Gender-Affirming Voice Training

Our voice and communication style plays an integral role in how we perceive and express our identity. Regardless of your unique gender identity, having a voice that truly matches and aligns with your authentic self is critical for overall well-being, happiness, and confidence.

For some transgender individuals, their voice may not align with their gender identity and gender expression, causing possible feelings of discomfort or dysphoria. This can affect a person’s quality of life, self-esteem, and fear of being misgendered.

While not all transgender individuals may wish to modify their voice, gender-affirming voice training, also known as transgender voice therapy, can help those who do. In this guide, we answer frequently asked questions about gender-affirming voice training. We also discuss how working with a speech therapist specializing in gender-diverse voice can help you discover and develop your desired vocal qualities and communication style. 

This article was authored by Heather Gross, M.S., CCC-SLP, a speech-language pathologist and voice specialist with extensive experience working with gender-diverse speakers and singers. 

1What is gender-affirming voice training?

2How does hormone replacement therapy affect a person’s voice?

3What aspects of communication can be changed?

4Why professional guidance is recommended

5What does gender-affirming vocal training involve and look like?

6What is Expressable’s approach to gender-affirming voice?

What is gender-affirming voice training?

Gender-affirming voice training, which you may hear referred to as a type of voice therapy or transgender voice modification, is a nonsurgical intervention used to change the gendered aspects of a person’s voice. The voice specialist and client often 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 a series of individualized sessions geared toward helping gender-diverse people explore their authentic voice and communication. Helping a gender-diverse individual find their true voice may consist of adjusting resonance, pitch, intonation, nonverbal communication, syntactical choices, vocal quality, and more.

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, also known as speech therapists, with a specialization in gender-affirming voice training can help clients 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 working to become more culturally competent in serving this population.

How does hormone replacement therapy affect a person’s voice?

According to the National Center for Transgender Equality, voice treatment 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 hormone replacement therapy (HRT), generally have a different effect on the pitch of someone’s voice.

When transgender men decide to use testosterone, this can have a masculizing effect on their voice. When testosterone is used over time, it 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.

Voice and communication training has been shown to result in gains in areas important to listeners’ perception of gender (Hancock & Garabedian). Even more important, it has been shown to increase reported quality of life, happiness, contentment, confidence, and ability to find authenticity. 

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 hormone replacement therapy (Irwig, Childs & Hancock). Since the onset and duration of voice deepening varies considerably, transgender males may elect 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.

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.

What aspects of communication can be changed?

Gender-affirming voice training, or transgender voice therapy, can include a wide variety of vocal and communication aspects. These include pitch, resonance, intonation, articulation, nonverbal communication, language, and vocabulary use.

There is a wide range of feminine and masculine vocal qualities. You may be looking for MTF (male to female) or FTM (female to male) voice training. Your focus may be on voice feminization or voice masculinization. Or you may want a gender-expansive voice, so you can modify your voice depending on context and the gender identity you present across settings.

The key is to listen to and understand your own inner voice. Accessing your authentic voice means understanding who you are, whether that's transfeminine, transmasculine, nonbinary, gender nonconforming, genderqueer, bi-gender, agender, cisgender, or something else! Behavioral voice change is intended to help you find the ideal range that feels most natural to your authentic self. Each session is individualized to your goals. Your voice specialist will only target those areas which feel authentic to you.

When you work with a speech therapist specializing in voice modification, there are many aspects of your verbal and nonverbal communication that can be explored to better align your voice and identity. These may include:

• Pitch: How high or low your voice sounds, which is impacted by the number of vibrations your vocal cords produce

• Resonance: The quality of the sound your voice makes

• Intonation: How your voice rises and falls during speech--in other words, the melodic or rhythmic quality of your voice

• Rate of speech: How quickly or slowly you talk

• Volume: How loud or soft your voice sounds

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

In addition to voice qualities, there are other components of your communication that you may wish to alter. These can include how clearly you articulate certain sounds or words, your vocabulary and word choice, and certain social pragmatics that you follow during conversational exchanges.

Why professional guidance is recommended

It's important to seek care from a specialist in the area of gender-affirming voice care, as modifying your voice can be vocally fatiguing. Vocal health and hygiene is an important consideration for anyone seeking to change aspects of their voice. For many people beginning the journey to transform their voice, they may think simply adjusting the pitch or volume will help them sound more feminine or masculine. This is not necessarily true. A certified speech-language pathologist can provide techniques and warmups to prevent vocal fatigue or strain and to help you find a voice you can use for a whole lifetime! A professional can help you find your voice in a healthy, safe, and productive way.

What does gender-affirming vocal training involve and look like?

When you begin working with a speech therapist who specializes in gender-affirming vocal training, the first step is an assessment. This assessment seeks to uncover your existing communication profile, and establish your voice and communication goals.

An assessment may include several components, 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 vocal training will look different for every individual. This is because your existing vocal profile and your desired outcome will be used in developing a unique 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 matches your identity.

At Expressable, our clients have access to our client portal, which features educational Learning Paths covering the strategies taught in therapy sessions. You can access examples, tips, demo videos, quizzes, and more. Plus, through the portal, you'll receive weekly home practice activities tailored to your needs. The more you practice voice therapy techniques at home, between sessions, the faster you'll make progress!

What is Expressable’s approach to gender-affirming voice?

Our voice specialists use a holistic, whole-person approach to gender-affirming voice training. Our unique approach allows space for our clinical work to integrate with the human we are serving, covering many aspects of voice and communication.

Your therapist will never tell you what to do or how to be. They will simply present information and introduce vocal aspects that may align with your identity in a safe and supportive environment. This approach includes traditional voice therapy to ensure your vocal health and vocal hygiene, voice physiology, coaching and mindfulness. Together, we'll help you explore your unique identity, begin to visualize your authentic self, and ultimately find happiness and confidence in who you are.

Gender identity refers to your internal sense of self, your internal knowledge of your gender. It’s in your heart. We believe it must be explored with great sensitivity and care.