Introduction
The human voice and the ability to speak are often taken for granted by most laymen. This is because over the course of the lifespan most individuals will never require assistance with speaking or with their voice. Despite the fact that voice disorders are not widely recognized in mainstream public healthcare the reality is that there are a host of voice problems and that can promulgate distress for the individual. In an effort to address these issues researchers have developed voice therapies aimed at improving voice quality for those suffering with voice related disorders.
With the realization the voice related disorders and voice therapy are an integral and important part of healthcare, there is a clear impetus to examine this field and its implications for individuals in need of this type of treatment. To this end, this investigation considers the voice issues impacting transsexuals. Through a careful consideration of the voice disorders and problems that can arise for transsexuals it will be possible to provide a more integral understanding of how voice therapy can be used to improve the quality of life for individuals in this group. Further, by examining the voice therapies available to transsexuals the impact of voice disorders on the individual will be elucidated.
Transsexual Voice Problems
In order to begin this investigation, it is first helpful to consider the specific voice issues facing transsexuals. Van Borsel, De Cuypere, and Rubens (2000) in their examination of the voice issues facing transsexuals note that individuals seeking gender reassignment often utilize a speech pathologist to help them alter their “speech in the direction of the desired sex” (p. 428). These authors go on to note that, “In the majority of cases the intervention of the speech pathologist boils down to providing voice therapy to male-to-female transsexuals with the main focus on raising the client’s speaking fundamental frequency” (p. 428-9). Van Borsel, De Cuypere, and Rubens further note that speech therapy is not typically used in female-to-male transsexuals as “The prevailing opinion is apparently that in female-to-male transsexuals the desired voice change (i.e. lowering of the voice) takes place automatically under the influence of androgen administration so that voice therapy for fundamental frequency modification is not indicated” (p. 429).
Other researchers examining the challenges that exist when it comes to male-to-female gender reassignment note that voice therapy is critical for improving outcomes for these patients. According to Brown and Cheesman (2000) the gender reassignment surgery that occurs for male-to-female transsexuals does nothing to change the structure of the larynx. Intake of estrogen has on effect on the vocal cord or the cartilaginous framework. Consequently, they retain a larynx and vocal tract of male size and their voice may retain its male character” (p. 129-30). For individuals undergoing this type of surgery, the persistence of the male voice can impede social development after surgery. In an effort to improve outcomes for these patients, voice therapists can provide assistance toward improving the feminine character of the transsexual’s voice.
Therapies For Male-to-Female Transsexuals
Although the voice challenges facing male-to-female transsexuals have been well noted in the literature, the specific voice therapies that have been developed to assist these individuals have not been evaluated or examined in a systematic manner. Rather, the therapies that have been developed appear to have been independently examined by researchers in a myriad of publications. As such, in an effort to provide a comprehensive overview of the current voice therapies that have been identified in the literature, this review considers what each author has noted about voice therapies for male-to-female transsexuals.
Brown and Cheesman (2000) in their examination of the specific voice therapies that have been developed to help male-to-female transsexuals note that, “Voice therapy will aim to alter pitch and resonance and to increase breathiness. More holistically, the transsexual may be helped to acquire a more naturally feminine mode of speech and mannerism” (p. 130). In order to accomplish this task, Brown and Cheesman assert that pitch is an important and integral part of making the voice sound more feminine. However, these authors also note that speech therapists, in their efforts to improve the voice of the transsexual, focus on more than just voice pitch. Specifically, voice therapists work to “increase the precision and prominence of consonant production” and help client’s develop a “softer tone” which is viewed as characteristic of the female voice (p. 131). Further, speech therapists help clients learn how to mimic “a characteristics female intonation pattern with greater pitch variability” in an effort to make the transsexual’s voice more feminine.
In addition to general studies that have been used to identify voice therapies that can be used for transsexual clients, there have been a few notable case studies that have been presented in the literature. For example Kalra (1976) published the results of voice therapy given to a 17-year-old male that had undergone gender reassignment surgery to become a female. The specific methods used for therapy in this case are described as follows:
(Voice therapy…).
Voice therapy was successful in raising the optimum pitch of the subject’s voice to 193Hz. The author notes that this change contributed to helping the client perceive herself more completely as a woman.
While the specific research that has been conducted on the techniques used by does not provide a comprehensive or definitive understanding of the specific therapies that are used to improve voice quality for transsexuals, an extensive search of programs offered by speech therapists who work with transsexual clients provides a more concise picture of the voice therapies that are available. For instance, Davies (2006) currently provides a comprehensive voice program for transsexuals living in Canada. Her program, which is called Changing Keys, is sponsored by the Transgender Health Program of British Columbia provides an evaluation for the client, a seven week course of speech and voice therapy, a home tutorial program and a follow-up program for reevaluation.
