#20: Voices in T(ransition)
COMMUNITY VOICE: Sandy Sahar Gooen | HEALTHCARE EXPERTS: Kris Königin, Rachel Coleman MS CCC-SLP | COMMUNITY REVIEWER: Preston Max Allen
RESOURCES
Things we mention
CoreIM episode (from Richard/Gaby among others) on trans health (with useful information about expected timelines for physical changes on gender affirming hormones - both masculinizing and feminizing - please note, intended audience is healthcare providers!)
QHP’s very own non-binary health episode, Beyond the Binary
GLMA - our season 3 partner! More on them soon!
Things Rachel mentions
Vocal Congruence Project - collated resources to help people find alignment between who they are and their voice/speech
Univ of Iowa’s Voice Team Locator
App for voice modification - Attuned Voice (heads up! Still in beta testing as of October 2024)
Sean Parker Institute Gender Affirming Services
Lastly…
A plug for TheeTEMPO, Sandy’s Trans & Expansive Music Professional Organization!
SHOW NOTES
Our disclaimer
This episode is about trans folks using gender affirming testosterone and resulting changes in their voices.
This episode does not focus on:
Transfeminine folks (or their voices!)
Many of the other body changes related to T (see above links to CoreIM and QHP episodes for information on this!)
Anatomy (and some related concepts)
The anatomy
The voice box AKA the larynx: the area where the vocal cords sit (between the lungs and the top of someone’s windpipe, or trachea)
The vocal cords: sit inside the voice box, and make noise (AKA, speech or singing) when air passes over them
What impacts pitch?
Length and thickness of vocal cords
To some extent but less so, the position of the vocal cords within the larynx (or voice box)
The volume of someone’s lungs and overlying chest tissue impact resonance, or how the air vibrates as it moves over the vocal cords
Testosterone is not the only gender affirming step someone can take that impacts their voice.
Voice coaching or training with the goal of modulation is always an option
Binding can limit the range of lung expansion, which in turn can impact voice
More notable in singers or folks who require projecting
Folks who bind and then stop may find their voice or vocal endurance changes due to changes in lung capacity
A reminder - here’s a safer binding resource from our friends at Callen Lorde!
Top surgery, or a gender affirming mastectomy, can also impact voice to some extent due to impact on chest tissue
The “how long until…?” question
Short answer - it’s hard to predict timelines for voice changes, as our bodies - and their responses to hormones - are highly individual!
Long answer
Usually, somewhere in the range of 6 months to two years for things to completely settle, though folks can notice changes to voice before
Testosterone dosing probably, but not for sure, impacts the rate of change (i.e. the lower the dose the slower the change)
As such: folks who use their voice professionally may consider lower doses at first to minimize changes that their coaching or training cannot keep pace with
Testosterone does not cause “vocal trauma”
What is this vocal trauma, anyway?
Refers to unintentional damage to vocal cords
Commonly see vocal trauma due to vocal nodules or overuse injuries
What vocal trauma isn’t
The conscious changes in voice and adjustments a speaker or singer makes that change voice
These do not themselves constitute damage or harm, even though they can cause someone’s voice to sound different
A related (but distinct) term: muscle tension dysphonia
When the muscles that control the larynx (voice box) and vocal cords are too tight and spasm
This can cause voice cracking, limit vocal endurance, and make folks feel like they don’t have good control over their voice
And yes, this can happen on testosterone
So, why aren’t T-induced voice changes vocal trauma?
The idea that testosterone for gender affirmation is “traumatic” is an idea inflected with a touch of transphobia
Like we said before, just because there is change doesn’t mean there is harm
Pitch is not the only thing that impacts voice!
Yes - testosterone primarily changes pitch!
But, other qualities of voice include:
Voice color
Brightness
Tone
Roughness/smoothness
Breathiness
Intonation emphasis
The gendered perceptions of voice often traffic in or are based in larger stereotypes about gender. So while some folks may want a more “binary” voice, there is an elaborate and multidimensional spectrum of ways to modulate voice
You, your voice and your voice team
What’s in a voice team, anyway?
In addition to the person prescribing testosterone (a clinician such as a doctor or a NP), the team can include some specialized folks, such as:
A speech and language pathologist (or SLP) – who helps address medical and structural concerns with T-induced voice changes
A voice coach
Who can help train other aspects of voice (brightness, color, tone – oh my!)
