A resource for speech pathologists
 Female-To-Male Transsexuals
There is a lack of literature relating to voice and communication issues in female-to-male transsexuals.34 This is due, in part, to the small size of this population and the fact that female-to-male transsexuals often do not seek voice therapy.37
The effects of hormone therapy
A decrease in the fundamental frequency of the female-to-male voice occurs as the result of structural changes in the vocal folds and larynx following the prescription of androgenic hormones.32 As fundamental frequency is a critical indicator of gender, this lowering in fundamental frequency increases the likelihood that the voice of a female-to-male transsexual will be perceived as male and eliminates the need for voice therapy.32
The effects of androgenic hormones take several months before a reduction in pitch is perceived.37 The extent of the change in fundamental frequency, whilst significant, is typically less than an octave.37 The degree of change in fundamental frequency is associated with an individual’s original fundamental frequency. 37 An individual with a high starting fundamental frequency will achieve a greater decrease in pitch than an individual with a low starting fundamental frequency. Androgenic hormones also result in a reduction in pitch range.37 This is of particular concern for female-to-male clients who sing professionally.37
Despite the vocal changes brought about by androgens in the female-to-male transsexual, a voice assessment and counselling is recommended prior to commencement of hormone therapy.2
Voice therapy for female-to-male transsexuals
Voice and communication therapy may be required by some female-to-male transsexuals. Hormones alone may not produce an acceptable masculine voice.35 In addition, clients may experience excessive laryngeal pressure from using a lower pitch and may develop a hyper-functional voice disorder. 2
Unfortunately, there is little empirical evidence to support speech pathology intervention for this population. Suggested therapy techniques include education and training on vocal hygiene, pitch modification and vocal exercises to assist in the maintenance of a lower fundamental frequency. 2
Laryngeal surgery
As with male-to-female transsexuals, pitch in female-to-male transsexuals can be altered via surgical intervention. This is an option for those individuals who do not achieve a satisfactory reduction in pitch following hormone therapy. 2 The procedure, known as a Thyroplasty type III, shortens the anterior-posterior length of the thyroid cartilage, thereby lowering pitch by as much as 100Hz.2 Despite this change, voice therapy may still be warranted as the voice may become weak and monotonous post surgery.2
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Next: General terminology
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