When actor Elliot Page gave his first interview after announcing he was transgender, he talked about the massive impact of gender-affirming surgery. It was “not only life-changing,” he told Time in February 2021, “but lifesaving.” Other trans men—who can be at a higher risk of suicide or hate-based violence because of their identity or appearance—have shared similar stories about a short haircut or their first beard. But, according to a 2021 BU-led study, the most sought-after physical change among trans men is a deeper voice.
Despite its importance—and its lifesaving potential—there’s been little research on helping trans men find their voice. For many, the typical route to a deeper sound has been testosterone therapy, but it’s not always effective.
“There is an unfounded prevailing view that taking exogenous testosterone will ‘fix’ the voice, but we still don’t know the mechanism of action of testosterone in this population—and we know for certain that it simply isn’t sufficient in a large segment of speakers,” says Cara Stepp, a coauthor on the study and professor of speech, language, and hearing sciences.
“There is an unfounded prevailing view that taking exogenous testosterone will ‘fix’ the voice, but… we know for certain that it simply isn’t sufficient in a large segment of speakers.” —Cara Stepp
Her lab is looking to address that knowledge gap, exploring the factors that make someone sound masculine and alternatives to testosterone for shaping voice.
One recent project, led by master’s student Felicia A. François, investigated the effectiveness of pitch-shifting techniques borrowed from the treatment of disorders such as puberphonia—when a male voice doesn’t change after puberty.
François (’21) recruited 15 people who identify as transmasculine, recording them speaking before and after a therapist massaged the muscles around their larynx and performed laryngeal reposturing, a noninvasive method of moving the voice box to a lower position. She then evaluated changes to their voice’s pitch, how high or low it sounds, using acoustic analysis software.
“It was really effective for folks who didn’t already have a super low pitch and were on the cusp of the feminine and masculine zone,” says François. She also calculated vocal tract length—the distance between the lips and vocal cords—which can have an impact on resonance, or the fullness of someone’s voice.
The therapeutic techniques didn’t work as well for those with a long history of taking testosterone or with an already low pitch. One limitation of her study, says François, was that the massage was given once and for just 15 minutes. She thinks that might not be enough for people with a lot of tension and tightness around the larynx. “If we tried out these techniques every week, maybe we would have better results for some of the folks who didn’t have a quick response.”
The immediate next move, says Stepp, is to combine François’ findings with those of a new perceptual study: independent listeners rating how masculine or feminine a participant’s voice sounds to the human ear before and after intervention.
Although François recently wrapped up her master’s program, helping gender diverse people find their true voice is something she’s continuing as a clinical fellow at the University of Wisconsin–Madison. For her, the work is personal. As a singing and voice coach, she’s guided many people who are transgender through their journey. And her husband is trans too.
It’s all part of crafting who they are,” she says, “who they want to be, and how they can show themselves authentically in the world, feel affirmed, and feel good about themselves.”