There are differences between male voices and female voices in the sociocultural understanding of gender. The most striking difference is the fact that men are expected to speak with a lower pitch than women. This has to do with the average vibration frequency of the vocal cords, which is around 120 Hz for cis men and around 220 Hz for cis women. In between there is a gender ambiguous zone (150 to 185 Hz). However, there are other differences, and to ensure that one’s voice is perceived as desired, it is advisable not to lose sight of other aspects, such as articulation, intonation, resonance and vocabulary.
Speech therapy
The voices of trans women and non-binary people assigned male at birth do not automatically become higher under the influence of oestrogen therapy. Speech therapy is usually the first choice to raise the voice frequency: nothing about the vocal cords changes, but people learn to use them in a different way. Speech therapy for this group usually starts when beginning social transition, because there are then sufficient opportunities to practice in daily life.
With trans men and non-binary people assigned female at birth, the voice drops automatically under the influence of testosterone therapy, because the muscle mass of the vocal folds increases and thus the frequency of vibration falls. However, some trans people have unrealistic expectations about the influence of testosterone therapy – they often expect a faster and greater drop in tone. One should expect three to four months before a clear drop in tone is heard, and after one year or more, the maximum in voice drop due to hormones may be reached. For some, the maximum drop will not put them into the stereotypically “male” range, regardless of the length of time taking testosterone. Speech therapy may also be appropriate in this case.
It is possible to access speech therapy through the gender wellbeing clinic.
Surgery
If speech therapy cannot achieve a sufficiently high or low pitch, surgery can be opted for. Different types of intervention are identified.
- Voice enhancements:
- Thyroplasty type IV (cricothyroid approximation) whereby the vocal cords are tightened externally.
- Anterior commissure webbing where the vibrating part of the vocal cords is shortened. This is done via micro laryngoscopy through the mouth.
- Voice-reducing procedure:
- Thyroplasty type III where the vocal cords are relaxed by external means. This service is currently not provided through the NHS.
