{"id":73343,"date":"2018-11-27T16:51:18","date_gmt":"2018-11-27T22:51:18","guid":{"rendered":"http:\/\/news.medill.northwestern.edu\/chicago\/?p=73343"},"modified":"2018-11-27T16:51:18","modified_gmt":"2018-11-27T22:51:18","slug":"voice-therapy-helps-trans-people-sing-at-a-different-pitch","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/voice-therapy-helps-trans-people-sing-at-a-different-pitch\/","title":{"rendered":"Voice therapy helps trans people sing at a different pitch"},"content":{"rendered":"

By Colleen Zewe<\/strong>
\nMedill Reports<\/em><\/p>\n

This story originally appeared in INTO<\/a>.<\/em><\/p>\n

One of the most defining gender characteristics, voice, often gets overlooked in technology and medicine, but new advances in voice therapy may help transgender people feel more like their true gender.<\/p>\n

While hormones may help some people change their voice, they don\u2019t work for everyone. But new research shows promising options in coaching and speech therapy for transgender people whose voices don\u2019t change after hormones. The research sessions used biofeedback from voice frequencies shown on computer screens to help participants modulate their voices.<\/p>\n

Actress and advocate Delia Kropp, 61, tried all the traditional hormones for transitioning male-to-female, including estrogen, progesterone and testosterone blockers.<\/p>\n

\u201cAs with all trans women, these made no noticeable changes or feel to my voice,\u201d she said.<\/p>\n

But Kropp, who lives in Chicago, wanted her voice to match her gender, not only to experience less misgendering, but also to help with her career. She self-trained her voice to sound more feminine using YouTube and books, and she took lessons with theatre voice coach Kate DeVore.<\/p>\n

\u201cTo some [my voice] reads female, to others it doesn\u2019t,\u201d she said. \u201cIt\u2019s largely a challenge on the phone, where I am repeatedly misgendered. Professionally, my voice can be a challenge for acting female roles. I have yet to develop a convincingly female voice for the stage because the size, dynamic range, and power required to hold an audience\u2019s attention for two hours does not brook feminization well [for me]. When auditioning for cisgender female roles, this sometimes holds me back.\u201d Cisgender refers to identifying with a person’s sex assigned at birth.<\/p>\n

\"\"
Kropp taught herself to speak at a higher tone, but still struggles with her voice professionally. (Photo: Delia Kropp)<\/figcaption><\/figure>\n

Kropp transitioned her voice with the help of a vocal coach and self-teaching after hormones failed to help. She has since contributed to a professional vocal coach manual.<\/p>\n

Many transgender people have similar experiences due to their voices being different than what\u2019s considered traditional for their gender. But voice and speech therapy often go uncovered by medical insurance. However, research at New York University shows the success of new vocal training options.<\/p>\n

The study, published in the\u00a0Journal of Voice<\/em>, documents how NYU speech pathologists Deanna Kawitzky and Tara McAllister helped transgender women raise their voices to a more feminine tone.<\/p>\n

The study used visual-acoustic biofeedback, which relies on microphones and computers to help people see the frequency of their voices on computer screens. Frequency refers to how often the sound wave vibrates. The more it vibrates, the higher and more feminine the sound. Frequency can be changed by reshaping mouth motions, but this can be difficult.<\/p>\n

The study compared the voices of 12 transgender women and 19 cisgender men. Initially, the transgender women produced a slightly higher voice than the men, but the difference was small. Both groups naturally produced a more masculine voice range. \u00a0But seeing voice targets on screens and sessions to practice reaching those targets helped produce change.<\/p>\n

Participants spoke\u00a0vowels in the contexts of short words, such as \u201cbat,\u201d\u00a0into a microphone, and their pitch frequency, or resonance, was shown as a wave on a screen.\u00a0The participants were\u00a0given a target that approximated the average vowel frequency of a cisgender female.\u00a0They were asked to try to\u00a0match that target by manipulating their resonance.\u00a0The biofeedback would show how close they came to reaching\u00a0the target.\u00a0Finally, after attempting to reach the higher\u00a0frequency\u00a0multiple times, the participants were asked to say the vowel with their eyes closed\u00a0in order to try to get the words to sound less stretched out and more natural.<\/p>\n

\"\"
The biofeedback helped the trans women change their formants, or frequency. According to Victoria Ernsberger, a master’s of speech-language pathology candidate at Saint Mary’s College in Indiana, formants can be altered by changing mouth positions.<\/figcaption><\/figure>\n

The study measured formants, which are frequencies controlled by the movement and position of the vocal tract. Changing the movement of the mouth can make the voice sound higher or lower.<\/p>\n

In the end, the trans women were able to significantly shift their frequency formants to better match the biofeedback targets, and blinded listeners rated the words produced with higher frequencies as \u201cmore feminine\u201d sounding. Frequencies are controlled by different vocal trace movements positions.<\/p>\n

Biofeedback is traditionally used to monitor vitals like heart rate, but this study shows it has the potential to change how transgender people modify their voices.<\/p>\n

\u201cResearch on transgender voice therapy has been limited but is expanding, and we\u2019re excited to have identified a new direction with biofeedback,\u201d study author Kawitzky said.<\/p>\n

Transgender voice training is a relatively new branch of voice therapy, but it can help transgender people feel more confident in their gender presentation.<\/p>\n

