image from https://www.staceyjanevocals.com/blog/www.staceyjanevocals.com/blog-2
People are unaware of the importance of their voices until they have a problem. It is our most expressive tool and most people don’t even realise it. A voice conveys almost everything there is to know about a person within a few seconds – age, health status, emotional state, education and socio-economic background (see my post, Just This). As such, achieving a speaking voice that conveys the real person inside is the goal for most trans people - and usually, the most difficult.
It is a daunting challenge for many trans people to modify their speaking voices to the degree that is satisfying for them, especially trans women. Voices are not like musical instruments, where pressing a key or covering a hole changes the pitch and quality of the sound. The voice is nebulous and just like clouds, if the desired sound is achieved, it is difficult to hold on to and recreate consistently.
We can remove hair, change our facial features with surgery, apply makeup, buy new clothing – all comparatively quickly and easily. If we can’t do it ourselves, someone else can do it for us. But the final touch, the clincher that ensures no mis-gendering, remains elusive to most people – that of a reliable, authentic voice. And in this new world of remote working, when visible cues may be limited to a headshot, the voice is of paramount importance.
Can anything make attainment of this goal any easier? There’s vocal fold surgery, but it’s risky and expensive and satisfying results are not guaranteed. My musings brought to mind a practice that is considered more and more often by medical professionals who help people with gender dysphoria - the delay of onset of puberty.
Pubertal delay is highly controversial, because by definition, pre-pubescent children are considered to not yet have enough maturity to make life-changing or medical decisions for themselves. Conversely, this argument may be one of the strongest reasons to consider puberty blockers, because the effects are not considered to be permanent. Once the treatment is stopped, puberty resumes. According to the Mayo Clinic, there are advantages, which make use of blockers worth considering: “…it pauses puberty, providing time to determine if a child's gender identity is long lasting. It also gives children and their families time to think about or plan for the psychological, medical, developmental, social and legal issues ahead.”
Of course, nothing is so simple. Although it is considered to be reversible, “The evidence of ‘reversibility’ is from studies in a different set of children; namely children with precocious puberty (a puberty disorder in which puberty commences very early.)” In these children, puberty is halted with blockers, but reinstated at a time that is in sync with other developmental growth stages. Most children with gender dysphoria go on to take cross sex hormones, the effects of which are not reversible. For those who do choose to discontinue using blockers without continuing to pursue a change of gender, the cessation of use does not coincide with other maturation stages. In addition, users are at risk of long-term effects on bone density and fertility, so this intervention must be carefully managed. To top it all off, the effects of pubertal blockers on the developing brain are as yet undetermined.
With regards to achieving a voice that is in keeping with gender, delaying onset of puberty is helpful for young trans women. “At puberty, boys' vocal fold grows up to 1 cm, leading to an average lowering of the fundamental frequency by one octave. In girls, the vocal fold grows less than 4 mm.” (Schneider, MA, et al. Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression, 2017) In this study (and many others), hormone therapy (gonadotropin-releasing hormone, GnRH) to suppress onset of puberty of an 11 year old cismale mitigated the effects of testosterone on the maturation of vocal folds. Without the effects of testosterone, lowering of fundamental frequency (f0) was limited to 30Hz during the first year of treatment. After 20 months, the mean f0 increased again to 228, well within the average range for women in Brazil, which is considered to be 150-250Hz.
The current available evidence suggests that young trans women who have undergone hormone therapy to suppress puberty may find production of a satisfying female voice easier to achieve, because the physiological changes to the larynx (laryngeal lowering, decrease of angle of thyroid cartilage, vocal fold lengthening) were halted. As one’s voice is central to one’s identity, use of puberty blockers bears consideration.