What you can expect

Voice feminizing therapy can include speech therapy aimed at feminizing your voice or laryngeal surgery with therapy before and after surgery.

Targets of voice feminizing therapy might include:

• Pitch. The average speaking fundamental frequency of adult males is approximately 107 to 120 hertz (Hz), while for females it's 189 to 224 Hz. To be perceived as female, it's helpful for the voice to stay above around 165 Hz.
• Prosody. Prosody is the melody of speech and includes loudness, pitch and stress changes. Men tend to use stress or loudness for emphasis, while women often use greater pitch variability.
• Vocal resonance. This term often refers to the perception of vibrations when using one's voice. The location of vocal resonance isn't fully dependent on your gender. You can have a throaty resonance, where vibrations are focused in the throat or chest, or a forward resonance, where vibrations are experienced around the lips and nose. A speech-language pathologist can help you find a healthy resonance that reflects who you are. This takes practice, exploration and experimentation with your voice.

Therapy will also address:

• Voice quality
• Articulation
• Speech rate and phrasing
• Nonverbal communication, such as eye contact, use of hand gestures, facial expression, posture and head nodding

During a session, you'll learn and practice techniques to feminize your voice. A keyboard or piano may be used to help you target pitches, and visual frequency tracing software can help measure progress in real time and for reassessment.

The frequency and duration of treatments will depend on your needs. Treatment can involve individual or group sessions.

You also might consider surgery to raise the average speaking pitch of your voice. Your surgeon will explain how much surgery can be expected to change your voice and the possible risks.

Voice surgery doesn't require the referral of a mental health provider. However, talking to a surgeon and mental health provider can help you make a fully informed decision about the timing and implications of the surgery in the context of your social transition.

Two surgical options used most frequently to raise voice pitch include:

• Anterior glottal web formation. This surgery creates a web or scar band at the front of the V of the vocal cords (anterior commissure). This shortens the vocal cords to help raise voice pitch. Anterior glottal web formation affects frequency range by eliminating the ability to produce lower pitches. It also narrows the airway to some degree. As a result, this surgery might be less appropriate for vocal professionals and, perhaps, serious athletes.
• Cricothyroid approximation (CTA). This surgery fixes the cricoid cartilage to the thyroid cartilage, elongating the vocal cords. This results in a higher speaking pitch and a reduction in the ability to lower pitch. However, studies have found that this technique doesn't have a lasting effect.

After surgery, you'll have follow-up visits with a speech-language pathologist to make the most of your surgery, protect your vocal health and learn to use your changed voice.

Keep in mind that surgery to minimize the thyroid cartilage or Adam's apple (tracheal shave) isn't considered a voice feminizing procedure.