\u201cI came [into NYU] knowing I wanted to learn more about the intersection of voice and gender and methods for transgender voice therapy as a way to help trans people find a voice that matches their presentation of their gender identity,\u201d Kawitzky said. \u201cWhen I became a research assistant at Tara\u2019s Biofeedback Intervention Technology for Speech lab, which studies the use of biofeedback to change speech patterns, we decided to collaborate on this study as my master\u2019s thesis.\u201d<\/p>\n

Though the field is just beginning, it\u2019s also growing. Adrienne Hancock, a speech pathology associate professor at George Washington University, has dedicated her research to transgender voice and communication, and has watched the field grow throughout her career.<\/p>\n

\u201cWhen I came to work at GW, I started teaching voice and working with voice disorders, and I realized that the clinic at GW had a lot of trans people working on their voice,\u201d she said. \u201cThere wasn\u2019t a lot of research on that at the time in 2005. It\u2019s growing a lot. 2011 was the first time that voice and communication was included in the factor in the\u00a0Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People Care Guidelines<\/a>.\u201d<\/p>\n

Before biofeedback, transgender voice training relied on tactile perception, or how it feels when the person speaks, and also on auditory perception. This study shows that biofeedback can add another dimension to voice training by helping the patient visually see how their voice works, and what they can do to change it. It also gives people the opportunity to train their voice from home, or practice between sessions.<\/p>\n

Despite this progress, work still needs to be done to help all transgender people access this kind of care.<\/p>\n

\u201cI think utilizing technology would be helpful to provide the services more through tele-health, long-distance ways, and improve overall access to this care,\u201d Hancock said. \u201cThis is a problem right now particularly for trans people, and particularly marginalized trans people, like trans people of color or trans people with socioeconomic challenges who may want and benefit from voice and speech modification, but they can\u2019t access it for any number of reasons.\u201d<\/p>\n

Those who can\u2019t access a professional voice therapist can also turn to vocal coaches. In Chicago, a music instructor works with transgender singers to both modify their voice and become confident with the voice they have.<\/p>\n

Hodges, an LGBTQ advocate, started offering this service after he was invited to workshop with\u00a0ResonatE<\/a>, Chicago\u2019s transgender choir. \u00a0He said he sees trans people wanting their voices to change instantly, but for most, it doesn\u2019t work like that. Instead, it\u2019s a slow, personal process.<\/p>\n

\u201cI\u2019ve worked with trans men whose voices dropped quickly, and some take a long time,\u201d he said. \u201cI love using the second puberty illustration because just as in puberty, everyone did it at different times. When you\u2019re transitioning, there is no timeline. Everyone\u2019s body absorbs hormones differently and adapts to them differently.\u201d<\/p>\n

Actor Donnie Cianciotto of Staten Island had a very high voice before he started taking hormones in 2012. Hormones quickly made changes in his voice, but it took him six years to gain control of the changes.<\/p>\n

\u201cThe doctor I had at the time put me on what is considered twice the average dose of hormones because my estrogen count was particularly high,\u201d Cianciotto, 38, said. \u201cThe first thing that it did was it affected my range where I could only speak two or three notes. I couldn\u2019t speak very high or very low.\u201d<\/p>\n

With the more limited vocal range, Cianciotto felt like he had lost control of his voice and could no longer engage in one of his passions: singing.<\/p>\n

\u201cFor the first two and half, maybe three years, I couldn\u2019t sing at all,\u201d Cianciotto said. \u201cThere was no ability. I would go to sing a song I had been singing all my life, and I couldn\u2019t do it. You could definitely tell there was a difference there as it was adjusting. It lasted a really long time.\u201d<\/p>\n

\"\"
Actor Donnie Cianciotto put off beginning hormonal therapy because he feared the hormones would change his singing voice. (Max Kristula-Green)<\/figcaption><\/figure>\n

That\u2019s where vocal coaching comes in. Hodges helps transitioning vocalists find the center of their voice, or a natural, comfortable place to sing, and warns them that\u00a0singing in the wrong vocal range could cause vocal injury.<\/p>\n

Cianciotto said that after taking vocal lessons, he finally feels comfortable with his singing voice, but the process of getting to that point was not easy.<\/p>\n

\u201cIt was hard emotionally for a hot minute because even though I hated my [pre-transition] speaking voice, I loved my singing voice,\u201d he said. \u201cWhen it went away, I was afraid it was never going to come back. I had to stop performing because I couldn\u2019t sing. It was traumatic to lose this thing that I\u2019ve had my whole life.\u201d Now he\u2019s training to sing with the new voice he has.<\/p>\n

Because the vocalist\u2019s natural voice may not be the voice desired, Hodges reminds his clients that their voice is beautiful no matter how feminine or masculine it sounds.<\/p>\n

\u201cYes, I\u2019m a vocal instructor, but I\u2019m also a confidence booster,\u201d he said. \u201cWhen you have a trans man whose voice isn\u2019t transitioning the way they want it to, it can be very emotional because they want the whole package. They want society to see them as a man. If I\u2019m working with a trans man and the voice is high, I let them know that that\u2019s their voice. Your voice doesn\u2019t have to be anything but yours.\u201d<\/p>\n

Photo at top: Participants spoke into a microphone for the visual-acoustic biofeedback therapy. (Dennis Hill\/FLICKR)<\/div>\n","protected":false},"excerpt":{"rendered":"

By Colleen Zewe Medill Reports This story originally appeared in INTO. One of the most defining gender characteristics, voice, often gets overlooked in technology and medicine, but new advances in voice therapy may help transgender people feel more like their true gender. 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