Can also be useful at providing strategies to work around voice changes – for example, singers might try to find music in different pitches to allow for dynamic, day-to-day variations in voice
Also, possibly an ear/nose/throat doctor
When’s a good idea to consider seeking out a team of voice professionals when starting T?
Per Sandy (our community voice): if voice was a professional priority and someone is starting testosterone
Per Rachel (a speech language pathologist and one of our healthcare experts): if you’ve had prior vocal issues (such as nodules) before beginning T
TRANSCRIPT
Sandy: There are certain vocal qualities that are kind of stereotyped as like, "trans guy voice" that I personally don't experience. And some people want to sound a certain way, and seek that quality out. But I think that there's just such a diversity of how people–both on testosterone and not–sound, that the fact that there's a monolithic stereotyped trans guy voice is just not universally true.
[QHP THEME MUSIC BEGINS]
Gaby: Welcome to Queer Health Pod!
Sam: I'm Sam, I use he/him pronouns, and I am a primary care doctor in New York.
Gaby: I'm Gaby, I use she/her pronouns, and I'm also a primary care doctor in New York.
Richard: And I'm Richard and I use he/him pronouns and I’m – wait for it –also a primary care doctor in New York City.
Gaby: And you are listening to Queer Health Pod, season three, episode one: voice changes for folks on T. Which is not me. I just have a cold.
[QHP THEME MUSIC ENDS]
Gaby: Welcome back, everyone! We have a really amazing season three lined up for you. But before we start that off with today's episode, we do have a little bit of QHP news, which is that: this season, we partnered with the organization GLMA, Health Professions Advancing LGBTQ Health Equality.
Sam: In fact, right before we sat down to record this episode, we had just gotten back from GLMA's 42nd Annual Conference.
Richard: Full disclosure, I love this organization and I used to be on the board. Since its inception in 1981, GLMA's annual conference on LGBTQ+ health has served as the premier scientific conference shaping the future of LGBTQ+ healthcar – where health professionals come together to share innovative breakthroughs and interventions as well as the latest research on LGBTQ+ health.
Sam: The conference is open to healthcare providers of all disciplines, researchers, academics, health administrators, policy experts, advocates, and all LGBTQ+ health supporters.
Gaby: Because GLMA is our season partner this season, we're really, really stoked to be putting forward two episodes covering content on this year's conference.
Sam: More on that next episode. But let's jump into today's topic, which is vocal cords.
Richard: What Sam means is: on this episode, we're going to be talking about voice changes for folks who are taking testosterone.
Sam: You already heard from our community voice, but let's give him time to introduce himself.
Sandy : My name is Sandy Sahar Gooen. I use he/ him pronouns. I am a singer, music professional. Trans man that's about it.
Gaby: As an aside, you don't need to be a professional singer or anything like that to benefit from the information that we're going to put forward in this episode. But, Sandy's particular story and his identity is going to really help us get into some of the subtle nuances that come with voice changes..
Richard: The highs and the lows you might say?
Sam: Oh, wow.
Gaby: Oh god, Sam, help. He's starting with the dad jokes. I – I guess I mean daddy jokes?
Sam: Season three and you're both taking the stupid puns for me! I can't tell if this is a demotion or a compliment.
Richard: A little bit of both.
Gaby: All right. All jokes aside. This episode today is going to be structured in three parts.
Sam: First, we'll talk about reframing the whole gendered idea of voice ranges and misconceptions around voice changes that flirt with or are overtly transphobic.
Gaby: Next, we're going to detail the different qualities of voice that change, not just pitch, when people start testosterone. We'll also talk about the timeline for some of these changes.
Richard: Finally, we'll share some of our guests advice about how, when, and why to engage with voice professionals around your voice change journey.
Gaby: And then finally, a caveat, which is that folks assigned female at birth who use gender affirming testosterone are gonna have many other changes to their bodies as a result of T. Those changes aren't going to be covered on today's episode, but we do cover them a little bit in our episode on non-binary health. And I'm going to link to some of the episodes that Richard and I worked on for a different podcast, it's called Core IM. Full disclosure, the podcast is actually meant for health professionals, but I think the discussion of timeline of changes to your body that can happen on hormones is still really useful here.
Richard: Highly recommend, but let's get back to Sandy, who's going to start off by telling us about how his voice changed long before even starting T.
