Gender Affirming Hormone Therapy

Can Gender Affirming Hormone Therapy Change Male & Female Voices?

A person is so much more than the “sum of their parts”. There are so many aspects of a person that go into making them feel like their authentic self.  And one of the most recognizable elements of any person is their voice. Whether someone is face-to-face, talking on the phone, video-conferencing, making a presentation at work, and or even posting videos on social media, others will recognize them by their voice.

The majority of cis-gender people take their voice for granted. Unless they are an actor or public speaker, most cis individuals don’t give much thought to the natural pitch or “timbre” of their voice. But for transgender and nonbinary women and men, a voice that authentically matches their gender identity is often an important part of truly feeling like themselves.

As providers of gender affirming hormone therapy (GAHT), we are often asked by our TNB patients if gender affirming hormone therapy will also affect their voice. In this article our gender affirming hormone therapy experts answer this important question.

TNB Men’s Voices & Gender Affirming Hormone Therapy

Let’s start with the good news! Gender affirming hormone therapy can indeed assist in lowering the “pitch” or “frequency” of TNB patients who are transitioning to men. Gender affirming testosterone therapy can help vocal characteristics to become less traditionally female (higher) and more aligned with societal ideas of a lower male voice.

One of testosterone’s primary effects is to thicken body tissues such as skin and muscles – including vocal cords. And vocal cords operate like plucked rubber bands. A thin rubber band vibrates faster and makes a higher pitched sound – while a thick rubber band that is plucked vibrates slower at a lower frequency, which makes a deeper pitched sound.

So, as gender affirming testosterone therapy thickens a man’s vocal cords, his voice will also drop in pitch.

For many TNB men, the voice deepening effects of masculinizing testosterone therapy may be enough to make them comfortable with their own voice. However, for other transgender men, additional gender affirming voice care may be undertaken to alter their communication style, rhythm, and ‘prosody’ (inflection) to achieve a more traditionally masculine voice.

Research on TNB Men’s Voices & Gender Affirming Hormone Therapy

In a groundbreaking research study on TNB voice characteristics, conducted at Brigham Young University, 30 transgender men who were undergoing gender affirming hormone therapy all reported that having a masculine sounding voice was important to their identity.

The researchers determined that testosterone therapy did a highly successful job of bringing transitioning TBN men’s voices into the average cis male range. However, the study authors also noted that testosterone therapy did not fully masculinize some of the men’s more subtle sounds and intonations.

This led the conductors of the study to conclude that adding voice therapy to a GAHT treatment plan for trans men is often needed, as testosterone alone does not completely “do the job all by itself.”¹

TNB Women’s Voices & Gender Affirming Hormone Therapy

Unfortunately, gender affirming hormone therapy for TNB women who begin hormone therapy as adults will not raise the pitch of their voice.  This is due to the fact that, once testosterone has thickened vocal cords puberty, estrogen cannot make them shorter or thinner. So, neither anti-androgens nor estrogens will have a feminizing effect on the voice of adults.

Fortunately, there is clinical evidence that when feminizing gender affirming hormone therapy is started before puberty, TNB girls are able to retain a traditionally higher pitched female-sounding voice. Stated another way, administration of pre-puberty gender affirming female hormones can prevent someone assigned male at birth from developing the thicker vocal cords that typically cause a voice to “drop”.

Additionally, there are other gender affirming voice treatments that can help feminize a TNB woman’s voice so that it matches her gender identity and helps her live more authentically. Both vocal coaching and vocal cord surgery can help transgender women achieve a higher, more traditionally female sounding voice.

But it is essential to note that, while voice therapy can be an integral part of combating gender dysphoria and helping a woman present as female, voice modification is not the right or only choice for every transgender woman. No one should ever feel pressured to present their voice – or any aspect of their identity – in a way that doesn’t make them feel comfortable or align with their authentic self!

Research on TNB Women’s Voices & Gender Affirming Hormone Therapy

A research study conducted in 2016 investigated the effect of subcutaneous (beneath the skin) testosterone therapy on the vocal cords of 10 TNB patients who were assigned female at birth. The research participant’ voices were recorded prior to testosterone therapy and then again at 3, 6 and 12 months afterwards. The study simply confirmed what many gender affirming hormone therapy providers already knew: “Therapeutic levels of testosterone, delivered by subcutaneous implant, have no effect on the female voice – including lowering or deepening of the voice.”²

Gender Affirming Hormone Therapy | Santa Fe, NM

While a person’s voice is just one of many important aspects of who we authentically are, for TNB individuals, finding a voice that aligns with their authentic self is a very personal and individualized process.

Bioidentical gender affirming hormone therapy available at Live Well in Santa Fe, NM is effective at aligning many characteristics with a TNB person’s identity whether the goal of hormone treatment is feminization (male-to-female) or masculinization (female-to-male).

Choosing your gender affirming hormone therapy is a lifetime commitment. We offer a supportive, caring, and knowledgeable approach to helping you make this decision. Schedule a consultation to discuss GAHT with Nurse Practitioner Terri Selvage, FHP-BC, at Live Well in Santa Fe, NM today.

Gender Affirming Hormone Therapy | Santa Fe: 505-988-4922

Citations:

¹ Carolyn R. Hodges-Simeon, Graham P. O. Grail, Graham Albert, Matti D. Groll, Cara E. Stepp, Justin M. Carré & Steven A. Arnocky; Testosterone therapy masculinizes speech and gender presentation in transgender men; Scientific Reports volume 11, Article number: 3494 (2021).

²  R. Glaser, A. York & C. Dimitrakakis (2016) Effect of testosterone therapy on the female voice; Climacteric. 2016 Apr;19(2):198-203. doi: 10.3109/13697137.2015.1136925. Epub 2016 Feb 9.

IMPORTANT DISCLAIMER: This article is provided as general information only and is not intended to be used as medical advice. While the benefits of hormone replacement are well documented through clinical research, only your treating physician can determine if hormone replacement therapy may be a beneficial for you, based on your age, overall health, risk factors, and lifestyle.