Therapy gives new voice to the person some people believe they should be

November 13, 2000

With a small but growing number of male-to-female transgender clients, the need for consistently effective voice feminization therapy has increased in the United States. At the same time speech and language pathologists are looking for tools that better identify clients who will be the most successful candidates for such therapy.

Speech-language pathologist Michelle Mordaunt, a lecturer and clinical supervisor at the University of Washington's Speech and Hearing Clinic, will present five videotaped case studies at 2 p.m. Friday afternoon at the American Speech and Hearing Association's annual conference in Washington, D.C. She also will show a screening form being developed at the clinic that may help identify optimal candidates for voice feminization therapy.

Over the past four years Mordaunt has seen nearly 25 male-to-female clients in the UW clinic and currently has a waiting list of about 40 others awaiting the speech therapy program.

Transsexuals often want to alter their voices as well as their bodies. It is far easier for female-to-male transsexuals to acquire a masculine-sounding voice than for male-to-female transsexuals to acquire a feminine-sounding voice. Getting a more masculine-sounding voice has been achieved for decades by injecting clients with male hormones to lower the pitch or frequency of their voice. But female hormones do not raise the voice pitch of male-to-female transsexuals. An alternative treatment involves surgically stretching the vocal cords to raise the frequency to a more feminine pitch. The surgery is not always successful because it is not possible to accurately tune the voice of an anesthetized person, sometimes leaving patients sounding like Minnie Mouse, according to Mordaunt. The surgery also is non-reversible.

Programs such as the one Mordaunt runs at the UW offer an alternative to the surgical procedure. "The goal is to improve the general perception of having a more feminine voice," she said. "The idea is that a person has to pass as a woman. They don't necessarily have to have a higher pitch voice, but the whole communications package has to be perceived as female. Your voice usually is the scariest thing to change. It may be relatively easy to wear a dress, but people have to work at changing their voice because it is the essence of who we are."

In her conference presentation Mordaunt will highlight the success stories of two of her clients and the less-than-optimal performances of three others. The UW voice feminization program is intensive, running about a year. Clients work one-on-one with a master's level speech therapy student under Mordaunt's supervision. Clients generally visit the clinic twice a week for three quarters and then once a week for one quarter.

By the third quarter, some clients dig their heels in when it comes to generalizing or practicing the skills they are learning in real-life situations, according to Mordaunt. These skills are very practical, such as being able to order a cup of coffee at a coffee bar. The UW program focuses on such things as the rate of speech, intonation, how a phrase is stressed and non-verbal communication through facial expression, eye contact, posture and gestures.

"Men and women speak differently," said Mordaunt. "Most people think women talk faster. Actually, women tend to talk slower. They talk fast using short rushes of speech, but have longer pauses while men keep a more consistent rate. Women tend to talk with a rising intonation, while men speak in more of a monotone voice. Women tend to stress individual words more. Women can say a lot with their face and hands, and transgender male-to-female clients can learn a lot from watching other women. They need to become students of non-verbal communication."

She also will be discussing a screening form that is being developed at the UW clinic to help identify transgender clients best suited for successful voice feminization therapy. "We hope to find out why certain people do not succeed with this therapy and why some dig their heels in. Voice feminization tends to be the final step in the male-to-female transgender process, and usually proves to be one of the most difficult because our voice is like a blueprint of who we are. We identify very closely with our voice and how we sound. Changing the voice a person has used for many years is a complicated and delicate process," she said.

"Changing your 'voice' is a life change. Our goal one or two years down the road for our clients is that their new speech pattern comes so natural that they don't have to think about it while they are talking," Mordaunt said.
For more information, contact Mordaunt in Washington, D.C. Nov. 15-19 at the Grand Hyatt Hotel at (202) 582-1234. After those dates she can be reached at (425) 649-9533 or

University of Washington

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