Sandy: Some people find that binding doesn't impact their voice…it definitely did for me. I am somebody who is in a larger body –especially for folks that are listening, so they wouldn't necessarily know that about me. And so binding – and asthma, which is something else that I've lived with – it really did a number on my breathing to have to bind. And then being done with binding and recovering from surgery and learning about different ways to breathe, to accommodate my changing physique, improved my quality of singing and my comfort level once I was done with binding.
Sam: Binding impacts the volume of someone's lungs by adding extra pressure and tension to the chest. The ability to move air through and over the vocal cords is what allows for speech and singing. In addition, overlying chest tissue or a change in that chest tissue, like from top surgery, can also impact resonance or how the air vibrates when it moves over the vocal cords.
Gaby: We're going to revisit vocal cord anatomy a little later in this episode. I want to get us back to Sandy's story. I'm going to fast track us to after his initial professional voice training in college, and to his first day of testosterone.
Sandy: And I actually had my first shot of testosterone the day after my senior recital. There was a concern that it would interrupt my training; that it would interfere with the process; that it would become the entire focus of our work in my voice training; that I would be unpredictable. And, you know, that is somewhat true, but what I've learned in my experiences, both as a singer and teaching voice, every voice is unpredictable, not just trans voices.
Gaby: For Sandy, the voice changes that came with his T use were an important part of his transition and his gender affirmation. But this isn't a universal feeling. As it's been said before in this podcast, transness isn't a monolith.
Sandy: Before I say what I'm about to say, I want to acknowledge: I know a lot of transmasculine people who choose not to go on testosterone, whether or not they're singers, because their parameters of masculinity do not hinge on their voice. For me, I was being placed in boxes in my work and in my life where I felt very small. I was kind of just perceived in a way that felt kind of unfinished. I was kind of, uh, infantilized, almost. And I felt like to step into my own voice and my own self that I was kind of missing lower resonances, and I wasn't going to achieve that personally through just voice training. And there were other things that I wanted testosterone to do, so I knew that it was the right choice for me.
Richard: All that being said, Sandy had some really lovely and expansive ways of thinking about the relationship between voice pitch and gender.
Sandy: So I just did my thesis research about voice parts, and I'm not a huge fan of those labels, but I know that there's something that people recognize. So because they have a gendered history and also because range is so variable. The labels that we use to dictate that can change on a dime just by a pitch or two. I think that rather than marrying oneself to a fixed identity term, it's better for solo singing, in my opinion, to focus on the functional aspects of the voice rather than, be like, “I am baritone” – or whatever. In a string quartet, you've got your high voice, you've got your low voice, you’ve got your inner voices. And if you talk about it that way, and you think about people as a human string quartet that are each playing a role…gender is not really what we're talking about anymore. We're talking about the musical relationship. And I think that makes people feel better and more included.
Gaby: I really love this reframe. And also, Sandy makes a point, which is that not everybody is thinking as expansively as he is about this so-called human string quartet.
Sandy: I've heard people just straight up complain about working with trans people. I don't love it. I'm just acknowledging that that's part of the conversation. There are people for whom hormones have longer term, uh, let's say vocal concerns that may pop up I've heard people blame that on hormones. But I also think that there are cis people with vocal concerns and that they should all be treated with dignity and having a good care team.
[TRANSITION MUSIC STARTS]
Richard: Dignity. Famously something we love on this podcast.
Gaby: For everybody, but me, because I embarrassed myself on this podcast daily.
[TRANSITION MUSIC ENDS]
Gaby: So this is the part of the episode where we get to zero in on the science. We're going to talk about vocal anatomy, we’re going to talk about how that's affected by testosterone, and then finally, we're going to talk about how that shows up as voice changes for some people.
Sam: And we have two clinical experts today to help explain all of that.
Rachel: My name is Rachel Coleman, she/her. I'm a senior speech language pathologist. I work at the Sean Parker Institute for the Voice, which is at Weill Cornell Medicine, and I evaluate and treat patients with voice disorders. There are lots and lots of subspecialties within the world of speech pathology. Sometimes, when people meet me, they assume that I work with people who stutter or children with lisps. Those certainly are things that some speech pathologists do. My specialty is helping people who have problems or concerns related to their voice. My clinical and research specialties include care of the professional voice, treatment of neurological voice and speech disorders, and gender affirming voice care, which is a research interest of mine
Sam: OK, and here's guest number two.
