New Ideas on Voice Therapy for Transsexuals

Susan Clark

M.Phil., Head Speech and Language Therapist, Royal Victoria Infirmary, Newcastle upon Tyne
Gendys Conference, 2002

I attended a three-day workshop at Charing Cross Hospital in July, which was led by Alison Bagnall, a Speech and Language Therapist who is based in Adelaide, Australia. I would like to share with you some of the techniques she uses to assist in voice improvement with male to female transsexuals. My talk today is to supplement techniques that I spoke about at this conference four years ago.

There are important criteria to be met before embarking on therapy:

1. Transsexuals must be referred by a psychiatrist.
2. They must be motivated. Changing the voice must be a priority for the transsexual. For some people what they have to say is more important than how they say it.
3. They must be emotionally ready for therapy.

The voice deepens slightly with age and with smokers. If a transsexual has a large frame they are not likely to sound authentic if they use a high pitched voice so to aim for a high pitch is not appropriate.

Before therapy, clients are asked to bring along a tape of a female voice they particularly admire and their therapist asks them what would be their wish list!

Therapy focuses on seven areas:

• Pitch
• Resonance
• Articulation
• Language
• ntensity
• Roughness
• Non-verbal communication

The most important area to improve is roughness; taking care of the voice is the most important aspect of voice work and is often forgotten in the attempt to raise pitch

A healthy voice

Look after your voice as well as you look after your body, which includes the following points.

• Avoid coughing and throat clearing as much as possible.
• Go to the doctor if you have a troublesome or persistent cough
• Avoid yelling and screaming.
• Rest your voice if you have a throat infection
• Keep neck and shoulders relaxed and seek treatment for any neck problem.
• Do not smoke, and avoid noisy smoky atmospheres as much as possible.
• Drink lots but avoid excess alcohol.
• If someone has not understood you, rephrase what they are saying rather than angrily repeating it.
• Do not whisper as it strains the voice.

Voice Quality

Some transsexuals tend to speak with a breathy voice to emphasise femininity. This is not to be encouraged as it is not an effective or confident voice. Voice needs energy and brightness and must reflect a person's personality. Putting the vocal cords firmly together gives the voice power, and it must be maintained during the length of a sentence.

How to make the voice sound higher and smoother.

To produce good voice quality, the vocal cords must close. If we close them too tightly with a lot of tension, we are producing sound with what is called laryngeal constriction, which is harsh and uncomfortable.

It is necessary for transsexuals to be able to produce voice with constriction to give them the "feel" of what they should not be doing. Constriction is made by opening your mouth and taking and holding a breath, as if you are going to cough.

So how is good voice produced?

First breathe in and out feeling the breath on the palm of your hand and feel the size of the breath. Notice how quiet the breath is. Then feel the size of the windpipe and the air passing through it. Keep a big space in the throat when you breathe in and out. Is the airway open on in and out going breath? What is the width of the airway? With practice it should feel wider and the breath on the hand bigger.

Laughing or giggling, even silently, are ways of relaxing the throat. When you giggle silently and say numbers 1-10, the vocal cords hardly open and are relaxed. To make an efficient voice, the vocal cords must be brought completely together but in the posture of a silent giggle in your throat so that there is no constriction. Practice saying vowels, words, phrases and sentences etc.

The factors altering the pitch of the voice are the mass, length, and tension of the vocal cords.

The vocal cords are like a musical instrument. The tighter the string of an instrument the higher the note. By making the vocal tract shorter the larynx is raised, which shortens the vocal cords. Every time a swallow is initiated, the larynx lifts so it is possible to feel this movement by placing your finger on your larynx. To shorten the vocal tract, place the edges of the tongue against the top molars and smile. Press the tongue against the palate as in the beginning of a swallow. The larynx can now be felt in this high position

To gain contrast, the larynx can be lowered by keeping the tongue low, opening the mouth and making the 'AH' sound. Practice speaking the vowels a, e, i, o, u, first with the larynx neutral, then low, then high. The larynx in the high position will sound higher because the vocal tract is shorter. The vowel sound "ee" will sound higher than "ah" as the larynx is higher and more forward in the mouth. The tongue position can cause laryngeal constriction if the tongue is lowered and goes back in your mouth. Speaking with a long vocal tract will not carry as well as speaking with a short tract.

Exercises to help protect the voice

Keep the silent giggle posture to release the breath.

Make a "miaow" sound like a cat:
"nyiaow", "nya", "iaow"

Make each sound 10 times
"ny" 10 times.

Use this sound with all the vowel sounds
e.g. a e i o u

Phrases

"Give it to me"
"do it again"
"Dinner ready"
"be quick"
"bye bye"

Singing practice

"All I want is a room somewhere"

"There's a hole in my bucket"

General points to remember

• Do not be afraid to exaggerate when practising exercises.
• Practice for short periods, but frequently
• Learn to use your larynx in a high position all the time
• Changing the voice takes time. Continue therapy until you have achieved the voice that you feel confident with. It is the individuals perception of their voice not anyone else's.

You will be discharged when the therapist feels you have reached maximum improvement, or you feel content with your voice.