Your voice transition – the role of Vocal Physiotherapy

Your voice is made up of so many facets to make it sound like you.  You may never have considered the importance or pitch, quality, resonance, articulation and prosody. However, If you are transgender and transitioning, there is no doubt that you think about your voice A LOT.

In cismen and ciswomen there are anatomical differences in the vocal tract that mean the voice is produced at different frequencies and thus your voice will identify a male versus a female voice.   When transitioning from female to male, hormone therapy makes the vocal cords larger and thus change the frequency at which they vibrate, creating a lower pitched voice.  

If you are transitioning from male to female, hormone therapy doesn’t create changes in the vocal tract or cords and therefore, feminisation of the voice requires an excellent support team in your speech pathologist to ensure that you can alter not only the pitch of your voice but also vocal qualities, intonation and behaviours.  Inflection in speech at a higher frequency as well as breathiness has been associated with a more feminine voice.  

When transitioning your voice and working through either feminisation or masculanisation this creation of new speech patterns requires intensive repetitive practice. This can become tiring and you may find that you experience vocal fatigue at either the vocal fold level (phonotrauma) or at the musculoskeletal level.  It is therefore imperative that you have effective voice protocols from your speech pathologist to minimise any damage to your vocal folds.  

A Vocal Physiotherapist is able to assist you with the musculoskeletal components of your voice transition.  As you practice either feminisation or masculinisation of your voice, you will be using the muscles around your neck and larynx in a different and possibly unfamiliar way.  This can create muscle feedback that may feel like tension or tightness.  Vocal Physiotherapy treatment can alleviate this tension or tightness.

Vocal Physiotherapy can also assist in head and neck posture to minimise additional load through your larynx so that you are able to practice your speech pathology exercises and vocalising on a day to day basis effectively.  

If you are transitioning from female to male, you may be chest binding and you may be feeling tension in your chest or breathing.  Discomfort in your chest can impact the breathing component of your voice and treatment of your rib cage and upper back can alleviate this tension in your body.

Feminisation or masculanisation of your voice can be a long process as it requires you to change many deeply ingrained vocal habits.  Vocal Physiotherapy can assist with this by increasing your physical awareness of your larynx, head, neck and body posture. Treatment can be used as a neuromuscular cycle breaker where it allows different information from your muscles around your larynx, head and neck to be provided  to your somatosensory cortex (the part of your brain where your body is represented) so that it can start to change the information being sent to the muscles.  It may allow you to feel less tension around your larynx whilst you are producing your voice so that it is more comfortable and you can cope with the accumulation of tension from transitioning your voice.   Of course, any Vocal Physiotherapy for a transitioning voice is done in conjunction with your Speech Pathologist.

It is recommended that anyone transition genders or becoming non-binary do seek professional help from a voice expert in transgender voice.  In Victoria, the La Trobe University has a Voice and Communication clinic for those transitioning

If this has sparked some interest for you, or, you are feeling muscular symptoms when you produce your voice, please don’t hesitate to contact the friendly team at Performance Medcine.


Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside, Shelagh Davies,Viktória G. Papp &Christella Antoni,

Voice and Communication Services for Transgender and Gender Diverse Populations

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