“Gender-affirming voice therapy is fundamentally about safety. . . .
There is immense satisfaction in helping someone find their freedom
through speech coaching, as the ability to communicate and express
oneself without fear is a fundamental human right.”
Hannah Sumner (She/Her) is a director and speech coach at Seattle Voice Lab. She is a Berklee College of music graduate and has a Master’s in Speech Language Pathology from Lehman College in NYC. She has been teaching for over twelve years, and there is nothing she loves more than helping her students succeed. Previous students have appeared on The Voice, American Idol, MTV and Broadway.
Afua Agyapong is an assistant professor of speech-language pathology at Francis Marion University in Florence, South Carolina. She received her bachelor’s degree in Linguistics from the University of Ghana and earned her master’s and doctoral degrees in Communication Sciences and Disorders at the University of North Dakota. Her current research focuses on transgender voice and cultural diversity. She has published papers in peer-reviewed journals, and has presented locally and nationally.
Voice is an important element of a person’s identity, impacting their self-expression and interpersonal relationships. For transgender individuals, achieving congruence between their voice and their gender identity is a critical element of their path toward self-affirmation.
The disparity between an individual’s perceived gender and their voice can cause distress and have detrimental effects on their mental well-being. Although transgender identities are becoming more visible and accepted, there is still a notable lack of understanding of transgender voice issues in the wider health care field.
A recent qualitative study conducted by Agyapong and Jones-Brown (2024)[1] revealed that certain transgender individuals may engage in phonotraumatic behaviors, such as yelling and smoking, in order to align their voices with their gender identity. This emphasizes the significance of vocal congruence for transgender individuals and highlights the necessity of appropriate voice therapy to promote their overall well-being.
As someone with a decade of experience as a professional singer, I have found the creative challenges and acoustic manipulations involved in gender-affirming speech therapy to be intriguing. The ability to alter the sound based on tongue positions and air pressure changes is both fascinating and rewarding. The voice is truly an incredible instrument! Moreover, working with clients in this capacity is deeply meaningful and necessary. Teaching gender-affirming speech is a privilege, as it contributes to the safety and comfort of individuals in their daily lives.
What is Gender-Affirming Voice Therapy?
Gender-affirming voice therapy is a specialized type of speech-language therapy that focuses on assisting individuals—specifically, transgender and non-binary individuals—in adjusting their voice to be congruent with their gender identity.
The objective of gender-affirming voice therapy is to assist individuals in attaining a voice that is genuine and comfortable, thus enhancing their overall quality of life and mental well-being. Transgender voice modification therapy is often administered by speech-language pathologists who possess particular expertise in this field.
This therapy specifically targets multiple facets of voice and communication—such as pitch, resonance, intonation, speech patterns, and nonverbal communication.
Gender-affirming voice treatment comprises these five essential elements:
Pitch and Airflow:
Pitch is how high or low a voice sounds. The fundamental frequency, average pitch, of masculine and feminine voices has gotten closer in recent years. As women entered the workforce and more flamboyant inflections appeared in masculine speakers, which is why when altering the fundamental frequency one must also pair it with airflow.
Respiratory Control and Vocal Health:
Instructing the individual in applying certain methods to effectively manage respiratory control and preserve vocal well-being, hence minimizing the likelihood of phonotraumatic behaviors. The airflow will also help to reduce the strain and soften or thicken the tone as one expands their range.
Resonance Training:
Resonance is the amplification and modification of sound produced by the vocal folds as it passes through the vocal tract and holds great significance in trans voice theory. Resonance training is the process of modifying the vocal tract, consisting of the pharyngeal, oral, and nasal cavities to achieve a voice that exhibits a more masculine, feminine, or androgynous quality.
Intonation and Speech Patterns:
Adapting the cadence, emphasis, and melodic patterns of speech to conform to gender-specific communication methods, while still allowing for cultural and personal preferences.
Nonverbal Communication:
Examining the alignment of body language, gestures, and facial expressions with the individual’s gender presentation.
Gender-Affirming Therapy at Seattle Voice Lab
Gender-affirming therapy, particularly in the realm of voice, is an evolving field with various schools of thought. Although research in this area is still emerging, insights from speech science can offer valuable guidance.
At Seattle Voice Lab, our Chief Executive Officer Claire Michelle’s personal journey of developing her feminine voice—combined with her background in singing and her thorough research in the field of speech science—has shaped our approach. Over the years, we’ve refined our technique to ensure that it continues to be rooted in evidence-based practices.
The Role of Resonance in Gender-Affirming Therapy
Resonance is a key focus in gender-affirming voice work. It involves the amplification and modification of sound as it passes through the vocal tract, and it holds significant importance in trans voice theory.
Sandy Hirsch’s research on the acoustic quality of the vowel /i/ has been particularly influential. The /i/ vowel is characterized by increased F2, indicating a high front tongue position.[2] By training individuals to maintain a similar tongue position to that of /i/ across all vowels, using more of the tongue’s apex, we can achieve a brighter overall tone in the voice.
However, merely brightening the resonance is not sufficient for a natural sound. To feminize the voice, one must also “lighten” the sound. This involves increasing the open quotient (i.e., softening the sound with increased airflow) and pitch elevation, along with achieving brighter resonance (i.e., twang/volume) to create a healthy and authentic sound.
In Conclusion
Gender-affirming voice therapy is fundamentally about safety. It can help individuals dampen feelings of dysphoria and feel more comfortable in various social settings, such as using restrooms. There is immense satisfaction in helping someone find their freedom through speech coaching, as the ability to communicate and express oneself without fear is a fundamental human right.
I will always remember when a previous client shared with me, “I am no longer afraid to speak at my daughter’s PTA meetings.” Moments like these reinforce why we do this work—everyone deserves to have a voice.
[1] Agyapong, A., & Jones-Brown, J. (2024). Voices of identity: A qualitative study on transgender individuals’ perceptions of their vocal expression. Unpublished manuscript.
[2] F2, which is short for the second formant, in vowels is related to the degree of “backness” (i.e., the more “front” the vowel, the higher the second formant (but it’s affected by lip rounding).