Voice feminisation

What is voice feminisation?

Voice feminisation is a treatment for transgender or nonbinary individuals to modify their vocal tone in order to sound more feminine and aligned with their gender identity.

Voice feminisation often involves the combination of vocal cord surgery and speech therapy, but patients may choose to undergo one or the other alone.

Why would a patient undergo voice feminisation treatment?

Unlike other facets of transgender care, voice feminisation is not strictly achievable through biomedical means like hormone replacement therapy and surgery (although surgery can certainly be an aspect of it). Regardless, it is still an important characteristic for many gender-diverse individuals in order to combat dysphoria and feel that their gender is accurately represented, as well as preventing social stigma and prejudice.

Trans-masculine patients who are undergoing testosterone therapy will naturally develop a deeper voice due to the effect of the hormone; however, for trans-feminine patients who are undergoing oestrogen therapy, there will be no such impact on their voice (if they are beginning their transition after going through puberty).

What does voice feminisation therapy entail?

Voice feminisation therapy helps the patient alter the key characteristics of vocal tone, such as pitch (for feminising voices, the goal is above 165 Hertz), prosody, resonance, and frequency. The aim of the therapy is to produce a voice that is naturalistic, authentic, and comfortable for the patient. To achieve this, there may be additional focus on speech and breathing patterns, voice quality, articulation, tempo, and even nonverbal communication like body language, hand gestures, and eye contact. Voice therapy is important for avoiding damage and injury to the vocal cords by teaching patients how to raise their pitch safely.

Sessions for voice therapy will be tailored for each patient, and thus will differ in length of each session, duration of the therapy, and exercises undertaken. Some sessions may be conducted in group settings. In general, the course of therapy can range from a couple of months to a year, but this will also depend on the patient’s satisfaction with their progress.

What does voice feminisation surgery entail?

For patients who are interested in pursuing it, voice feminisation surgery is typically recommended after some voice therapy. It involves shortening, tightening, or thinning the vocal cords to raise the pitch of the voice. It may be conducted via incisions into the throat, or with a lighted tube that is fed into the throat through the mouth, called a laryngoscope. There are several techniques that can be employed for the surgery, such as removing or ablating layers of tissues, stitching together the vocal cords, and removing cartilage. The patient will be on vocal rest for at least 10 days after surgery whilst they recover.

While voice feminisation surgery isn’t necessary to achieve a feminised voice, it can be helpful for some patients to maintain a consistent higher pitch when speaking, as it reduces the range of the voice, preventing the patient from going lower than they may desire. This means that even if the patient is tired or not concentrating on their voice, a deeper register won’t ‘slip’ out. After surgery, voice therapy sessions may be resumed (which is highly encouraged).

However, there is risk of the voice becoming weakened or strained with hoarseness, instability and tremors, or the results being too high and therefore sounding unnatural. There is also the possibility of damage to the vocal cords and airway that can lead to lesions and dysfunction.