Kris: I'm Kris Königin. My pronouns are they and he – slight preference for they. I am a freelance voice teacher and I'm the company manager for Teatro Nuevo, which is a bel canto opera company. And I've been training exclusively trans singers for the last eight years, and I've given lots of workshops on the topic and masterclasses usually at the Philly Trans Wellness Conference, I've done a lot there. So I've been immersed in the world of trans singing for the last eight years.
Richard: All right. So now that Kris and Rachel told us what they do, let's identify what the difference between a voice coach and a speech and language pathologist is.
Kris: I think depending on the field, the term “voice coach” might mean different things. So like, whenever I'm working like an opera, a voice coach is usually coaching the singer, like, on stylistic things and, like, how to interpret the music. Whereas like a voice teacher voice instructor, which I consider myself more of, focuses a lot on technique and like technical aspects in addition to the other stuff.
Rachel: A speech pathologist, even if they are a voice specialist and rehabilitate singers, someone such as myself, our job isn't necessarily to make you the best singer. Our job is to rehabilitate your instrument so that you have the capacity to become the best artist.
Gaby: Okay. So by way of summary, a speech language pathologist focuses on the medical and I don't know, structural integrity of the voice instrument, making sure it's up to snuff. And that's going to enable a voice coach to work on technique and stylistic choices to create the optimal sounding voice, for the project at hand. Now that we have the full cast on the stage. Let's get into some anatomy.
Richard: The vocal cords themselves are two pieces of soft tissue that close in on each other like curtains, and the opening that air passes through determines the type of sound produced.
Gaby: Right, which if we sort of demonstrate for you will
Sam (singing): Did you know I was in the Godspell Chorus?
[CRICKETS CHIRPING]
Gaby: Sam, just a clarifying question – when were you in the Godspell Chorus? Like, was this in like, seventh grade?
Sam: That was, um, private information.
Richard: And while we didn't get to ask Rachel about her previous middle school musical experiences, we did get to talk to her about how gender and sex assigned at birth can play a role in vocal anatomy.
Rachel: The vocal folds of cisgender men are 60% longer than those of cisgendered women. In addition, the larynx is lower in the vocal tract and all of that contributes to a lower pitch and just a more masculine sounding voice.
Sam: So what exactly does testosterone change about the vocal cords?
Rachel: So when someone is taking testosterone, what it's doing to their vocal folds, it's essentially making them thicker and longer. The research is showing that it's partially changing the size of someone's vocal tract, meaning it's kind of lowering the vocal folds and the larynx somewhat, but not entirely. What it's not doing is changing their lungs, which is, you know, our breath support is the power behind our voice.
Richard: Regardless of the T dose, the vocal cords wouldn't change overnight anyway. So there is some individual variability in how long it takes to see voice changes.
Rachel: The timeframe can really vary. So, for some people, there can be a dramatic change occurring in, you know, the two to three month range. For some people, the changes are very gradual at first, and then there's a dramatic change in the six-month mark. For most people, it takes six to 12 months to really kind of get a sense of where you're going to end up from a pitch standpoint. But anecdotally, we've heard from people where years later it's still evolving, not necessarily in terms of the pitch itself, but again, your voice is more than just your pitch. It's everything, right? It's the pitch, it's the quality, the color of the voice, communication style. And I would say that that's true for voice in general, no matter what the gender. It's very fluid, and it's really very person dependent.
Gaby: And here's Kris on the timeline they frequently see.
Kris: For transmasc folks who have just started testosterone, realistically, it takes anywhere from two to four years to fully “settle.” I don't like using that word, because the voice is always changing, but that first year is the most turbulent. And the head voice, too when you're singing – like (in head voice) aaaaah – like up high, like that is the most unwieldy part.
Sam: Part of the timeline and setting expectations is emphasizing how practice is critical to rehoning and retraining specific musical skills with someone's voice instrument.
Kris: I think there's a misconception, especially with trans masculine folks, that because the voice changes, like you don't really have to practice. And that is absolutely not true because it's a different instrument. It's an entirely different instrument. This has come up a lot, especially for people who are still in university –like if they're doing undergrad music degree. When they take sight singing and ear training, I've had so many people come to me and say, “My teacher thinks I suck because I can't match pitch – I can match pitch. It's just not doing what I want it to do.” You have to relearn your instrument. It's a very frustrating period, but you have to devote a lot of time to practicing, even like 10 minutes a day, it can take you a very long way.
Richard: Hey Sam, how do you get to Carnegie Hall?
Sam: I buy a ticket and I take the R train?
