Gender-affirming Speech Therapy

There are going to be a lot of adjectives that are relevant to this account of gender affirming speech therapy. They are: transmasc, nonbinary, singer, adhd. Alright, hit it.

A long digression about singing

It's hard for me to pin down exactly what possessed me to pursue speech therapy. Probably a couple rough misgenderings brought it back to the forefront of my mind. But for whatever reason, I decided to ask my primary care physician cum endocrinologist for a referral.

My voice, before testosterone.

A little bit about my voice before this whole thing. I’ve been singing for years, both in chorus and in private lessons. I think I must’ve been pretty good at it, since I went to the all-state chorus a couple of times. I stopped singing “seriously” in college, but afterwards I picked up guitar and started singing a lot more for myself. By the time I was trying to figure out if I wanted to start testosterone, my voice was probably the one change I was most worried about: one of the neat things about T, almost everything is reversible, except for the vocal changes.

Even prior to engaging on a non-standard hormone path, I’d have struggled to characterize my voice. Soprano, mezzo-soprano, and alto are the standard categorizations for “female” voices. I regularly sang all three: soprano in casual choruses, alto in the ones I had to audition for, and if I were being honest, something mezzo was probably actually correct. You may be thinking, wait, you took private lessons and your teacher didn’t tell you what part you were? Well, for Reasons, I think both my parents and my teacher thought that being a soprano was the most “prestigious” of the parts, and thus constantly pushed me to sing soprano, even if my voice had stronger qualities elsewhere in my range. It was physically fine though: properly warmed up I could hit the queen of the night notes, which, by the way, is a completely useless skill outside of impressing your chorus friends and being an actual opera singer. Point is, even though I’d done a lot of singing and was pretty darn good at it, I still had a big gaping hole in my vocal identity, which, in retrospect probably had a lot to do with the traaaaaaans.

My voice, with testosterone.

Speaking of, eventually I started hormones. At low-dose, a lot of the changes were gradual, including my voice. It was kind of like the tickle you get in your throat when you’re just catching a cold. I’d always enjoyed that, cuz I could hit way lower notes than usually. The pitch change for T was actually less than a lot of the colds I’d been through, the big difference was this time, when the tickle faded the voice stuck.

I wasn’t singing too much while my voice was changing--my guitar was slightly out of reach so I didn’t find myself pulling it out too much. I did notice a little more inconsistencies when I was singing along with music--wasn’t always as unerringly correct with my starting pitches, even though adjusting once I got started was fine. I also noticed my voice range was more segmented--there were “rough patches” at some points, little breaks where the resonance used to be smooth. I wasn’t alarmed by this--I’d listened to enough cis dudes trying to figure out how to sing again post puberty to know what to expect, and again I adjusted pretty easily to these. Eventually, some time after the voice changes stopped, I actually checked my lower range at the piano and realized I was all the way down to G2. Now, G2 isn’t too impressive all things considered, but it’s the bottom of the bass clef, so it was pretty symbolic to me.

In general I was very happy with my singing voice. I was really worried about going from my powerful alto-ish (this is where I landed when I started singing for myself) voice to something thin and trumpet-y, like some of the brighter tenors I’d sung with. But it didn’t pan out that way. I think I just generally drifted lower, maintaining the same qualities of my voice. I lost a bunch of my high notes (I haven’t tried to see what my new upper range is yet), but again, all those E5+ notes really aren’t much fun for everyday use. The new segments were weird and interesting and fun, and I like the resonance and timbre in these new parts even more than I’d ever liked any male tenor sound. I suspect if I were to go to a classical vocal teacher and do my thing, they’d have no idea what to do with me. I don’t think I have enough lower range for anything lower than tenor, and definitely don’t have the typical “color” of voice for the high-tenors that would be in the same pitch range. Contralto might be a decent match for the “color”, but then I’ve also got these weird, interesting segments like a male singer, even though I don’t sound like one when I use them. Basically, anyone composing music specifically for transmasc enbies yet? HMU.

My speaking voice before therapy

Back to speech, which is what this post is actually supposed to be about. The thing is, throughout this whole process, gaining a whole-ass octave at the bottom of my range and losing at least that much off the top--my speaking voice didn’t change. I’m 999% sure if you asked anybody who heard me talking, they wouldn’t have noticed any change whatsoever. Now part of that was work from home plus shitty laptop mics, but part of that is vocal range is only one part, and honestly, it may well be the least important part.

I do have one interesting data point from this time though. We got a new team member at the start of covid, and we worked together for ages. When offices finally opened back up, we met in person for the first time. Big surprises, like she was really tall and I am much shorter than I project myself. But also she commented that my voice was "a lot lower in person". I wasn't talking any differently than usual, so it either came down to a) shitty mics dropping lower frequencies, but also b) "higher" is how we think of "female", and so much of the way I was talking gets read as female that it gets wrapped up in people's assessment of pitch.

Session 1: Diagnostic

Onto the actual speech therapy. The first part was a medical assessment. I went in knowing that I was perfectly happy with the physical development of my vocal tract but needed help with the psychological and social aspects. Nonetheless though, they put a camera down my nose and looked at my vocal chords while I made various sounds. It was super alien, highly recommend looking at some videos of it. Even weirder when you can control the weird alien thing yourself. It was definitely unnecessary (and unfortunately also the most expensive part, but I have decent insurance) in my case, but lots of transmasc folks apparently can have weird physical structures. My choice for low-dose T probably helped a lot in this regard. They also had me record some vocal sounds, read some passages, and also just talk. At that point it was hard to ignore how far my "conscious" speech diverged from my "unconscious" speech.

