Heather Gross, M.S., CCC-SLP
At Expressable, we often work with people who are exploring how to change their voice to reflect who they truly are. Whether you're searching for gender-affirming voice therapy near you, looking into transgender voice training, or wondering how to make your voice deeper or more feminine, you’re in the right place.
Our voice is deeply personal. It’s part of how we express our identity and connect with others. For many transgender and gender-diverse individuals, having a voice that aligns with their gender identity can be an important part of feeling seen, heard, and understood. When the way you sound doesn’t match how you feel inside, it can lead to stress, low confidence, or fear of being misgendered.
That’s where gender-affirming voice therapy, also called transgender voice therapy, can help. Whether you're exploring how to voice train MTF (male to female) or how to lower your voice FTM (female to male), speech therapy can help you find a voice that feels right for you.
In this guide, we answer common questions about gender-affirming voice training. Learn what to expect in therapy and how a licensed speech therapist can help you express your authentic self with confidence.
This guide was written by Heather Gross, M.S., CCC-SLP, a licensed speech-language pathologist and voice specialist with extensive experience supporting transgender and gender-diverse clients on their voice journey.
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Get startedWhat is gender-affirming voice therapy?
Gender-affirming voice therapy, also called transgender voice therapy or training, is a nonsurgical intervention used to change the gendered aspects of a person’s voice. The voice therapist and client work together to explore the client’s identity and a variety of vocal characteristics that will more closely align their voice and their identity.
Gender-affirming voice training consists of individualized sessions designed to help gender-diverse people explore their authentic voice and communication. Changing your voice may involve adjusting aspects such as resonance, pitch, intonation, nonverbal communication, syntactical choices, vocal quality, and more.
Gender-affirming voice training is completely dependent on each person's needs and communication goals.
People across the entire gender spectrum, including transfeminine, transmasculine, nonbinary, gender nonconforming, genderqueer, bi-gender, agender, cisgender, and more, may choose to participate in voice training.
Training is completely dependent on each individual's needs and communication goals. Speech-language pathologists with a specialization in gender-affirming voice training can help people explore vocal characteristics in a safe and effective way. These speech therapists, in addition to having a high level of experience, offer a unique understanding of voice physiology, vocal hygiene to safely modify the voice, and coaching to provide a whole-person, holistic approach. They are lifelong learners focused on becoming more culturally competent in serving this population.
Do I need surgery and hormones to change my voice?
Gender-affirming voice training has been shown to help individuals across the entire gender spectrum safely modify their voice to more closely align with their identity. For many people, voice therapy alone enables them to meet their goals for self-expression. Several research studies have shown its effectiveness; here are just a few:
Voice and communication training has been shown to result in gains in areas important to listeners’ perception of gender. Even more important, it has been shown to increase reported quality of life, happiness, contentment, confidence, and ability to find authenticity.
This study from 2023 focused on transgender women receiving online voice therapy. They had significant improvements in acoustic measures such as fundamental frequency and semitones, auditory-perceptual ratings, and self-perception of voice femininity.
In this study, eight weeks of voice therapy resulted in MTF vocal changes that persisted for up to 15 months.
Some people may also consider hormones or surgical treatment to help change their voice. Any decision about surgery or hormone replacement therapy (HRT) is highly personal, but here is some information to consider.
Vocal feminization surgery
Vocal feminization surgery changes your habitual speaking pitch,or the average pitch that you naturally speak with. 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.
Use of HRT and testosterone
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.
When transgender men use testosterone, it can have a masculinizing effect on their voice. Used over time, testosterone can thicken the vocal cords, which can deepen vocal pitch gender-affirming levels. However, estrogen often has no significant impact on the pitch of someone’s voice.
Some transgender men 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 pitch during the first two to five months of HRT. Since the onset and duration of voice deepening varies considerably, transgender males may decide to work with a voice therapist to modify their voice further. This might include deepening the resonance, rounding the vowels, and changing intonation, volume, and articulation.
How transgender voice therapy can change your voice
In transgender voice therapy, also known as MTF (male-to-female) or FTM (female-to-male) voice training, you work on much more than just the pitch of your voice. The goal is to help your voice and communication style better match your gender identity in a way that feels natural and affirming.
If you're exploring voice feminization, you may focus on elevating pitch, modifying resonance, and adjusting intonation patterns to create a more traditionally feminine vocal quality.
If you’re seeking voice masculinization voice training, or want to deepen or lower your voice, therapy often involves developing stronger chest resonance, breath control, and articulation patterns.
But voice therapy isn’t just about how you sound. It also involves nonverbal communication, such as facial expressions, gestures, posture, and eye contact. These elements can be just as important in shaping how others perceive your gender expression, and more importantly, how you feel while communicating.