Richard: No, practice, practice, practice.
[SAD TROMBONE “WOMP WOMP” NOISE]
Gaby: Anyway – we do want to note that the changes that Rachel described about how T impacts the vocal cords are seen as something that's irreversible.
Sam: Correct. The thickening and lengthening effect does not go away if the body sees lower levels of testosterone after gender affirming testosterone use.
Richard: So as primary care folks who prescribe hormones, the irreversible nature of this change is something that we discuss with all of our patients before we start T to make sure that they're on board and know that this will happen.
Sam: We've been talking a lot about voice pitch because that's what T primarily changes, but in reality, there's a lot more to the picture.
Rachel: I hope that the one thing that, that people take away is that pitch isn't everything. How people feel about their voices and even how we perceive other people's voices - pitch is a huge part of that, but it's not the only parameter that goes into our perception.
Gaby: What Rachel's getting at here is that there are a lot of qualities to your voice that aren't tied to your vocal cord anatomy. Like – well, actually, let's just let her tell us.
Rachel: We also talk about the color of someone's voice. So whether it's like a really bright quality of voice, think like Disney princess –
[DISNEY PRINCESS SINGING SOUND EFFECT]
Rachel: – you know, people who have that kind of pingy, cartoony, quality voice versus a darker tone. We talk about roughness versus smoothness. We talk about whether we want something that's breathy or not. We talk about intonation. Whether we want someone who (using exaggerated intonation) really exaggerates their intonation versus someone who's (using flat intonation) just very flat and kind of talks all in one tone. A lot of this deals in stereotypes. You know, stereotypically, for example, females have a very, wide intonation pattern or a varied intonation pattern where we have people talking really high and then dipping down really low. Whereas males have have less variation in their intonation. There are plenty of male speakers who don't fit that norm, and that's fine. It’s really up to my patients and clients to decide what works best for them. But generally speaking, if we're kind of playing into the stereotypes, we're going for a lower pitch – a darker, bigger, chestier sound. Some people like that kind of rougher tone with a flatter intonation pattern, shorter vowels, more clipped speech patterns. So those are some of the stereotypes that we might play into. But again, it's really about the individual to determine what they like, what they don't like, and what feels authentic to them.
Gaby: Rachel's point is that there are so many gendered aspects of voice that have absolutely nothing to do with pitch, and are actually variable and within an individual's control.
Richard: But for some people, like Sandy, pitch ends up being really important.
Sandy: So for me, part of the point of my interest in taking testosterone was to have a changed voice. I had a classically trained mezzo soprano voice prior to this, and I had a great amount of dysphoria and discomfort with my speaking and singing voice. I will say that my biggest fear because of the language around it was that I would either have an abrupt drop or I would have lots of cracking and, you know, tension dysphonias and other issues in my voice based on things I'd heard.
Sam: Dysphonia? I don't know her.
Richard: It does sound like a drag name.
Gaby: Tension muscle dysphonia, not a drag name, is what happens when the muscles around the voice box or vocal cords get tighter than normal. Because they're tighter, they're more likely to spasm or cramp, and when that happens, voice production can crack, or voices can fatigue more easily.
Richard: And that's not the only change. You can see increased vocal roughness, increased fatigue, and increased vocal strain... which is a big part of Sandy's story with T.
Sandy: I knew about but I didn't anticipate, the biggest thing for me with my voice – and it's still taken time – is the stamina and the vocal fatigue. That was the biggest thing. The cracks went away so fast for me because of my professional background. The fatigue did not. The fatigue took years to learn how to work through.
Gaby: Wait, hold on. Vocal. What?
Sandy: Vocal fatigue. I would describe it as the same way that you might talk about regular fatigue. Let's say you start off the day, and you're feeling just fine. But then, it's 2pm, and you already feel exhausted. Vocal fatigue basically means that your energy level and your voice use is depleted much faster.
Sam: There are ways to work around this.
Sandy: The approach that I took to taking testosterone was also to start on a lower dose and gradually monitor levels and increase because I'd heard that can sort of mitigate it. But – your mileage may vary and no one really has an absolute guarantee on that. It just happened to work out in my favor to do it that way.
Richard: If you're wondering whether there's any data behind this, welcome to our podcast and our lives. This has not been well studied.
Sam: But, in the absence of data, we do have Kris's extensive professional experience with testosterone dosing and the rate of vocal changes.
