hear the sound of a person’s voice, we gain quite a bit of information about them. That’s why voice is such an important area for any person exploring their authentic self. 

When the physical voice doesn’t match the person on the inside, this can cause feelings of distress or unease known as dysphoria. In turn, that can make it feel uncomfortable to speak. 

When the physical voice doesn’t match the person on the inside, this can cause feelings of dysphoria.

Research shows that voice and communication training leads to gains in areas important to listeners’ perception of gender. More importantly, it has been shown to increase reported quality of life, happiness, contentment, confidence, and the ability to find authenticity. 

A whole-person, holistic view of the voice is highly recommended when exploring your authentic voice. Transgender voice therapy should take place with an experienced speech therapist who specializes in this therapy, in an affirming environment, with great sensitivity and care. Communication is how we share how we feel, show who we are, and connect with others. Everyone deserves to feel empowered to communicate with confidence!

What do gender affirming voice sessions look like? 

How does transgender voice therapy work? Transgender voice training consists of a series of individualized sessions to help a person explore their authentic voice and communication. When people begin gender affirming voice training, often the first area they want to target is pitch–how high or low their voice sounds. Finding the right pitch for you is important, and it’s a great place to start! However, there are many other aspects of voice and communication that can be explored in therapy. 

The following areas are commonly targeted in transgender voice therapy: 

  • Pitch: How high or low your voice sounds 

  • Intonation: The rise and fall of pitch in speech 

  • Resonance: The quality of the sound your voice makes 

  • Articulation: The way your teeth, tongue, and lips come together to create sounds 

  • Volume: The loudness of your voice 

  • Rate of speech: How rapidly or slowly you speak 

  • Nonverbal vocalizations: Sounds you produce that aren’t speech, such as coughing, laughing, throat clearing, or sighing

In the area of nonverbal communication, your therapist can help you explore the following: 

  • Kinesics: Your body movements and gestures 

  • Proxemics: How close you stand with your communication partner during conversation

  • Facial expressions 

  • Social pragmatics: Elements of social interaction such as greetings, eye contact, staying on topic, etc. 

These are all areas that can be addressed in transgender voice therapy. But therapy goals are always driven by you, the client. 

Can gender affirming voice training focus only on pitch? 

Is working on pitch enough? It may be for you! Only you can decide which areas you want to work on. There are many vocal characteristics that impact the perception of your voice, including pitch, resonance, intonation, and articulation. It’s best to explore each area and then decide what feels most authentic for you. 

Does transgender voice therapy only target voice feminization or masculinization? Can it help me if I’m nonbinary or gender nonconforming? 

You may be looking for MTF (male to female) or FTM (female to male) voice training. But gender affirming voice training can help people who are nonbinary or gender nonconforming as well. It’s for anyone who wants to find their authentic voice.

Certain voice and speech characteristics are “gendered” based on societal stereotypes. But voice doesn’t have a gender. If a person identifies as female, their voice is female. If a person identifies as nonbinary, their voice is nonbinary. If your voice does not match your gender identity and/or expression, voice training can help you access your true voice and step into your authentic self-expression. 

Your therapist will never tell you how to be or how to sound. Voice doesn't have a gender.

Some people want a gender-expansive voice. They want to be able to modify their voice depending on context and the gender identity they identify with and present across settings. Your therapist will never tell you how to be or how to sound. They will help you access your true voice, with an emphasis on vocal health and well-being. 

Do I need surgery and hormones to change my voice? 

For many people, voice therapy enables them to meet their goals for self-expression. Any decision about hormone replacement therapy (HRT) or surgery to change your voice is highly personal.

Vocal feminization surgery changes your habitual speaking pitch (the average pitch that you naturally speak around). However, vocal surgery does not change other aspects of voice and communication, including resonance, intonation, articulation, cadence, and nonverbal communication. Since voice therapy is noninvasive and nonsurgical, many folks who are considering voice surgery decide to try therapy for at least six months to one year before making this decision. 

According to the National Center for Transgender Equality, voice therapy is the second most common intervention received by transgender individuals assigned male at birth. This is largely because testosterone and estrogen, as a form of HRT, generally have a different effect on the pitch of someone’s voice.

Since voice therapy is noninvasive and nonsurgical, many folks who are considering voice surgery decide to try voice therapy before making the decision. 

When transgender men use testosterone, it can have a masculinizing effect on their voice. Used over time, testosterone can thicken the vocal cords, resulting in a deepening pitch of the voice to gender-affirming levels. However, estrogen often has no significant impact on the pitch of someone’s voice. 

Some people find that combining HRT with voice therapy works well. In a study on the effects of testosterone on the transgender male voice, research showed the largest drop in fundamental frequency, or pitch, during the first two to five months of HRT. Since the onset and duration of voice deepening varies considerably, transgender males may choose to work with a voice specialist to modify their voice further. This might include deepening the resonance, rounding the vowels, and modifying intonation, volume, and articulation.

Does insurance cover gender affirming voice training? 

Insurance coverage for transgender voice therapy depends on the insurance company you have and state where you live. According to ASHA (The American Speech-Language-Hearing Association), as of 2021, the following states have affirmative coverage for medically necessary gender affirmation-related care for private insurance: California (vocal training is an example of a covered service), Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington. 

Oftentimes, insurance companies will require a diagnosis from a therapist or general care physician. If you have questions about insurance coverage for your gender affirming voice therapy, we always recommend you contact your insurance company to find out what’s needed for your services to be covered. 

Talk with a speech therapist about transgender voice therapy

Gender affirming voice training has been shown to help people across the entire gender spectrum safely modify their voice to more closely fit with their identity. If you have questions about gender affirming voice therapy, get in touch! You can schedule a free phone consultation with one of our speech therapists. We’d be happy to discuss a personalized approach to help you find your authentic voice. 

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