Working with a gender-affirming voice therapist can help you explore these aspects safely and effectively, ensuring that every part of your communication style supports your identity. Whether your goal is a more feminine, masculine, or neutral voice, your therapy plan will be tailored to what feels right for you.
Choose a gender-affirming voice therapist for safe, effective care
It's important to seek care from a specialist in gender-affirming voice care. This is because changing your voice can be vocally fatiguing. Vocal health and hygiene is an important consideration for anyone seeking to change aspects of their voice.
Many people think that simply adjusting the pitch or volume of their voice will help them sound more feminine or masculine. This isn’t necessarily true. An experienced speech-language pathologist can provide techniques and warmups to prevent vocal fatigue or strain. The goal is to find your authentic voice in a healthy, safe, and productive way–so you can use your new voice for a lifetime!
When searching for a gender-affirming voice therapist, many people choose teletherapy. With online speech therapy, you’re not limited to finding a therapist near you. You have access to a much wider network of voice therapists with experience in gender-affirming care.
What to expect from MTF and FTM voice training
How does transgender voice therapy work? The first step is an evaluation. This assessment seeks to uncover your existing communication profile and establish your voice and communication goals.
An evaluation may have several parts, including:
Examination of oral-motor skills: Oral-motor functioning is how the muscles in your face and throat, including your lips, jaw, and tongue, coordinate movement to produce speech. Your speech therapist may begin by examining this coordination to see how these muscles work together to produce desired sounds.
Voice evaluation: Your speech therapist may use a variety of tests and exercises to examine your current voice profile. This includes your voice’s existing pitch and pitch range, intonation, volume, resonance, and intensity. This also includes your respiration and breathing habits, which affect the “power” behind your voice.
Communication skills: In addition to your voice, there are many other verbal and nonverbal communication behaviors that we use during conversation. This style of communication can be adjusted to take on more feminine or masculine qualities.
Goals: Gender-affirming voice training will look different for each person. This is because your existing vocal profile and your desired outcome will be used to develop a unique voice training program tailored to your needs. Your speech therapist will take the time to clearly understand your goals and the desired voice and communication style that best match your identity.
Expressable’s approach to gender-affirming voice therapy
At Expressable, our voice specialists take a whole-person approach to gender-affirming voice training. This means we focus not only on your voice, but also on how it connects to your identity, emotions, and everyday life. We create a safe space where you can explore your voice and communication style without judgment. You can read all about how we support people exploring their authentic voice in our treatment guide to gender-affirming care.
Your Expressable speech therapist won’t tell you how you should sound. Instead, they’ll help you learn about different voice features, like pitch, tone, and resonance, and how they might connect with your sense of self. We’ll also work on things like breathing, vocal health, mindfulness, and confidence.
We believe your voice should reflect your authentic self. That’s why our program is personalized for you and guided by the latest research. It’s built for people across the gender spectrum and designed to improve both voice and quality of life. Studies show that gender-affirming voice therapy can help people feel more comfortable, confident, and empowered.
Your speech therapist won’t tell you how you should sound. Instead, they’ll help you learn about different voice features and how they might connect with your sense of self.
During your evaluation, your speech therapist will learn about your voice goals and listen to your current voice. They’ll assess areas like pitch, resonance, breathing, and vocal quality. If you have past imaging or test results, they may review those too. Then, you’ll work together to create a care plan that fits your needs, usually with 1 or 2 sessions each week.
Expressable’s voice therapists are here to support and guide you every step of the way as you discover your true voice and feel more at home in your communication.
Get matched with a speech therapist who's right for you
Get started nowSupport beyond sessions: The Expressable portal
Speech therapy doesn’t end when the session is over. With Expressable, you get access to our online client portal to help you keep learning and practicing between sessions.
This portal makes it easy to stay on track with your goals and build your confidence. Here's how:
Learning Paths: These are simple, step-by-step lessons that reinforce what you're learning in therapy. You’ll explore topics like breathing techniques, healthy voice habits, and finding your target pitch.
Demo videos: Watch real demonstrations of techniques in action, like how to adjust your intonation or use flow phonation during everyday conversations.
Home practice activities: Your therapist will suggest simple ways to practice your voice skills during daily routines. For example, you might practice a new pitch while making a phone call or use healthy resonance while ordering coffee.
Text messaging: Stay connected with your therapist between sessions. You can ask questions, get reminders, and receive helpful tips right when you need them.
This extra support helps you make faster progress and feel more confident using your voice in real-life situations.
Get started with Expressable
Every voice is unique. And so is every path to finding a voice that feels like you. Whether you’re taking your first steps or continuing to build confidence, Expressable is here to support you with compassion, expertise, and care. Let’s find your voice together. Get matched with a speech therapist here.