Even though the evaluation is a critical component of the program, the most notable features of this process involve what is taught during the speech, voice and communication therapy program. Davies notes that therapy takes place once a week for two hours over a seven week period. The program includes information for clients which covers: how speech is produced, the differences between men and women’s voices and the masculine/feminine characteristics of speech, voice and communication. Voice therapy follows and is more intensive and includes the following techniques for improving the feminine quality of the transsexual’s voice:
– Vocal “stretching exercises” to gain access the higher pitches of the voice.
– Finding a more feminine pitch range and becoming accustomed to the feel and sound of this voice.
– Using voice therapy techniques that make the higher voice easier to produce.
– Increasing/modifying vocal inflections in speech.
– Achieving a more feminine vocal quality, e.g., working with breathiness (desirable) and roughness (undesirable) (Changing Keys).
The Problems Associated with Voice Therapy
Although voice therapy for male-to-female transsexuals provides a clear method for transsexuals to complete their gender reassignment, researchers examining this process have noted that there are a number of inherent problems with voice therapy. For instance, Söderpalm (2004) “Even if voice therapy given to transsexuals is similar in many ways to voice therapy in general, these patients have very special demands and it is essential that professionals are aware of this and can offer highly qualified therapy based on vocal hygiene regimes and vocal modification” (p. 24). Further, Söderpalm goes on to note that voice therapy that focuses on changing the fundamental frequency of the voice can be a time consuming process. Many transsexuals who enter therapy may never be able to effectively achieve a high degree of frequency change in their voice.
Finally, Söderpalm notes that voice therapy sessions with male-to-female transsexuals may be more time consuming because of the overall nature of this group. According to Söderpalm, “The transsexual individuals may wish to discuss appearance, make-up, clothing etc. this may put pressure on the logopedist to extend therapy beyond what is usual and beyond what s/he is prepared to do” (p. 24). Söderpalm argues that when possible, professionals may need to share the burden of responsibility for a client in order to ensure that the individual’s voice needs are met. Thus, professionals offering voice therapy to transsexuals must be aware of the overall complexity of this process. Söderpalm also argues that the process can be quite overwhelming for clients. For this reason, professionals must be able to provide clients with the continuing support that they need to complete voice therapy. Overall, the process places notable strain on both the client and the voice therapist.
Conclusion
When all of the available information on this subject is synthesized, it becomes evident that there is a paucity of data which clearly demonstrates what voice therapies will work best for male-to-female transsexuals. Although the research seems to indicate the increasing pitch is critical to improving the femininity of the transsexual, there is considerable variation on the supplemental methods that can and are used to improve the feminine quality of the male-to-female transsexual’s voice. In addition to the fact that there is a paucity of information on this subject, it is also clear that there a number of inherent problems with voice therapy. Voice therapy is not guaranteed to provide results in all cases. Further, voice therapy can require a considerable amount of time and energy. This can place a notable strain on both the therapist and the client.
When placed in this context, it becomes evident that research on the use of voice therapy for the transgender clients needs to be expanded if best practices for male-to-female transsexuals are to be delineated. At the present time, the disordered and incomplete state of the research on this topic makes it difficult for professionals to accurately discern the particular methods that should be used to improve outcomes for male-to-female transsexuals. In addition to conducting more research on this topic, it is evident that a broad synthesis of the information that is currently available is also warranted. Until a greater understanding of the potential voice therapy techniques and methods that could be used to improve outcomes for transsexual clients is delineated, voice therapists will continue to struggle to provide salient treatment that provides quantifiable results for those in need.
Describe what the disorder is. How does it happen? Treatment options for these patients? An introduction, introduction that includes originator(s) and overview of technique, evaluation of the techniques underpinnings, efficacy/effectiveness data, and summary should be included.
References
Brown, M., & Cheesman, A.D. (2000). Pitch change in male-to-female transsexuals: Has phonosurgery a role to play? International Journal of Language & Communication Disorders, 35(1), 129-136.
Davies, S. (2006). Changing Keys. Transgender Health Program. Accessed June 30, 2006 at: http://shelaghdavies.com/workshops/changing_keys.html.
Kalra, M. (1976). Voice therapy in the case of a transsexual male. Gender Trust. Accessed June 30, 2006 at: http://www.gendertrust.org.uk/php/showarticle.php?aid=15.
Söderpalm E. (2004). Evaluation of a consecutive group of transsexual individuals referred for vocal intervention in the west of Sweden. Logopedics, Phoniatrics, Vocology, 29(1), 18-30.
Van Borsel, J., De Cuypere, G., & Rubens, R. (2000). Voice problems in female-to-male transsexuals. International Journal of Language & Communication Disorders, 35(3), 427-442.
