July 2019

The Nation Reviewed

You’re the voice

By Nicola Redhouse
Helping trans and non-binary gendered people define their vocal identity

“I’ve got a deep voice and a twang. I need to get the voice matching the body,” Tracy says, gesturing from her head down to her feet.

Tracy is among five people seated around an assembly of industrial-grey tables in a small room bordered by whiteboards and one-way mirrors. They are about to begin a program at Melbourne’s La Trobe University Voice Clinic, in the hope of gaining a communication style that better aligns with the gender with which they identify. “You can wear everything feminine,” says Tracy, “but you open your mouth and you’ll get stares.”

The Voice Clinic is both a tertiary training facility and a treatment centre, and is run by clinicians who oversee the final-year speech-­pathology students. The students will take the clients through the program – including group sessions such as today’s Education Day, and individual training – under the supervision of clinic coordinator Emma Ball. At the front of the room glows an image of Oprah, arms outstretched beneath the words “You get a voice! Everybody gets a voice!” But before that can be achieved the clients must understand what voice is, and today’s session is all about the basics of vocal anatomy.

“If we were training for the triple jump we’d need to train our legs, arms and core individually, and then practise coordinating these things together,” explains a student. “It’s the same with voice.” The clients will need to get a good balance between the key elements of voice production: breath, the larynx, and the bodily cavities through which voice passes to give it resonance.

They watch a vividly wet video of a larynx in action, and a student lying on her back demonstrates how the diaphragm muscle should move with breath. “You can get your clients to practise this lying on the floor, too,” Ball tells the students later. “It depends how comfortable they are to do this.”

Because you need optimal vocal health to sustain using a different pitch, the clients are told they must make an effort to avoid the main causes of vocal-fold damage, including internal dehydration from caffeine, medications and alcohol, and external dehydration from dry air, smoking and mouth-breathing. They should sip plenty of water throughout the day. “No point slamming down a pint, though,” says Ball. “That’ll go straight through you.” A ripple of water-sipping moves through the room. Throat clearing is another no-no for our vocal folds, as is yelling across a crowded, smoky room. Almost everyone shifts guiltily in their seats and there’s a muffle of coughs. Reflux is another red flag, and one more glistening video of the larynx shows us the frightening spectre of a giant nodule, like a hard corn on the vocal folds.

Once the basics are covered, the students pair off and take the clients through vocal trills (a sort of buzzing sound through the lips), and a series of techniques designed to strengthen voice production. The clients are expected to keep practising these exercises until they return for eight to 12 weeks of individualised voice-­training sessions, where the clinicians will record and analyse their natural pitch, and identify how they can manipulate it up or down within a healthy range.

“Voices are perceived as more masculine if they are between 80 to 160 hertz, louder in volume and use chest resonance, while they are perceived as more feminine if they are between 160 to 260 hertz, lower in volume, breathy, and use head resonance,” a student explains to the group. “Between 145 and 165 hertz is generally perceived as non-binary or gender neutral.”

While trans men who take testosterone as part of their transition will find their voice drops naturally (testosterone thickens the vocal cords), the oestrogen that trans women take won’t heighten their pitch. Laryngeal surgery is one option, but it is costly and outcomes are variable.

“Most of our clients are trans women looking to raise their pitch, or people identifying as non-binary who wish to bring their voice pitch into a more neutral zone,” Ball tells me later. Trans men might also come to the clinic if they need help accessing their new lower pitch and bringing it into habitual use.

The clients, who either self-refer or come through their GP, face a significant waitlist to access the clinic at La Trobe. For more than 35 years it has been the only public facility in Victoria for people looking to masculinise or feminise their voice and communication. While there are fee-free paediatric services elsewhere, the only option for many is a private speech-pathology clinic, which can be costly. “People can wait for up to 10 months to receive training here,” says Ball, whose team of clinicians ranges in number depending on funding. The clinic received four years of funding from Monash Health’s Gender Clinic. That ends in 2020.

At today’s session, one client has not turned up. “We do have a high cancellation rate,” Ball says later. “Transitioning clients have a lot going on in their lives; some are travelling from far away, and many have mental health challenges.” Ball and the team are working with regional partners to see how they can make voice training more available in those areas.

Statistically, the mental and physical wellbeing of the trans and gender-diverse community is markedly worse than that of the general population, because of stigma, social exclusion and discrimination. While many transgender people feel that to fit their voices into a specifically gendered range amounts to self-alteration to appease the discomfort of a transphobic society, for others voice remains one aspect of their identity that they struggle with. Tracy says that being misgendered because of voice and communication is a source of distress among her transgender friends. “We don’t want to be recognised,” she says. “It’s about ‘passing’.”

Many in the trans community try to alter their voices on their own. According to Ball, self-­modification vocal injury in the trans community is not unusual. “Some whisper to sound more feminine. Or they physically lift their larynx.” She demonstrates with her fingers. “This can be really damaging long-term.”

What if a person can’t achieve their hoped-for pitch range? “Communication style can be enough to project a stereotypical gendered identity,” a student explains to the group. One client, a trans woman whose work involved answering phones, could not shift her pitch from a range typically low for a woman, so, says Ball, “we worked on a greeting that used a lot of inflection with greater variation in pitch, which are typically female traits”. For Tracy, it will be enough if she can pass as a woman on the phone. “I answer and they say, ‘Can you put Tracy on?’ ” she explains with frustration. “I’m very annoyed by that.”

Gendered identity can be conveyed communicatively through traits including posture, gesture, intonation, vocabulary and grammar, as well as through conventions like inserting questions into conversation or nodding. Women, another student explains, are more likely to sit up straight and cross their legs, use an upward inflection and a lot of hand gesturing, and they tend to swear less and use more formal grammar than men do. The student reminds the clients that these are stereotypical behaviours. “We want to know what works for you. What do you want your voice and communication to sound like?”

Nicola Redhouse

Nicola Redhouse is a Melbourne-based writer and the author of Unlike the Heart: A Memoir of Brain and Mind.

Image of The Monthly cover July 2019

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