This was my main reticence and frustration with voice training, all throughout. I knew that I could have the voice I wanted if I thought about it, but I really didn't want to think about it. As an ADHDer, another thing to have to remember to do just fills me with rage and frustration. I really didn't want to be told "just remember forehead." Luckily this was not at all the case. I'll go more into detail later.

Session 2: Pitch

After the diagnostic, I got into my first appointment with the actual speech therapist. We did a couple more "okay let me hear you make these sounds" and talked about my goals. I was upfront that I felt good about my capabilities, but I felt bad about my voice and had no idea where I wanted to take it. I tried to emphasize that my problems weren’t physical or with what I was capable of--I just didn’t know what to do and what I wanted. I left that first appointment with some homework: 3 times every day, practice humming, sliding up and down.

Friends, I have never been able to successfully practice anything. Even though I wanted this, and was paying good pre-deductible money for it. I never quite managed to hit the frequency prescribed to me, but with sticky notes and some self bribing I managed okay. I was also doing this particular exercise for way longer than I think intended due to holiday scheduling so I got bored and then bad about doing it pretty quickly. I felt a little frustrated, like I was getting general advice not specific to my abilities or needs. Luckily the speech therapist seemed to be pretty receptive and the next homework I got came with some "and if you finish this you can move on to..."

Session 3: Resonance

So that was pitch, which I blew through. The next was vocal massage and resonance. Apparently some folks can have a lot of tightness in their vocal chords, which the massage helps with. For me, it mostly ended up as a mindfulness thing to relax not just my throat but also my shoulders and cheeks and everything else. Was pretty cool to hear the pre and post massage differences. The extra looseness also helps with the resonance, which is largely bright and forward for "female" and dark and backward for "male". Again I knew all about this from singing, but voice therapy helped me put together that oh yeah, I could do this with my speech too. Got some new exercises for moving resonance around, which I actually really enjoyed, and thus was a lot better at practicing at. May have figured out how to throat sing in the process too.

Resonance is probably one of the harder things to conceptualize. There are probably lots of good video / audio content on the topic, but to take my own quick shot of it, compare the sound you make when you yawn vs the sound you might make when you say something like "neener neener". Physically it feels like the point of maximum vibration moving around in your head, throat, and chest, and by tightening various muscles in your face and throat and changing the shape of your tongue, you can move it around.

I eventually landed on a resonance that was much further back, but also not say, maximally back. It felt a little too dude-bro-y for me. Also, interestingly, once I was aware of it, I found that it took a lot less mental effort to “remember” to use both the new resonance and pitch in everyday conversations.

Session 4: Breath

Our 45 minute lessons usually started with the doctor/teacher asking me how I felt about my voice, both in and outside of the exercises. After resonance week (actually, like month again. My hospital system is excellent but overwhelmed), I told him I was feeling mostly pretty good with the strength and color of my voice, but I needed a different voice for when I’m trying to be friendly or reassuring or approachable, which is necessary for 90% of my daily interactions--basically my ‘male’ persona--to be honest. At the time I was relying mostly on pitch for such a thing, which made me feel terrible. I word-vomited a bunch of adjectives to try to get at what I was looking for, but apparently the one word that hit was ‘breathy’, so my next homework was this exercise to work on really keeping up the breath support.

This was the most interesting homework. It was the first one that was actually physically difficult at first. Basically all of the breath you need for an extended ‘f’ sound, then start to voice it like a ‘v’ while still maintaining the same amount of breath. From there, it’s also interesting and difficult to modulate your volume and resonance and pitch all at the same time. Also part of it was to go from this heavily-breathed v into an actual phrase like “where are you going”?

This was one of my least consistent practice sessions but I went back into the next lesson and the doctor asked me how it went. I told him it went okay, but it didn’t really make sense to me. I could do the thing okay, but I wasn’t sure what I was looking for. But then he sort of did a compare and contrast and then suddenly yeah, I got it. I was sort of using my throat to articulate and modulate my breath, as opposed to holding it consistent and using my mouth and tongue and so on. So I sort of, held it open, and then all of a sudden it made sense.

Session 5: And Beyond

So that was the end of the lessons I’d had scheduled. The doctor confessed to me that often it feels like he’s leaving folks in the lurch until they get back onto the schedule again, but that wasn’t the case to me, which made me blush. I’m not done yet, but in the last couple minutes of that session, I managed to land on some weird combination of pitch, resonance, and breath that I really, really liked. Inconsistently, but we’ll get there one day.

Shortly after this point, Jess Mahler posted about customizing your voice and through that I took a peek at the online advice for masculinizing / feminizing your voice, which, believe it or not, I hadn’t looked at at all to this point. I’m tickled, as a half-androgyne half-agender enby (non-binary nonbinary?) to see in retrospect how the things I wanted span both sides of the advice--the pitch and resonance from the masculine advice, but the breath from the female advice.

I’m not at the end of my speaking-voice journey. Now that I’m out of the ‘will literally gauge out my ears rather than listen to it’ phase of my voice, next time there’s a recording of me I might actually listen to myself talk and see what I like / don’t like. To tie it back into my singing, the breath thing also somehow unlocked another breath dimension in my singing that I’d never figured out before (thanks singing teacher! /s). There’s also a lot more detailing, like consonance resonance and thinking some more about what kind of intonation I want.

Takeaways

I’m writing this 100% to share my experience, and not at all to give any sort of advice. I’m not even sure how useful it will be to the average person given how specific it all was to me. But there are a couple of takeaways that might actually be useful:

But of course, probably the most useful thing is just having another non-binary account of speech therapy out there on the internet. Hope you enjoyed it!

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