Kris: Some people will start off with higher doses and that's gonna affect the rate of change as well It's not that you can't sing or anything, like it's just gonna make it a little bumpier ride along the way. But medical doctors don't think about singing voice or even speaking voice that much. I was like, I shouldn't be giving advice on what dosage to take, I preface it with that, but say the higher dose you take, the bumpier the ride's going to be like, Either way, it's going to change.
Gaby: Sandy was pretty clear that just because testosterone causes changes that can be considered unwanted, those changes shouldn't be considered pathologic – or in other words, inherently problematic.
Sandy: I would say that it's harmful language because it discourages people from seeking out care that might otherwise benefit them. It paints a picture that if you take testosterone, you will not have a usable voice, which is often patently false. There are plenty of people who take testosterone and can still speak and sing and do other things just fine. But even at graduate school orientation week, the SLP that presented in her slideshow mentioned medications that cause vocal damage – she included testosterone. And I took umbrage at that because I don't know that if I, had a “damaged” voice that I would have gotten into a conservatory graduate program. But – I dunno!
Gaby: This idea that T damages vocal cords actually has a term, “vocal trauma.” And it's a term that Kris has a lot of feelings and thoughts about.
Kris: I hate that phrase. I really hate it. Because like, there's some instance where like, you know, like if you develop nodules or whatever, then yeah, that's a trauma issue. Like you've done something to it. But like whenever it's connected to testosterone use, I hate the phrase so much. The most often I've heard that used towards transmasculine people in particular is usually when, what we lovingly call “trans guy voice,” like that raspy horse sound or not being able to project but like, it's not a permanent state of being. They're judging part of the process not going to be there in a few months. It also verges on, like, transphobiaC Dause no trans person wants to hear that our experience is traumatic for other people. What you're perceiving as vocal trauma is actually just part of the growth process because my instrument changed. That hoarseness and raspiness, whatever, that can go away through practice and training. You just have to get used to the new instrument. I want people to like, wipe that from their vocabulary in regards to trans voices because that's not what's happening.
Rachel: When most medical professionals are talking about vocal trauma, we're talking typically about a physical injury to the vocal fold. Usually we're talking about physical wear and tear, some kind of accidents, surgeries, scarring, and I would really caution people from thinking of this thickening and lengthening of the vocal folds as trauma, particularly in a group of people who are intentionally seeking out that effect.
Richard: It all goes back to Sandy's first reframe of taking the exceptionality out of the trans experience with voice changes in singing and speaking.
Gaby: And with that, I think it's time for a recap.
[TRANSITION MUSIC BEGINS]
Testosterone causes voice changes by thickening and lengthening the vocal cords. These vocal cords are a big contributor to voice pitch, but they actually aren't the whole story.
Sam: There's tone, brightness – lots of other qualities about the voice that can be modified without hormones. If someone is starting testosterone, they will see a change in voice pitch, but timelines are variable. Generally, we know that the lower the dose, the slower the change. And – that change will also come with the risk of dysphonia, fatigue, and cracking, Many of which will self resolve or be gotten rid of with speech therapy.
[TRANSITION MUSIC ENDS]
Richard: For the last part of today's episode, we're going to focus on how healthcare consumers can engage with professionals to support their voices transition.
Sam: Looking back on his experience, Sandy has some general advice about seeking resources for his voice in general.
Sandy: I would love to have found a steady, stable provider from day one. Not just not talking about my prescribing provider. I'm talking about my voice care team, my voice teacher. Because I started like leaving school, I personally was in a position where I had to go hunt for a voice teacher while navigating the early parts of a transition. Which is – hard. My prescribing provider and I had a lot more conversations about a lot of the other aspects of testosterone. We did talk about it, and it was a very, you know, informed consent process. But he wanted to make sure, because I'm a singer, that I understood that I wouldn't always sound great. He didn't put it as a “you can't sing” the way that other people did. He put it as a "you'll probably have some rough times," which is true of most people who undergo testosterone puberty. I wish I had had more of a community. I had some, but I've seen other people more recently having support of fellow trans people going through the same thing. And I encourage people to have people around them who understand the mental and physical process of being on hormone therapy. It helps. For future people doing that, I would say: find your team, get them on board, have them along for the ride, know that it will be bumpy.
Gaby: Even if you're not a professional singer or a professional part-time evening podcast host, there may be a reason to bring in a voice team. Rachel talks about how for folks who have had some kind of trouble with their voice before transitioning, getting voice experts involved on the earlier side may be a good idea no matter what you do with your voice professionally or in your living room. At home. At night.
