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Health

When You’ve Transitioned But Your Voice Hasn’t Caught Up

How transgender people perceive their voices can have a big impact on their health and well-being.

When Charlie Martin, a race car driver in Leicester, England, began transitioning from a man to a woman, she took painstaking steps to avoid conversation. If she had trouble finding something at a store, she combed the aisles for it herself instead of asking an employee for help. Martin, 37, worried that her deep voice, paired with her feminine appearance, would lead to confusion or, worse, being mis-gendered, which would hurt and embarrass her. “Day to day, you get used to [being mis-gendered], but it can wear you down,” she says.

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Speaking still causes Jae Noel anxiety. Since transitioning a little more than two years ago, the already introverted 22-year-old, who attends college in Gainesville, Florida, began isolating herself even more. Now, she takes classes online whenever she can to avoid interacting with professors or other students.

Beyond contributing to social anxiety, speaking aloud can also make transgender people targets of violence. “It’s scary,” Martin says. “Voice could be a real giveaway.” Amid polarizing debates about bathroom access rights for trans people, Noel takes extra precautions in public restrooms, suppressing even her coughs and sneezes. “I don’t want to put myself in a situation where I can be assaulted,” she says. “I just want to use the bathroom, wash my hands, and leave.”

In general, trans women tend to seek voice training more often than trans men, the experts in this piece say. Testosterone—for trans men who choose to take it—thickens the vocal cords, which slows the frequency of their vibrations, lowering vocal pitch. But taking estrogen doesn’t make trans women’s vocal cords thinner, so their vocal pitch stays the same.

Emerging technology could help transgender women like Martin and Noel adjust their voices to more closely align with their gender identity, helping them feel not only more authentic and confident, but also safer. In a recent study, New York University researchers showed that a technique that offers visual feedback on users’ resonant frequency, or how their voice is filtered through their vocal tract. The training mechanism teaches people how to control their voices to sound more feminine.

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“Vocal presentation is a huge part of gender transition and often the most challenging,” says Tara McAllister, an associate professor of communicative sciences and disorders, who co-authored the study with Deanna Kawitzky, a speech-language pathologist in New York City. “We hope that it can be a really helpful tool.”

How transgender people perceive their voices can have a big impact on their health and well-being. “The voice is an important piece in how we feel about ourselves and how we understand our psychological sense of identity,” says Phillip Hammack, a professor of psychology at the University of California, Santa Cruz. If someone’s voice doesn’t match up with their gender identity, it can not only trigger gender dysphoria—distress over the disconnect between her body and her gender identity—but hypervigilance as well. Hypervigilance can mean “always being worried about what gender people are attributing to your voice and feeling like you’re constantly negotiating it,” says Paz Galupo, a professor of psychology at Towson University. She adds that, over time, this hypervigilance can make trans folks less trusting in general, straining the relationships they need to help them weather the discrimination and other stresses that often come with their identity.

Living in this constant state of stress can heighten the risk of depression, self-harm, and suicide. Indeed, 41 percent of trans participants in the National Transgender Discrimination Survey attempted suicide, compared to 4.6 percent of the general US population.

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Other elements of vocal quality besides pitch—which, remember, is controlled by how fast the vocal cords vibrate—also shape our perception of a speaker’s gender. One example of these elements is resonant frequency: how the sound produced by the vibrations of the vocal cords are filtered through the vocal tract, which depend on physical attributes, such as its size. Cis men’s vocal tracts have lower resonant frequencies than cis women’s vocal tracts, since they’re taller on average and their larynxes drop during puberty.

As a result, they have larger vocal tracts—larger spaces resonate at lower frequencies. (Think of the difference between the sound of a cello and that of a violin, McAllister says.) In speech therapy, trans women learn techniques to make their vocal tracts resemble the average vocal tract of a cis woman. McAllister and Kawitzky wondered: Could training trans women to use these techniques, with the aid of visual feedback, lead others to perceive their voices as more feminine?

When participants in their study—12 trans women and 19 cis men—spoke into a microphone, a series of jagged peaks appeared on a monitor, representing the resonant frequencies of their vocal tracts. Kawitzky showed them how rounding or un-rounding their lips, and moving their tongue toward the front or back of their mouths, could shift these peaks.

Next, she asked them to use these techniques while saying simple, one-syllable words—“bud,” “bad,” and “bod”—to shift one of the peaks so that it aligned with a target frequency that fell within the range of a cis woman’s resonant frequency. They then said each word eight times as they tried to hit their targets. Another group of participants listened to audio recordings of these attempts and rated how masculine or feminine the voices sounded. Sure enough, they tended to rate voices with higher resonant frequencies as more feminine.

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Ultimately, the researchers envision their technology being incorporated into a comprehensive speech therapy program that also offers training in other aspects of vocal quality. “Resonance is one part of a bigger picture,” McAllister says.


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McAllister and Kawitzky’s research emerges amid a handful of trans voice-training phone apps that have cropped up in the past five years, such as EVA and VoiceUp. EVA offers visual feedback on pitch, breath, and other elements of vocal quality. (A feedback system for resonant frequency is still in the works.) In VoiceUp, users repeat after speech therapist Christella Antoni, starting with single words and building up to passages, much like in language learning apps.

But Alex Ahmed, a PhD candidate at Northeastern University’s College of Computer and Information Science, worries that voice training technology plays into gender norms by setting the bar for an “ideal” feminine voice range, implying “there’s only one way to be a woman.” “It produces a lot of stress,” says Ahmed, who is herself trans.

A participant in one of her studies said she delayed transitioning because she felt pressure to “come out of the box meeting the perfect female binary, including voice.” For her doctoral dissertation, Ahmed is collaborating with other trans individuals to develop a free, open-source app that would allow users to set their own goals for how they want their voice to sound, which can fall anywhere on the gender spectrum, unlike currently available apps, which typically offer only two options: masculine or feminine.

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Indeed, McAllister believes voice-training technology still has a long way to go before it can provide the same kind of personalized instruction as a trained human. A speech therapist can help clients work within their natural physiological limits, preventing vocal cord injury, and provide them with a more nuanced understanding of how their voice works so they know precisely how to adjust it to reach their goals—even if they don’t fit neatly into a gender binary, says Carly Schiff, a speech therapist at Columbia University Medical Center. For instance, “maybe at work I want to sound more gender fluid, but with my friends, I want to sound more feminine.”

But if a client happens to be a trans woman who wants a stereotypically feminine voice, Schiff doesn’t see it as her place to convince her one way or the other. “It’s up to the person sitting across from me…They’re the ones going through this experience.” Hammack agrees. Trans people are already struggling with gender identity and presentation, he says. “We should be promoting their ability to live in the world in a way that feels right to them.”

As much as Noel wishes she didn’t feel pressure from society to make her voice conform to feminine norms, she doesn’t think she has much of a choice. “I feel like I have to in order to succeed in life and just belong,” she says. She diligently watches YouTube voice training videos, and practices feminizing her voice at her job as a cashier, tracking her progress in videos she records of herself. While unsure of whether she’ll ever feel completely satisfied with her voice, she’s much happier with it now than she was earlier in her transition. “I’ve definitely grown a lot.”

After undergoing months or so of speech therapy with Antoni, who created the VoiceUp app, Martin rarely gets mis-gendered. “This is something that matters to me so much, and to feel like I’m succeeding at it—it feels really amazing,” she says. Indeed, Antoni says finding their authentic voice draws her clients out of their shells. “It helps complete a picture for people,” she says. “It helps them go from surviving into thriving and blossoming.”

Now, Martin says reverting to her old voice feels strange. “This just feels like my voice now.”

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