Voice training for trans women: courage to speak

The voice is very important for many trans women. For almost a year, Sophie S. worked with a speech therapist on one that suits her.

Sophie S. (l.) and the speech therapist warm up their voices with "bubbling" (picture from 2018) Photo: Laurenz Schreiber

Sophie S. looks at the Asian restaurant’s blackboard, which lists the dishes. "The M17 for me, please," she says to the waitress. S. doesn’t speak too loudly, but not too softly either; she doesn’t mumble, she doesn’t look at the floor. She orders so that the waitress understands what she wants to eat. She orders the way people order fried noodles with vegetables and tofu in a restaurant.

A year earlier, this would have been very unpleasant for S.. Because S. is trans. And while she was able to adjust her appearance with makeup and clothing without too much effort, her voice remained deep – some would say "masculine".

"As soon as you open your mouth and it doesn’t match the expectations of the person you’re talking to, you get funny looks," S. said just under a year ago. "It just doesn’t match: My appearance, how I feel – and the deep voice on top of that. I scare myself in parts." For her, as for many trans women, the voice is particularly identity-forming and important for self-confidence.

So S. has been fighting, an exhausting battle against her larynx. She has spent a lot of time in a practice room in Hamburg’s Wandsbek district. There S. also sits on a day in the fall of 2018 and has a large straw in her mouth. She is using it to bubble in a glass of water. Sitting opposite her is speech therapist Maria Wilde, also wearing a straw. The two women thus warm up their voices. Wilde is to help S. develop a voice that is perceived as feminine.

Nail, Fog, Navel

Sophie S. is 27, studies computer science at the University of Hamburg and works as a developer in a software start-up. At the end of 2017, she turned to the University Medical Center Eppendorf (UKE), which has established its own competence center for trans people. "I put it off for a long time, but then I realized: there’s no other way." At UKE, she learns that voice alignment is considered an important part of transition. She hears about how speech therapy can help with this in YouTube videos and contacts Wilde.

Wilde is an expert on voice alignment for trans women and published one of the first German-language books on the subject. Now she sets a tone on the computer that S. should achieve with her voice. presses out a sound. "Come on, a little higher," says Wilde, pointing to the ceiling with his index finger. The next sound fits. reads out individual words that begin with the letter N. The letter is particularly suitable "because the voice can be raised here," says Wilde.

Surgery can shorten logo-pedagogical training. For Sophie S., however, that was out of the question.

S. speaks: Nail. Fog. Navel. She’s unhappy.

"I can’t control the voice right now, it sounds a bit like Mickey Mouse," she frets. So the two reach for the straws again and bubble in the tap water for a few minutes.

"The mucous membranes have to work a lot," Wilde says, "but don’t forget: mucus is our friend, we need it." S. clears her throat. She brushes her long blond hair behind her shoulders and starts over.

Making a phone call is a hurdle

"I can see your larynx going down," Wilde says. She puts a mirror in front of S. "But it should stay up!" the speech therapist demands. reads again: nose, nights, nanu. Now the larynx stays up. "Very good," praises Wilde. The two women smile at each other.

It is only S.’s third lesson with Wilde, she is still very dissatisfied with her own voice. That’s why she says little or even nothing in some situations, for example, when she enters the quiet carriage of the Hamburg subway. There she immediately speaks more quietly than on the street, where the noise of a jackhammer from the construction site still provided acoustic protection.

S. does not like ordering in restaurants. But telephone calls are even more unpleasant. Because voice is the only means of interaction here, she doesn’t dare call in using her name, Sophie. "The old life then stumbles across the way," she says.

Medically, there are different ways to get a voice that is perceived as female. Taking hormones is not one of them; these have no effect on the voice in trans women. Instead, speech therapy or a combination of surgery and speech therapy can lead to success. ENT physician Markus Hess specialized in "voice feminization" twenty years ago. He offers surgery for trans women at the German Voice Clinic, which he founded in 2013 on the grounds of Eppendorf University Hospital.

Alternative: surgery

"There are trans women who can adapt the female voice in such a way that they don’t need surgery. But in the moments when one is uncontrolled, for example when laughing or sneezing, it can be that a low tone slips through. Some people are bothered by having to constantly watch their voice," says the physician. Then Hess uses microsurgical instruments to shorten the front part of the vocal folds, which are only a few millimeters long anyway.

He then sews them back together with a thin thread. Through the operation, a trans woman can raise her voice up to an octave, the doctor explains. He prepares his clients in detail for the decision to undergo surgery, he says. "Because once you have this kind of surgery, there’s no going back."

Anyone who wants voice therapy must go to an ENT doctor or phoniatrist. The doctor can write a prescription and the health insurance will cover most of the voice therapy. It is not necessary that "transsexuality" has been diagnosed – a "functional voice disorder" should be diagnosed on the prescription.

Speech therapistswho specialize in trans people can be found via the search function on the website of the German Federal Association for Speech Therapy (dbl-ev.de). There is also a map of Germany with contact points on the blog "hormonmaedchen.de". Further information, for example on possible operations, can be obtained from special outpatient clinics.

For Sophie S., surgery was out of the question, although it could have potentially shortened the duration of speech therapy. "I’m very cautious about surgery and afraid of complications," she says. And so, for ten months, about 30 times in total, she went to the speech therapist for a 45-minute session. Just under a year is the usual length of therapy, Wilde says. In her case, the health insurance company covers a large part of the costs.

The training is strenuous; Wilde calls it "high-performance sport for the voice. "If you want to have a washboard stomach, it’s not enough to do five sit-ups once," says the speech therapist, "You have to work at it every day." That’s the only way the muscles can build up and the technique can develop. trained for half an hour a day in the beginning.

Higher and higher

In the meantime, it has become significantly less. In July, S. was at the speech therapist for the last time, she is satisfied with her voice. "At some point, the moment came when I realized: Now it’s okay," she says. The adjustment of her voice was a gradual process, in which she herself often hardly noticed the progress.

But when the speech therapist recently played her an audio recording from one of the first lessons, she realized how much her voice had changed, S. says. And even though she still sees "room for improvement," she’s satisfied: "I have the courage to speak." At the startup where she works, she’s even taken calls with customers, she says, looking proud.

S. pays less attention to her voice now – and that’s a good sign. But perhaps she will practice more in the future, of her own choosing. In junior high, she sang in her school’s choir until her voice broke and she lost the fun. Vocal cord surgery was also not an option for her because she was afraid of losing her singing voice.

So she still has the option of singing in the choir again. "You never know," she says. But singing karaoke with friends is just about enough for her. She’s been doing it again for a few weeks now.

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