Voice Therapy

When looking to alter how you speak you can change your voice or your speech and both are distinct changes. Voice is the sound produced by the vocal folds, speech is changing that noise into language. Both can be changed and can be used to denote femininity or masculinity.

Voice Therapy

Voice therapy target to change the pitch, prosody, and vocal resonance. Pitch is the frequency that your voice resonates at. For men this is lower and generally sits around 107 to 127 hertz, for females this is 189 to 224 hertz. Prosody is the melody of speech, masculine individuals tend to use stress or loudness to emphasize, feminine individuals tend to utilize changes in pitch to accomplish emphasis. Vocal resonance is the perceived placement of the vibrations of speech and can include chest, throat, and noes/lips. Vocal resonance does not have a gender but can be used to speck more comfortably depending on where the perceived vibrations come from. When in voice therapy a keyboard may be used to help learn to match pitches and a visual frequency guide may be used to help further match the pitches of a new voice. Frequency and length of treatment will very depending on induvial needs.

Pitch of your voice can be altered through testosterone hormone replacement. Testosterone is known to lower the pitch and masculinize the voice whereas estrogen will have little to no effect in changing the pitch and surgical options are nor as regularly utilized when masculinizing the voice as they are for feminizing the voice.  

Voice Surgery

You could also utilize voice surgery to alter the natural voice. Voice surgeries don’t require a referral of a mental health provider but talking with both a mental health provider and the surgeon prior to surgery about expectations and induvial needs is important and may be beneficial for expectations and results of the surgery. The two surgical options are the ‘Anterior glottal web formation’ and ‘Cricothyroid approximation’ and raise your natural voice. Anterior glottal web formation shortens the vocal cords by creating a scar at the front of the vocal cords, the shorter vocal cords will raise the natural voice. Cricothyroid approximation adds cartilage to the thyroid cartilage to elongate the coal cords, the result is an increased pitch in voice and limited ability to lower your voice. After surgery you will follow up with a speech language pathologist to learn about changing you voice and how to protect the change in voice.

Surgeries to lower the pitch of your voice can include increasing the volume of the vocal fold through injecting fillers directly into the vocal folds. The injection is minimally invasive, and the fillers used for injections include a hyaluronic acid filler, collagen, or autologous fat tissue. This is a much easier solution than other invasive surgeries; however, the results are not consistent, and the filler will be absorbed by the body and the change is not permanent. Invasive surgeries would include the relaxation laryngoplasty or type 3 thyroplasty, both of these surgeries start with an incision in the neck to reach the thyroid cartilage. Then, one of three options are chosen by the surgeon to lower the pitch of the voice. First, one or two pieces of cartilage are removed, and the cartilage is overall shortened, and this relaxes the vocal folds and decreases pitch. The second option is a vertical incision on one or two sides of the cartilage and the cuts are overlapped to achieve the same relaxation of the vocal folds, but the cartilage is not removed. The third option is where the anterior commissure is moved back, the further back it goes the less tension there is and the lower the voice becomes.

Speech Therapy

Speech therapy is treatment for stuttering, pronouncing, improved tone, and to increase confidence when speaking. Speech therapy can be used with or without the prior surgery. If you do opt to have those surgeries part of recovery will include learning to talk and utilize your new voice with speech therapy. Without the surgery speech therapy can help learn to annunciate and smooth out speaking in a new tone or pitch that may change with testosterone. Speech therapy may help with gender dysphoria and becoming confidante with the changes in voice you may experience.   


Schneider, S., MS, SLP-CC, & Courey, M., MD. (2016, June 17). Transgender voice and communication – vocal health and considerations. Retrieved April 25, 2021, from https://transcare.ucsf.edu/guidelines/vocal-health

MFMER. (2019, September 28). Voice feminizing therapy and surgery. Retrieved April 25, 2021, from https://www.mayoclinic.org/tests-procedures/voice-feminizing-therapy-and-surgery/about/pac-20470545

James P. Thomas, M. (2014, February 11). What’s the difference between speech and voice? Retrieved April 25, 2021, from https://www.kevinmd.com/blog/2014/02/whats-difference-speech-voice.html

Connected Speech Pathology LLC. (2021). Speech therapy for adults. Retrieved April 25, 2021, from https://connectedspeechpathology.com/therapy-for-adults

University Ghent. (2021, January 14). Effectiveness of speech therapy in trans women. – full text view. Retrieved April 25, 2021, from https://clinicaltrials.gov/ct2/show/NCT04708600

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