Many singing teachers are now meeting a relatively new but rapidly expanding group of voice students – those who are transgender. If you are new to working with transgender students, you may have some questions and maybe feel a bit uncertain. In this article, I hope to give a bit of background, answer some of your questions, and welcome you to this important and rewarding area of practice.

What is gender transition?
Until fairly recently, the terms “sex” and “gender” were used interchangeably and considered to mean the same thing. It was assumed that a person’s “sex” (genetic makeup) matched their “gender” (inner sense of maleness or femaleness). But we now realize that, for some people, the sex they were assigned at birth does not match their personal sense of gender identity. The technical term for this is “gender dysphoria” and it can cause huge suffering for someone who feels trapped in the wrong body.

To relieve that suffering, the person may go through a gender transition and take steps to make their outward appearance better match who they feel inside. People who undergo this process are called transgender; a transgender man (transman) has female genetic makeup but knows within himself that he is male; a transgender woman (transwoman) has male genetic makeup but knows herself to be female. The term “transgender” also includes people whose sense of gender is not completely binary – either strictly male or female. In this view, gender is like a rainbow with the gender colors blending into each other.

How can I show respect for a trans person?
A kind, open, friendly approach is appreciated by all students, trans or not. For trans people, using the right name and pronoun shows respect. A transwoman is referred to as “she/her” and a transman as “he/him.” Some people prefer the androgynous pronoun “they,”e.g., “They had a good lesson yesterday.” If you’re not sure, just ask – it’s respectful and that way you’re sure to get it right. And if you make a mistake, just apologize.

Questions about gender reassignment surgery and hormone use are inappropriate and unnecessary except in two situations: You may wish to know if a transwoman has had laryngeal surgery to elevate the pitch, and you need to know if a transman is taking androgen therapy because this has a direct effect on the voice.

Is the voice affected in the same way for transgender women (male to female) and transgender men (female to male)?
No! A transgender woman will have gone through puberty as a male. Her larynx enlarged and descended in the neck, the vocal folds became thicker and longer and the voice deepened into an adult male voice. Once puberty is complete, there is nothing that can reverse the process so she may choose voice therapy or phonosurgery to sound more feminine. Voice therapy should be undertaken with a speech-language pathologist qualified to work in this area. Voice therapy goals include raising the average speaking pitch, usually to an androgynous pitch area and modifying voice quality, resonance and inflectional patterns.

There are several phonosurgical procedures used to raise speaking pitch and eliminate lower pitches. However, these are controversial, the outcomes are mixed and they don’t address other vocal characteristics, such as resonance or voice quality.

For transmen, the situation is quite different. Many transmen take testosterone, which automatically and irreversibly deepens the whole pitch range and the average speaking pitch. These changes happen gradually and it can take a year or more before the voice settles. Some men have described this process as “going through puberty”; their voice cracks, squeaks, and is unreliable. While many transmen are delighted with the deeper, masculine sound, some are troubled by the discrepancy between the deeper pitch produced by the larynx, and the unchanged resonance, produced by the shorter, smaller vocal tract. Some transmen are unable or choose not to take androgen therapy and so look to voice therapy to give them a more masculine sound. This can involve reducing vocal inflections, developing a more resonant, less breathy voice, and flattening vocal inflections.

What fach and pitch range should I be targeting?
This is an important question for all singers and particularly for those who are transgender. It’s also one you will want to discuss with your student. Some students would like to keep both a male- and female-sounding voice while others want to leave the old voice behind.

How can I make sure I don’t harm the student’s voice?
Training easy, efficient voice production is paramount. Your student is using their voice in a non-habitual way, and a way that the larynx was not initially designed for. Singing technique can be monitored in the usual way: Does the singer feel any strain or sensation in the throat? Is there any observable strain? Is the voice quality clear and easy? How is the speaking voice after singing? But take heart: The research literature on speaking voice clearly shows that voice feminization and masculinization can be done without harming the voice.

Transwomen and the singing voice
Most transwomen singers benefit from gentle, gradual stretching of the upper pitch range. This can be done safely using a semi-occluded vocal tract technique (vocalizing through a straw, lip bubble, tongue trill, etc.) keeping within a comfortable pitch range. There should never be any strain and the speaking voice should feel normal or better afterwards. Replacing the masculine sounding chest register with lighter registration of a mixed or head voice can also feminize the voice. Slight breathiness may also be useful, depending on the repertoire.

Transmen and the singing voice
In working with transmen, it’s important to ask if he is taking testosterone, for how long, and if the voice is now stable. If the voice is still changing you may want to simply develop more efficient singing habits to reduce strain. Once the voice has stabilized at a deeper pitch, you can help the student learn how to use his new instrument with maximum ease. If your student is not taking androgens and wants to develop a more masculine singing voice, training a resonant voice quality can be useful. You can help him develop an easy, clear, and non-breathy voice with strong, forward resonance sensations. Singing very low pitches should be avoided or undertaken cautiously since this can be fatiguing and damaging to the voice.

Voice teachers truly understand the deep connection between our voices and who we are. You have so much to offer transgender students and their joy as their real voice emerges is wonderful to see. Best wishes in this important work!

Recommended reading
What follows are just a few of the readings I would recommend on the topic:

• Voice, Speech and Gender: a brief overview - http://www.shelaghdavies.com/workshops/information_handout-october_2015_voice_speech_and_gender.pdf

• Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside: a recently published, comprehensive article reviewing the literature on voice and communication change in transgender people:  http://www.tandfonline.com/doi/full/10.1080/15532739.2015.1075931

• Voice and Communication Therapy for the Transgender/Transsexual Client, 2012. ed.: The only publication containing information on training transgender singers.  Adler, Hirsch, Mordant. Chapter 18, The Singing Voice, Anita Kozan.

Shelagh Davies (www.shelaghdavies.com) is a speech-language pathologist in private practice and clinical assistant professor at the University of British Columbia. She specializes in voice training and rehabilitation, in particular with singers and transgender people.

This article first appeared in the "Independent Voices" section of the Spring 2016 edition of Inter Nos, the semiannual publication that provides important information about the work of NATS to its members. Each issue of Inter Nos includes the "Independent Voices" section, focused on the work of independent teachers. 
View the current issue of Inter Nos here.