Rachel: What I would say is if you're someone who has a pre-existing or a baseline voice problem, meaning if you're someone who's always had hoarseness or strain, or you've always lost your voice easily, then I definitely think it's worth seeking out not just a speech language pathologist specifically, but a voice team.
Richard: That being said, Rachel points out that there are many ways to go about a journey of voice changes and that you may not necessarily need a voice team.
Rachel: Medical professionals are really important and there are times where I will absolutely, you know, die on the hill of like, "No, please seek medical attention and medical advice." This is not that time. This is not that hill. I think it's really important to not gatekeep this, and recognize that, that there are plenty of folks who have done this successfully without us. I think it's really important to acknowledge that working with a speech language pathologist is not the only way to successfully modify your voice. There are plenty of people who were extremely successful at modifying their voices using different methods, whether that means they go online and go on Reddit or go on YouTube or, you know, there are apps available, or they seek out the services of a coach. So even though they're not medical professionals, many of them are extremely skilled in doing this.
Gaby: Now, if you are looking for a voice team, Rachel pointed us towards the University of Iowa's voice team locator. And you can check out our show notes on the website for more details.
Richard: Here's Sandy's advice on how to engage with the non-prescribers who are also on the voice team.
Sandy: Checking in with voice care teams that they are comfortable with the idea of working on things in different keys, and that they're comfortable with knowing that there's a student that might walk through the door that has a different voice one day to the next day. As I was saying earlier, there's this idea of coming in and always being the same that is not a realistic expectation for any singer, much less a singer on hormone replacement therapy.
Sam: Kris talked a lot about how he works with students who are new to taking testosterone.
Kris: Particularly with transmasculine folks on testosterone, because the change is so drastic and there's lots of things that, lots of hurdles that come up, especially during that first year – so it's really important to have easier songs. that you can sing through. And we have them in six or seven different keys because – sometimes it changes day to day, it changes week to week. So my goal for all of my students, regardless of gender, is to help them get to the voice that they want to use. I try to get my students to focus on not what they think sounds good, but what feels good.
Gaby: Just because you are trans and your voice is changing doesn't mean something is wrong or pathological. Trans people aren't the only folks whose voices change. And actually, I'll tell you something, I listen to our voices all the time while sound editing. And there's huge variation year over year, episode over episode. Like, I have a cold right now, and I can tell you that my voice right now is a little bit huskier than it's gonna be for the rest of the season.
Sam: And some of us do our warmups before we record.
Richard: To recap, for folks whose voices are changing, there are many ways to engage with professionals, medical and vocational, to support the process. Voice coaches can provide flexible arrangements or ranges of songs to help with the day-to-day vocal variation that accompany being on testosterone. And everyone can normalize that voice changes happen to all people, not just trans people.
Sam: Okay, so we've clearly all become deranged by the end of this episode, so let's get back to Sandy to share one of his other excellent reframes.
Sandy: I wanted to add about talking about the, the stigma against trans performers specifically, and say that there are definitely artists, particularly trans artists, or people who are very trans affirming artists out there, that are more experienced and aware who are making good art. A nd that I'm grateful for that too, even if there are some people who are still unfamiliar. And that I hope that we can bridge that knowledge gap.
[QHP THEME MUSIC STARTS]
Richard: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our community voice, Sandy Sahar Gooen, and our healthcare experts , Kris Konigin and Rachel Coleman. We would also like to thank our community reviewer, Preston Max Allen.
Gaby: More details about this episode can be found on our website, www.queerhealthpod.com.
Richard: And if you like what we're offering, help others find this information by subscribing on Spotify or Apple Podcasts.
Gaby: Lastly, we are on Twitter and Instagram. Our handle at both is Queer Health Pod.
Sam: As always, Thank you to Lonnie ginsberg, who composed the theme music heard throughout this episode.
Richard: Opinions in this podcast are our own and do not represent the opinions of any affiliated institutions. Even though we are doctors, don't use this podcast as medical advice. Instead, consult with your own healthcare provider.
[QHP THEME MUSIC ENDS]
Sam: This thickening and lengthening effect –
Gaby: When are we going to make a joke about "thickening and lengthening" by the way? Is that not -
Richard: I've been waiting for it, Uh, I love the way Gaby says thickening and lengthening.
Gaby: Ew. I just got gayer.