Those transgender individuals with either the financial means or, in some rare cases, coverage through insurance can select a number of medical interventions that will assist in merging their physical appearance with their identities.
While a growing number of people state that a transgender individual should not have to acquire society's predeterminations of what is masculine or feminine beauty in order to be respected as a valuable member of it, others insist that medical procedures, whether on the face or body, can have positive effects on an individual's self-confidence and ability to navigate society without always experiencing ridicule, discrimination and abuse.
However one physical characteristic that many transgender people, particularly women, are unable to successfully modify is their voice.
Surgeries exist to alter vocal chords but many who have undertaken the procedures have reported mixed results.
Another option teaches a transgender or gender nonconforming individual to find her, his or their voice without a costly and risky visit to an operating room.
Medical psychologist Marco Hidalgo works both in the Gender & Sex Development Program at Ann & Robert H. Lurie Children's Hospital of Chicago as well as serving as the assistant professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine.
"There's very little research done on the role of voice therapy in transgender populations," he told Windy City Times. "Particularly with a pediatric population there are some young people regardless of their natal gender who may want to improve their voice quality and who could use some support from a professional voice or speech therapist on how to do that in a healthy way."
Hidalgo found that opportunity in an idea suggested by Northwestern University clinical instructor and licensed speech-language pathologist Nathan Waller, who works with voice in children, adults and the elderly.
"The transgender community is a population that we will sometimes see coming for help to sound more feminine or masculine," Waller said. "Throughout my career I have worked with the trans community one-on-one helping them learn better strategies, vocal health and so forth."
"I got a leaflet advertising Nathan's clinic in Evanston," Hidalgo said. "I thought this would be valuable for some of the young people I see in my work at Lurie so I emailed Nathan to see if he would be open to coming down and meeting with our unit's staff."
"I did a presentation about what speech and voice services look like and we brainstormed the idea of [trying] a group setting for trans youth to work on pitch and better vocal habits without causing vocal problems," Waller recalled.
So a partnership was formed between the Lurie's Gender & Sex Development Program and the Northwestern University Center for Audiology, Speech, Language, and Learning which yielded an eight week program for transgender youth and young adults they called "Be Heard for Who You Are."
The program launched on April 13 at the Lurie Children's Center for Gender, Sexuality and HIV Prevention on Chicago's Northside.
Waller said that they enrolled seven students of mainly high school age who include transgender men, women and those who are gender nonconforming or questioning. "They're all kind of at different points in their transition," he noted.
"From a psychosocial perspective having a group of other people like yourself and learning something is a nice avenue to building a sense of community," Hidalgo said.
That small community began with a vocal screening and evaluation for each of the participants—similar but on a condensed scale to the services Waller offers individual clients. "After we were finished with those, the very first class focused on vocal health," he said. "We did a little bit of vocal anatomy and physiology lessons which showed some videos of the vocal chords in action which are always a lot of fun for kids and we talked about how the voice works where you have to have a good repertory system, vocal chords and resonance. Then we spent some time talking about vocal health—typical pointers like how much water you should be drinking on any given day, if you are vocally very busy how it's important to take voice breaks throughout the day and of course not smoking."
As the classes progress, Waller, his team and a Lurie staff member will introduce lessons on pitch modulation. "If someone's working on establishing a lower pitch, some healthy ways to find and be able to hear that and if someone's working on a higher pitch how we do that too," Waller said. "We find the pitch that's comfortable for each individual person. Oftentimes the clients I have seen are speaking too high than what their voice can accommodate on any given day. They can develop all kinds of muscular tension, feel uncomfortable vocally and feel really discouraged."
While hormone replacement therapy can assist transgender men in achieving the desired sound and lower pitch naturally, Waller maintained that there are still many of the same risks. "Sometimes they try to speak even lower or yes the pitch has dropped but they're not quite sure how to operate that," he said. "Just like using a pitch that's too high that can put a lot of stress on the vocal chords. But also looking at intonation and stress patterns during speaking, men tend to use a different inflection than women. They have a smaller vocal range in the speaking voice. Men are not as great as articulating all the consonants and final sounds in words as women speakers are."
Once the students have found their pitch, it will be reinforced with resonance. "It's the placement of voice," Waller explained. "Resonance is when you're placing the voice in your mouth, your sinuses, your chest—those are the healthy chambers that really amplify a voice."
He added that the attainment of both pitch and resonance take as much practice on the part of each individual as it does teaching. In Hidalgo's opinion the results may be well worth it.
"For those who are part of the group it can be very helpful," he said. "Some of the limited research that there is primarily in adults finds that one's own perception of voice is really linked to quality of life in transgender people."
"There's usually a positive reaction when they find that [voice]" Waller said. "The role I will often play is helping someone to feel comfortable with it and developing the ability to recognize the pitch."
Hidalgo said he is encouraged enough by the classes and the results so far that more workshops will happen in the future. "It will be interesting to hear even anecdotally in our pediatric population how these teens are doing as they start to be heard for who they are."
For more information about the workshop, see www.communication.northwestern.edu/f/clinics/TG.pdf .
