Voice therapy for trans women: It is essential to practice a lot
For trans women, voice therapy is almost as important as facial feminisation surgery. This is what Katrien Eerdekens, speech therapist at 2pass Clinic in Antwerp believes. Along with Danielle Long, she developed the 2pass Clinic Voice App with speech and voice exercises for trans women (see photo). But voice therapy is more than just a handy app. In this interview, Katrien tells all about it. “My trans women are my most motivated patients!”
Katrien, can you briefly explain what voice therapy entails?
“It means that we are going to work on the feminization of the voice. It is intended that after following of voice therapy, the patient should feel confident and dare to let her voice come out. I first focus on explaining how the voice works. What definitely comes into play, is resonance. A man talks mainly from the chest resonance, while a woman uses mainly head resonance. From there I will create a higher pitch. A woman talks at about 200 Hz, a man at around 120. Not every patient will be able to reach 200Hz. Often they are very satisfied with 165-185, the gender-ambiguous zone . That may be enough. Articulation is another important aspect. Women speak spicier, and use their tongues and their lips more. the sound is projected further forward. We also deal extensively with intonation. Women have a very fluctuating intonation, while men rather speak in monotone and shallow. Of course, non-verbal communication has to be addressed as well. What is their body posture? How do they sit? Do they use their hands when they speak? Women do this more often. I look at that too. I first and foremost am a coach. I help people in finding their new voice, but of course I’m not always there. So when the voice therapy stops, I want them to be able to continue managing their own voice and coaching it.”
Are the differences between male and female voices determined mainly physically?
“Definitely. A man has a greater vocal tract. You have your larynx, which is the part where the vocal cords are situated. A man’s vocal cords longer and thicker. More mass gives a lower tone. I cannot change that. Only a vocal cord operation can. In a man, the oral cavity and the nasal cavity are larger. We can change the sound and will adapt the articulation. It is intended that the larynx be placed higher up in the throat, so that the resonant cavities have a different shape and can sound more feminine.”
Does it matter if you’re sitting in front of a female or male speech therapist?
“Of course it has an influence. I am convinced that a lot of male colleagues can feminize a voice perfectly, provided they can produce the sounds themselves. A speech therapist is a model that sets an example of the correct voice use. Of course I do it good automatically because I’m a woman, but I have also previously practiced very hard. That is why I made a voice app. It also contains the sounds, with video and audio recordings of myself, so even when they are at home, patients can practice there with the model present.”
“The patient takes the speech therapist back home.”
Voice operations for trans women
Can trans women get good results using exercises only?
“Not always. Unfortunately,a voice is dependent on many factors. Our voice also is the stress trap of our body. When people are stressed, the neck and shoulder muscles immediately tighten. Trans Women often have mental stress. That has a big impact. Sometimes it is good, therefore, to wait until they feel better about themselves. Even then we do not always get the desired result. There can be many reasons for this. Either they do not exercise enough or they have a fear of failure to take the new voice outside. With me in the classroom and at home it works perfectly, but then they go to the bakery and forget it completely. At that time, their body stress increases so much that they have no control over these cavities and muscles. I always suggest they do speech therapy first. If you were able to work on all aspects, but you are still unhappy about your voice and you feel insecure, you can always have surgery as the finishing touch. That’s a perk to adjust the pitch so that they then only need to focus on the resonance, intonation and articulation.”
Is surgery always successful?
“The result is usually okay. Yet many trans women are not satisfied even then. Surgery is drastic. They work on the vocal cords and create scar tissue. They’re going to adjust the vocal cords. There are two operations that occur frequently. First there is CTA, cricoid-thyroid approximation. The vocal cords are then drawn up in a constant fashion, so that the tone becomes higher. It is a very simple operation and almost always succeeds, say NKO surgeons. An incision is made in the throat, but it recovers easily. The surgery does have drawbacks. The vocal cord is secured so firmly that only one sound is possible. Singing is no longer possible. You only have one tone. Also work on intonation in speech is difficult at the speech therapist’s. In the long run, the muscles also begin to dissolve back, making the voice descend again.
Another possibility is a glottoplasty operation. No incision is made in the throat; the surgeon goes inside via the mouth while the patient is under general anesthesia. Your vocal cords are two small muscles. A laser is used to create scar tissue that causes the vocal cords to become shorter. The disadvantage is a long recovery period, as the patient will not be able to speak for fifteen days after the operation. with glottoplasty there is often is yet a second treatment, where the vocal folds are treated by laser make them thinner. That has a very great effect. It takes a while, but after six months to a year, the result is really spectacular. You can do anything with your voice and the speech therapist can train it well. The vocal cord closure does reduce. Consequently, a light hoarseness occurs. Women have more air in their vocal cords and speak with more of a run-up. Transgender women usually find this quite nice. Personally, I don’t consider it a disadvantage, but they are very happy with it.”
The importance of voice therapy
Acceptance is important. Can you say that the voice is perhaps as important as facial feminization surgery?
“Absolutely. This is confirmed by trans-gender women. I once found a quote by Gerard Bauer: A voice is a second face. I agree with it. That is the case for cisgenders and certainly also for transgenders. On the phone, with no face to look at, you as a trans woman can fail the test completely. There are tools to give the voice a little more sharpness, so it comes across much better on the phone. This is not easy, and often is the last thing possibility in voice therapy. It remains incredibly difficult to pass as a woman on the phone.”
How long does voice therapy take, from the time it begins until the moment when the patient is satisfied and passes?
“That depends on how well the patient exercises at home. I usually see the patient once or twice a week. We get a lot done a lot in six months’ time. If we check back with each other regularly, it works well, provided the patient practices hard at home. I also have those who have been in treatment for a year to eighteen months. They can make their voices very feminine, but struggle to make the transfer to everyday life. Then we go to the bakery together and order some bread. Or we look together at how to do a presentation at work. Here too I help as a speech therapist. This is very dependent on the needs.”
Are transgender persons a nice group to work with?
“My trans women are my most motivated patients. They want to work on their voice, do their best to discover the sound, and are really obsessed with their own voice. This makes it super. Someone who goes to a speech therapist due to a vocal cord nodule finds it terrible. But trans women really want it. They’re constantly listening and are occupied with what people are thinking. They are very grateful patients. They are all dear to me!”