Transgender Voice

Christopher Donoso
GMSL 6525
November 2017
 ASHA Code of Ethics

(ASHA) Code of Ethics (Principles of Ethics I Rule C),

Individuals shall not discriminate in the delivery of

professional services on the basis of race or
ethnicity, gender, age, religion, national origin, sexual
orientation, or disability (ASHA, 2010).
The Genderbread Person
 Cisgender/Gender
Dysphoria/Transgender
Cisgender
Identifying as the same gender as what they were born as.
Gender Dysphoria or Gender Incongruence
The distress and unease experienced if gender identity and assigned
gender are not completely congruent. (Hembree, 2017)
The persons discomfort with his/her body development prescribed by
the se assigned at birth, especially at puberty. (Hembree, 2017)
NOT a gender identity disorder
NOT a pathology
NOT transsexualism
NOT gender nonconforming
NOT caused by hormones
NOT caused by changes in the brain
Transgender
A person whose gender identity differs from the sex the person from birth.
Trans Male (Transitioned from Female Male)
Trans Female (transitioned from Male Female)
 The Team
Speech Language Pathologist
Psychologist
Surgeon
Endocrinologist
ENT
Primary Health Care Provider
Friends/Family
 The Transition Process
1. Gender Dysphoria
2. Visit with Primary Health Care Provider
3. Visit with Psychologist
4. Visit with Endocrinologist
5. Visit with Speech Language Pathologist
6. Undergoing Hormonal Treatment (Approximately 3 Years)
7. Continuous check up with team members throughout hormonal
treatment
1. Speech intervention maybe necessary if pitch isnt lowering for
transgender men, or for strategies to increase pitch for transgender
women.
1. Surgical intervention may be necessary for trans women to
increase pitch (with referral from psychologist and ENT)
8. Referral from team members to undergo surgical procedures
9. Visit with Surgeon
10. Undergoing surgical intervention
11. Continuous check-ins from team members
 Trans Female: Transition
Hormone: Estrogen
Dosage and frequency vary on
drug type, individual, and
prescription site.
Surgery
Isshiki Original Thyroplasty
Approximation of the cricoid
and thyroid cartilage.
Increases tension on the VFs
Pitch drops over time (in
about a year or two)
Sataloff Cricothyroid Fusion
Fusion of the cricoid and
thyroid cartilage
Complete loss of cricothyroid
space
Reversible

(Sataloff, 2017)
 Trans Female :Voice
Feminization
Thyrohyoid Approximation
Suspends the thyroid cartilage
to the hyoid bone and narrows
the resonance tube
Alters resonance
No known changes in pitch
LeJeune Anterior Commissure
Advancement
Pulls the vocal fold forward
Results a in a prominence on
the thyroid cartilage
Scar Formation
Use to be done
Not Recommended
Causes stiffness & hoarsness
Can result in additional
problems

(Sataloff, 2017)
 Trans Female :Voice
Feminization Cont.
Abitbol Thyroarytenoid
Myectomy
Removal of muscle mass
Reduced VF mass
Increased pitch
Breathy but clear vocal quality
VF Web Formation
Shortening of the vibratory
length
Reduced mass during vibration
Increased stiffness
Increased pitch

(Sataloff, 2017)
 Trans Female: Therapy
Physical exam from the
doctor or ENT should always
be done prior to therapy
Ensure the vocal tract is intact
before doing anything
If something is found during
therapy (i.e., scaring, nodules,
etc.), fingers may get pointed
towards you.
Outing when baritone
voicing emerges during
moments of surprise, sleep
talking, high emotions, etc.
(Sataloff, 2017).

(Dacakis, 2017)
 Trans Male: Transition
Hormone: Testosterone
Dosage and frequency vary on
drug type, individual, and
prescription site.
Results in altered resonance
May or may not result in a
lowered F0
In some cases, testosterone
lowers the voice on its own,
but this is NOT the case for
every patient (Hancock, 2017).
Some pathologies aid in
lowering pitch
Polyps (good)
Scarring (bad)
 Trans Male: Therapy
Physical exam from the
doctor or ENT should
always be done prior to
therapy
Bindings around chest to
make the breast more
discreet but negatively
effect respiration.
Hunched
posturer/rounding of
shoulders
Restricted chest movement

(Ziengler, 2017)
 Gender Fluid or Gender
Nonconforming
Gender Fluid/Gender
Nonconforming
A person who does not
associate themselves with a
specific gender.
May jump between
presenting with more male
qualities to showing more
female qualities.
Voice Goals should target
what the patient wishes to
sound like.
Typically desire a wider
pitch range.
 Speech-Language Pathologist
and Transgender Patients
Consultation prior to transitioning is ideal
What does the patient want their voice to sound like?
Have they started transitioning/When do they plan on transitioning?
What levels of hormonal drugs are they taking/want to take?
High dosage = faster changes = less vocal control
Lower dosage = slower changes = more vocal control
What is their voice typically used for?
Do they require their voice to work?
May be best to utilize a lower dosage for reduced chances of vocal
misuse/abuse.
Age effects the voice
Ossification of laryngeal cartilage
Better to transition at a younger age
Less chance of complications
Ossification begins after 40 yr. and increases by 60 yrs. (Sataloff, 2017)

(Ziengler, 2017)
 Transgender Speech Therapy
Client centered goals
Referral source
Patients gender identity
Preferred name and pronoun
Phonetogram
Dynamic range of patients voice
Perceptual measures
How do you think you sound?
When you think, do you hear a male/female voice?
Support for transition process
Family/Friends/Employer
(Dacakis, 2017)
 Transgender Speech Therapy
Evaluation & Goals
Voice Sample (Decakis, 2017)
Sustained /a/ and /i/
Reading standardized passage
Rainbow Passage / Caterpillar Passage
Read in your best male/female voice.
Targets (Oates, 2017; Sataloff, 2017)
Pitch
Prosody
Resonance
Pragmatics
Articulation
Vocabulary
 Gender Congruence Scale
Strongly agree Somewhat Agree Somewhat Disagree
Strongly Agree Neither Agree nor Disagree
Please Indicate the response that best describes our experience
over the past two weeks.
1. My outward appearance represents my gender identity.
2. I experience a sense of unity between my gender identity
and my body.
3. I do not feel that my appearance reflects my gender
identity.
4. I am generally comfortable with how others perceive my
gender identity when they look at me.

(Dacakis, 2017)
 References
American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from
www.asha.org/ policy
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Person of the 21st Century. Contemporary Issues In Communication Science & Disorders, 4139-54.
Dacakis, Georgia. Evaluating Transgender Voice and Communication. 30th Annual Voice Foundation
Annual Symposium, 2 June 2017, The Westin Hotel, 99 South 17th St., IN. Keynote Address.
Hancock, Adrienne. Current Perspective and Future Directions for Transgender Voice Care. 30th Annual
Voice Foundation Annual Symposium, 2 June 2017, The Westin Hotel, 99 South 17th St., IN. Keynote
Address.
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