1. Transgender Voice Presented by Kelly Pritchard Presented to Rebecca L. Gould, MSC, CCC-SLP

2. Overview Introduction Surgical Options Behavioral Treatment Guidelines

3. “So, you’re dressed beautifully, your make-up is perfect, but as soon as you speak, your voice reveals something about you that’s incongruent with yourself.” ~unknown

4. “Nothing gets you read faster than a voice that doesn't match your appearance. Many gender folk dress up to the nines and look like goddesses... until they open their mouths. Suddenly, in spite of the grace and curves they turn into truck drivers or lumberjacks right before your eyes. Clothes may make the man, but it is voice that makes the woman.” ~Melanie Phillips

5. Although hormone therapy helps women attain a masculine voice, it does not work for male-to-female transsexuals. Male and female voice differ primarily in their pitch (frequency) and resonance. The characteristic pitch or fundamental frequency of the male voice ranges from about 100 to 150 Hz and from 170 to 220 Hz for females.

6. surgically 3 Ways to attempt to increase pitch surgically 1.By decreasing the vibrating length of the vocal cord (highly efficient) 2.By increasing tension of the vocal cord (less efficient) 3.By decreasing the density of the vocal cord (also less efficient). Next, I will attempt to summarize a few surgical voice feminization options.

7. Crico-thyroid Approximation (most commonly performed)

8. Follow up studies for CTA Neumann, Welzel, and Berghaus (2002) reported results in 67 patients; nearly all achieved an increase in fundamental frequency. Only 28% of patients achieved a pitch in the female range (defined by the authors as 174 Hz or greater) De Jong (2003) described outcomes in a series of 30 patients, 26 of whom were available for follow-up. Most patients (85%) were satisfied with their results; mean Fund. Freq. increased from 122 Hz to 181 Hz.

9. Follow up studies cont… Wagner, Fugain, Monneron-Girard, Cordier, and Chabolle (2003) reported results in 14 patients who underwent CTA (9 patients), anterior commissure advancement (2 patients), or both (3 patients). Over three quarters achieved subjectively satisfying results, but the median increase in F0 was only 11 Hz.

10. Laser Assisted Thyro-Arytenoid Muscle Resection (Abitbol Technique) Not Recommended

11. Laser Assisted Voice Adjustment Orloff Technique (LAVA) Not Recommended

12. Thyroid Cartilage and Vocal Cord Reduction Promising, but more research needed

13. Vocal Cord Shortening (cautiously recommended)

14. Behavioral Voice Feminization A program by Marylou Pausewang Gelfer (1999)

15. Voice Feminization Therapy Program Interview Select Target Pitch Habitualize Pitch –In syllables –Words (chanting) –Phrases –Sentences –Multiple Sentences Generalization

16. http://www.tsvoice.com/ http://www.tsvoice.com/ Katrina’s Archives

17. Resources: References Abitbol, J. (1995). Atlas of Laser Voice Surgery. San Diego, CA: Singular Publishing; retrieved July 7, 2005 from http://www.annelawrence.com/twr/ Brown, M., Perry, A., Cheesman, A. D., and Pring, T. (2000). Pitch change in male-to-female transsexuals: Has phonosurgery a role to play? International Journal of Language and Communication Disorders, 35, 129-136; ; retrieved July 7, 2005 from http://www.annelawrence.com/twr/ Gelfer, M.P. (1999) Voice Therapy for the Male-to-Female Transgendered Client, American Journal of Speech-Language Pathology, 8, 201-208; retrieved July 7, 2005 from http://www.tsvoice.com/ Gross, M. (1999). Pitch-raising surgery in male-to-female transsexuals. Journal of Voice, 4, 433- 437; retrieved July 7, 2005 from http://www.annelawrence.com/twr/ Pincus, S. J. (1997, June). Voice surgery. Paper presented at the Second International Congress on Sex and Gender Issues, Philadelphia; ; retrieved July 7, 2005 from http://www.annelawrence.com/twr/ Spenser, L. (1988). Speech characteristics of male-to-female transsexuals: A perceptual and acoustic study. Folia Phoniatrica, 40, 31-42; ; retrieved July 7, 2005 from http://www.annelawrence.com/twr/ Wolfe, V., Ratusnik, D., Smith, F., & Northrop, G. (1990). Intonation and fundamental frequency in male-to-female transsexuals. Journal of Speech and Hearing Disorders, 55, 43-50.