Many transgender women and men say they want a voice that matches their appearance. There’s a growing recognition among health professionals who have transgender patients that altering one’s voice can improve quality of life and reduce distress.

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In her 30s, Sophie Marat, now 42, used to record herself reading poetry aloud, then play it back to hear if she sounded like a woman. Marat, who is transgender, had spent years trying to remake her voice in private by speaking in a higher pitch but ultimately felt that her efforts were hopeless.

“I was feeling like changing my voice to match my gender identity was almost impossible,” she said. “It was terrible.”

Marat’s transition from male to female has been a gradual evolution. She had come out to friends and family back home in Mexico, then began to wear skirts to work as a software engineer in Manhattan, New York. Still, her confidence would falter with everyday tasks like ordering takeout. “It was really painful to speak on the phone,” she said, “because they would reply, ‘OK, sir.’”

That was before she started her weekly sessions with a voice therapist at New York University’s speech-language-hearing clinic, one of a growing number of programs that cater to transgender clients seeking to retrain their voices.

Just as some transgender women and men choose to take hormones or have surgery, or choose neither, some seek to feminize or masculinize their voices. Many say they want a voice that matches their appearance or that the change allows them to escape unwanted attention. There’s also a growing recognition among health professionals who have transgender patients that altering one’s voice can improve quality of life and reduce distress.

“This isn’t just a sidebar,” said Sandy Hirsch, a Seattle-based speech language pathologist who was a co-author of the pioneering textbook on transgender voice and communication therapy. “It’s an integral part of care for transgender people as they transition.”

Transgender men who take testosterone permanently thicken their vocal folds, which tends to deepen the pitch of their voice. But transgender women who take hormones — a mix of estrogen and androgen-reducing drugs, for example — typically hear no change in their voices. As a result, transgender women are more likely to work with voice therapists, though transgender men can benefit as well, as some struggle with pitch instability and voice fatigue.

A lot of what transgender women learn in voice therapy is how to safely use their vocal anatomy to create a higher pitch and oral resonance without straining, so their new voices are ultimately sustainable. “We’re asking them to do an Olympic athletic feat,” said Heather Krug, who has worked with transgender clients for four years at the University of Wisconsin-Madison. “If they are going to get pitch into a feminine range, they need to have nicely conditioned vocal cords so they don’t get injuries.”

Feminizing a voice, however, involves far more than just achieving a consistently higher pitch. Perhaps the most critical, experts say, is a quality called “forward resonance,” in which a speaker feels vibrations closer to the front of the vocal tract, toward the nose and lips.

Research has shown that “a higher pitch and more forward oral resonance corresponds to a voice consistently perceived as female,” said Adrienne B. Hancock, an associate professor of speech, language and hearing sciences at George Washington University.

Unlike pitch, which can be readily measured using phone apps, such as Pitch Perfect, resonance can’t be objectively pinpointed. “You need a human ear,” and the speaker has to learn to feel the difference, Hancock said.

While do-it-yourself YouTube videos from transgender women are available, sessions with a voice specialist can improve forward resonance and soften an elevated pitch, so someone doesn’t sound like Minnie Mouse, Hancock said.

Another voice quality to consider is intonation. While men tend to speak in a monotone fashion, women generally have more highs and lows, something Marat mastered during about a year of group and one-on-one lessons and practice at NYU.

Her fundamental pitch is consistently elevated in the feminine range at about 185 hertz, up from 147 hertz. Still, if Marat speaks for too long, she gets out of breath.

Marat works with Sam Jaffe, a graduate student at NYU, to get her vocal cords into better shape so she can raise her pitch and volume to where she wants it without becoming breathless.

But while therapists help clients gain technical skill, it’s up to each patient to “own” his or her new voice and figure out what sounds right for them, said Leah Helou, the director of the transgender voice program at the University of Pittsburgh Medical Center.

“It’s not my job to make someone into an image of a lady as I see fit,” Helou said. “The danger when they come to me is they think, ‘She’s going to tell me what I need to do to pass.’ ”

Speech and language therapists have been working with transgender clients as far back as the 1970s, but it wasn’t until 2006 that the first textbook was published. In the past decade, the number of speech pathologists and voice clinicians learning to work with transgender clients has grown exponentially.

In April, Hirsch, Helou and Christie Block, a speech language pathologist in Manhattan, joined forces to expand a two-day training program for voice therapists interested in transgender work. The weekend workshop, which started in 2007 with 25 voice therapists, has grown to roughly 85 clinicians this year, Hirsch said, with roughly half participating via webinar.

A Facebook group for speech language therapists and other professionals to discuss transgender care now has about 100 clinicians in the referral database from the United States and about 50 more from abroad, according to Helou, one of the moderators. Roughly 60 began working with transgender clients only in the past five years.

Speech language pathologists are also seeing a growing number of transgender people in their 20s and 30s, and even adolescents.

Voice modification can take six to 12 months or longer, with home practice required to achieve the stamina needed for sustaining a new voice throughout a tête-à-tête conversation or a work presentation.

Darlene Monda, the clinic supervisor who started the NYU group three years ago, said some participants haven’t told friends they’re transgender yet or started the physical transition. But “they want to start working on their voice, so when the time comes, they are ready to transition and have this piece underway,” she said.

Others are already out, she said, and they “don’t want to present visually female, open their mouths, and have people staring at them, like ‘You’re not really a woman.’ ”