Why transfeminine vocal training can be an important part of gender-affirming therapy — and how to do it effectively

• Transfeminine people can use methods like vocal therapy and vocal training apps to make their voices sound more feminine.
• This process can transform the voice by changing pitch, volume, resonance, articulation, and melodic intonation.
• Some people opt for vocal surgery, but the success rate is variable, so experts recommend vocal training first. 
• This article was medically reviewed by Ravi Iyengar, MD, an endocrinologist at Rush University Medical Center with clinical expertise in transgender medicine.
• Visit Insider’s Health Reference library for more advice.

Transfeminine people with deep, stereotypically masculine voices may train their voices to sound more in line with their gender identity. Working with a vocal coach or an app can help them speak in a higher pitch and with speech patterns common among women. This training can reduce gender dysphoria, which may improve confidence and comfort.

Here is a guide to transfeminine vocal training, including the various options and how they work.

Vocal training for transfeminine individuals 

A transgender person’s natural voice may be inconsistent with their gender identity. This can cause gender dysphoria, or distress due to an incongruence between a person’s gender and their sex-related characteristics, says Kathe Perez, a speech-language pathologist and founder of the vocal training company Exceptional Voice. 

Although estrogen therapy can reduce gender dysphoria related to appearance, it does not affect the vocal cords. 

Vocal training often works through guided sessions led by a speech pathologist. However, singing teachers and speech and drama coaches have also been successful. “There is no industry standard about who should do the training,” Perez says.

The goal of vocal training for transfeminine people is usually to get their voice closer to that of a typical cisgender woman. Each vocal therapist may aim to alter different aspects of the voice. Perez focuses on nine:

1. Pitch: Train the voice to be higher.
2. Voice quality: Women often have slightly breathier voices, Perez says.
3. Volume: When people reach a higher pitch, they often lose power in their voice and must train to keep it.
4. Resonance: Fine motor adjustments to the muscles in the throat and larynx make the voice sound less like a tuba and more like a clarinet.
5. Articulation: Women tend to articulate their vowels and consonants more than men do.
6. Phrasing: Keep the vocal cords healthy and improve other characteristics by controlling breath. Although this technique does not affect how feminine the voice sounds, it is a necessary part of any safe vocal training practice.
7. Pacing: Women tend to talk faster than men.
8. Melodic intonation: Women tend to use lower lows and higher highs in pitch while they speak.
9. Fluency: Women tend to connect sounds more smoothly when they speak.

How to train your voice effectively 

Vocal training usually takes about 10 one-on-one sessions that run between 40 minutes and an hour each, and they may be supplemented by group sessions, which provide an opportunity to practice vocal techniques in a spontaneous, conversational manner.

However, these figures vary. Perez usually starts with a six-hour course to go over the basics and measure a baseline, then holds 11 30-minute sessions over the course of four months or so.

In general, younger patients are able to catch on quicker and may need fewer sessions, Perez says. However, people of any age can change their voices.

Voice therapy sessions

The format of each session may vary between voice therapists. Perez begins with vocal warm-ups, similar to singing a scale. Next, she works on a technique related to the nine vocal characteristics. 

For example, Perez may have a client experiment with pitch by opening their throat and hitting the lowest pitch they can, then the highest. The client then "backs off" from the high pitch, paying attention to how their mouth and throat change, until they reach a desirable range.

Perez records each session so that her clients can listen back and practice the techniques at home. For beginners, she recommends practicing for five minutes, five times per day. More advanced clients practice for 20 minutes twice a day.

The vocal exercises are not painful, but they do cause mental strain. It may be relatively easy for someone to use vocal techniques during an exercise, but they may forget to speak a certain way while having a conversation.

Vocal training apps

Some transfeminine people have achieved the results they want solely through an app, which may include recorded video lessons, structured exercises, and pitch trackers. For those who can't achieve the results they want on their own, Perez says, apps are a useful primer before sessions with a professional.

• EvaF: Created by Perez, this app is available on Apple and Android. Each lesson costs $3.99, and there are 40 lessons available. The app has a 1.6 star rating on Apple.
• Christella Voice Up: Available on Apple and Android. The app includes three stages of training, each costing $19.99. The app has a 4.4 star rating on Apple.

Vocal training insurance coverage

Not all insurance companies cover vocal training for transgender people. In most states, Blue Cross Blue Shield does, Perez says. For Aetna, Cigna, and United Healthcare, it depends on the state and on the company where the employee works. Some major companies, such as Starbucks and Netflix, set aside money to cover their employees' voice therapy when insurance doesn't.

Last resort vocal surgery

Transfeminine people can opt for laryngeal surgery on the voice box to "feminize" their voice. The surgery itself may shorten the vocal cords, reduce their mass, and increase their tension. Surgery does not change all characteristics of voice, but it does increase pitch.

The success rate is variable, and some patients may be left with a voice that doesn't match their gender. They may also experience difficulties swallowing or breathing, scarring, infection, and sore throat. For this reason, Perez recommends trying vocal training before surgery. "If somebody has tried voice therapy, and they really aren't getting it, surgery is a reasonable option," she says.

Related articles from Health Reference: