Male and female voice differ primarily in their pitch (frequency) and in their timbre (resonance). The characteristic pitch or fundamental frequency of the male voice ranges from about 100 to 150 Hz; for the female voice, ranges from 170 to 220 Hz. The lower pitch of the male voice is primarily due to the greater length and mass of the male vocal cords.
The distinctive timbre or resonance of the male voice is primarily due to the greater length of the male upper airway (throat, mouth, nose, and sinuses.. Both fundamental frequency and resonance provide important acoustic cues to the sex of a speaker, but fundamental frequency is the more important cue.
There is currently no practical way to surgically feminize the resonant properties of the airway (more research in this area is needed), but there are several operations that can surgically modify the pitch of the voice.
Fundamental frequency, is proportional to the length of the vocal cords, proportional to the square root of the density of the cords, and is directly proportional to the square root of the tension of the cords
Consequently, there are really only three ways to attempt to increase Fundemental Frequency surgically: (a) by decreasing the vibrating length of the vocal cord (highlyefficient),
(b) by increasing tension of
(c) by decreasing the density of the vocal cord (also less efficient, since the relationship is square root).
Crico-Thyroid Approximation (CTA): The most commonly performed operation to raise F0 is crico-thyroid approximation (CTA), which is shown in the illustrations below.
In this technique, the thyroid cartilage (Adam's apple) is pushed against the cricoid cartilage that lies below it. The two cartilages are then sutured together with nylon sutures, usually placed over bolsters (Isshiki, Taira, & Tanabe, 1983; for another variation see Sataloff, Spiegel, Carrol, & Heuer, 1986). Some surgeons use metal clips to hold the cartilages together. The approximation of the thyroid and cricoid cartilages anteriorly increases the tension of the vocal cords by stretching them posteriorly. This raises the pitch at which the cords will vibrate. The operation mimics normal physiology: When we speak at the upper end of our pitch range, we do so by contracting the cricothyroid muscle, which pulls the two cartilages together and increases tension in our vocal cords. CTA is performed through a small horizontal incision in the neck, which is placed at a natural skin fold; the resulting scar is usually invisible or easily concealed. Either local or general anesthesia can be used. Because F0 varies with the square root of vocal cord tension, CTA is a relatively inefficient way to increase F0.
The few follow-up studies of CTA in the published literature have reported inconsistent outcomes. Neumann, Welzel, and Berghaus (2002) reported results in 67 patients; nearly all achieved an increase in fundamental frequency, with a mean increase of 5 semitones. However, the modal increase was only 2-3 semitones, and only 28% of patients achieved a F0 in the female range (defined by the authors as 174 Hz or greater), although this percentage increased to 38% at 6-month follow-up. Only 2 patients were made worse by the procedure. De Jong (2003) described outcomes in a series of 30 patients, 26 of whom were available for follow-up. Most patients (85%) were satisfied with their results; mean FO increased from 122 Hz to 181 Hz. Wagner, Fugain, Monneron-Girard, Cordier, and Chabolle (2003) reported results in 14 patients who underwent CTA (9 patients), anterior commissure advancement (2 patients), or both (3 patients). Over three quarters achieved subjectively satisfying results, but the median increase in F0 was only 11 Hz. Of the 9 patients who underwent CTA alone, only 4 achieved postoperative F0s of 160 Hz or greater. Brown, Perry, Cheesman, and Pring (2000) described outcomes in 14 patients; their patients had a relatively high mean F0 of 152 Hz before surgery. Mean F0 did not increase significantly after CTA, but modal frequency did, to a mean of 175 Hz. Results were highly variable, with 2 patients showing very large increases in modal F0, and 2 patients showing no increase. Advantages: No surgery on the vocal cords themselves; theoretically reversible if the patient is dissatisfied. Disadvantages: Requires neck incision; prolonged healing process; long-term results have sometimes been favorable, but are inconsistent and sometimes unsatisfactory. Assessment: Cautiously endorsed in selected cases. Laser Assisted Thyro-Arytenoid Muscle Resection (Abitbol Technique): Parisian ENT surgeon and laser specialist Dr. Jean Abitbol (1995) described a novel technique of laser-assisted endoscopic thyroarytenoid muscle resection. He has used this technique to attempt to raise the F0 of non-transsexual women with unusually low voices, and of at least a few transsexual women. His technique involves reducing the size of the thyroarytenoid muscle that runs parallel to the vocal cord; this may decrease the density of the cord, and may also be increase tension by creating scarring. However, both these methods should theoretically be relatively inefficient ways of increasing F0. Dr. Stephen Pincus (1997) has observed Abitbol’s technique, and he believes that it can produce only limited elevation of vocal pitch; he also believes that it has the potential to cause hoarseness. I am unaware of any published series of results using this technique in transsexuals or in non-transsexuals. Advantages: Performed endoscopically, no neck incision. Disadvantages: Minimal pitch elevation; potential for hoarseness or breathiness; no published series in transsexual women. Assessment: Not recommended. Laser Assisted Voice Adjustment (LAVA; Orloff Technique): Dr. Lisa Orloff, a professor of otolarygology at the University of California at San Diego, has performed Laser Assisted Voice Adjustment, an endoscopic technique in which a CO2 laser is used to scar and stiffen the area adjacent to the vocal cords, perhaps thereby increasing vocal cord tension. On theoretical grounds, this should also be a relatively inefficient way to increase F0. Advantages: Performed endoscopically, no neck incision. Disadvantages: Minimal pitch elevation; prolonged recovery period; potential for hoarseness. Assessment: Not recommended. Vocal Cord Shortening (Anterior Web Creation): Another technique to increase F0 is to shorten the vibrating length of the cords by suturing them together anteriorly, so that only the free posterior portions of the cords can vibrate. This creates what is called an anterior vocal web. Donald (1982) described an open procedure using an anterior neck incision to accomplish this. In his technique, a portion of the thyroid cartilage was also removed and the anterior one-third of the vocal cords were de-epithelialized, allowing them to fuse together to create an anterior vocal web. The illustration below shows before and after views of the result; it is redrawn from Donald’s article, but without showing the removal of any cartilage. Because vocal cord shortening reduces the vibrating length of the cord, it would be expected to be a relatively reliable and efficient way of increasing F0. Donald reported on only three patients. Two had good pitch elevation (one a complete octave); complications included breathiness of the voice in two patients, and a wound infection in another.
More recently, Gross (1999) described a similar procedure performed endoscopically, without any cartilage resection. In his series of 10 transsexual patients, the mean postoperative F0 achieved was 201 Hz (range 154 to 240 Hz). The mean increase in F0 was 81 Hz (range 49 to 125 Hz). Duration of follow-up ranged from 35 to 45 months. All but two patients suffered transient decreases in vocal intensity, some very minor; these reportedly improved with speech therapy. Advantages: Can be performed endoscopically, without neck incision; small published case series demonstrates long-term effectiveness. Disadvantages: Potential for breathiness or voice weakness. Assessment: One of the better procedures. Arguably the procedure of choice for patients who insist on undergoing pitch-elevation surgery.
Thyroid Cartilage and Vocal Cord Reduction: Recently a team of Thai surgeons (Kunachak, Prakunhungsit, & Sujjalak, 2000) reported a new, very aggressive, and highly effective (perhaps too effective) surgical technique for pitch elevation. Their procedure involved the open resection of a central strip of the thyroid cartilage, about 8 mm wide, along with resection of the anterior one-third of the vocal cords and reconstruction of the anterior commissure (where the vocal cord meet anteriorly). Their technique is shown in the illustration below.
The authors reported the results of their procedure in six Thai patients, the oldest of whom was 27 years old. F0 increased from a preoperative mean of 147 Hz (range 100 to 172 Hz) to a postoperative mean of 315 Hz (range 264 to 420 Hz). A mean postoperative F0 of 315 is fairly high even by female standards; when such a high F0 is combined with the resonant characteristics of a male airway, the subjective impression might be very unusual, and might perhaps result in unwanted attention to the voice. Interestingly, four patients in the study had preoperative F0s of 160 or higher; such F0s would typically allow them to be judged female without surgery, at least by Western standards (see Spenser, 1988, and Wolfe, Ratusnik, Smith, & Northrop, 1990). Two patients developed granulomas of the anterior commissure, which were easily treated with CO2 laser vaporization. Follow-up times ranged from 5 to 72 months.
Recently Portland ENT surgeon James Thomas web-published his results in a single case using a similar procedure, which he calls "feminization laryngoplasty." Advantages: Small published case series suggests long-term effectiveness; thyroid cartilage resection offers cosmetic benefits. Disadvantages: Highly invasive and irreversible; requires neck incision; high potential for over-correction. Assessment: One of the better procedures, albeit quite aggressive. The Problem of Mismatch Between F0 and Resonance: One potential problem with the pitch-elevation techniques described above is the creation of a mismatch between F0 and the characteristic timbre (resonance) of the patient’s voice. Timbre is the acoustic quality that allows us to distinguish different musical instruments (e.g., a violin and a trumpet) when both are playing the same note. In the human voice, timbre results from the resonant properties of the upper airway (throat, mouth, nose, and sinuses): Airway resonance determine how much the overtones, or harmonics, of the fundamental frequency will be emphasized or diminished. Females generally have a shorter resonator than males, and the timbre of their voices reflects this. In my opinion, the combination of a very high F0 (as is sometimes seen immediately after CTA) and a typically-male vocal timbre sounds very odd. This is one reason that a falsetto voice often sounds "false". Thus I would be concerned that a pitch elevation operation could sometimes be too successful, and might result in an unnatural combination of pitch and resonance – one that is rarely if ever encountered in normal humans of either sex. A highly unnatural voice may be nearly as bad as a masculine voice in impairing one’s ability to pass easily as female. My personal opinion is that optimal pitch elevation in transsexual women would place the postoperative F0 at the low end of the normal female range, which would minimize the potential for a mismatch between F0 and airway resonant properties.
Many if not most transsexual women are capable of achieving an F0 in the lower part of the female range through voice training alone, without voice surgery. The problem is not physiologic incapacity; the problem is finding the motivation to undertake the hard work of learning the necessary vocal skills and of practicing them consistently until they become second nature. Nevertheless, in my opinion, most transsexual women should concentrate primarily on voice training, and consider voice feminization surgery only as a last resort.
References:
Abitol, J. (1995). Atlas of Laser Voice Surgery. San Diego, CA: Singular Publishing.
Brown, M., Perry, A., Cheesman, A. D., and Pring, T. (2000). Pitch change in male-to-female transsexuals: Has phonosurgery a role to play? International Journal of Language and Communication Disorders, 35, 129-136.
de Jong, F. (2003, September). Surgical raise of vocal pitch in male to female transsexuals. Paper presented at the XVIII Biennial Symposium of the Harry Benjamin International Gender Dysphoria Association, Gent, Belgium.
Donald, P. J. (1982). Voice change surgery in the transsexual. Head and Neck Surgery, 13, 246-250.
Fitch, W. T., & Giedd, J. (1999). Morphology and development of the human vocal tract: A study using magnetic resonance imaging. Journal of the Acoustical Society of America, 106, 1511-1522.
Gross, M. (1999). Pitch-raising surgery in male-to-female transsexuals. Journal of Voice, 4, 433-437.
Isshiki, N., Taira, T., Tanabe, M. (1983). Surgical alteration of the vocal pitch. Journal of Otolaryngology, 12, 335-340.
Kunachak, S., Prakunhungsit, S., & Sujjala, K. (2000) Thyroid cartilage and vocal fold reduction: a new phonosurgical method for male-to-female transsexuals. Annals of Otology, Rhinology, and Laryngology, 109, 1082-1085.
Kerstin Neumann, K., Welzel, C., & Berghaus, A. (2002). Cricothyroidopexy in Male-to-female-Transsexuals – Modification of Thyroplasty Type IV. International Journal of Transgenderism, 6(3). Retrieved December 30, 2003 from http://www.symposion.com/ijt/ijtvo06no03_03.htm
Oates, J., & Dacakis, G. (1983). Speech pathology considerations in the management of transsexualism: A review. British Journal of Disorders of Communication, 18, 139-151.
Pincus, S. J. (1997, June). Voice surgery. Paper presented at the Second International Congress on Sex and Gender Issues, Philadelphia.
Sataloff, R. T., Spiegel, J. R., Carrol, L. M., & Heuer, R. J. (1992). Male soprano voice: A rare complication of thyroidectomy. Laryngoscope, 102, 90-93.
Spenser, L. (1988). Speech characteristics of male-to-female transsexuals: A perceptual and acoustic study. Folia Phoniatrica, 40, 31-42.
Wagner, I., Fugain, C., Monneron-Girard, L., Cordier, B., and Chabolle, F. (2003). Pitch-raising surgery in fourteen male-to-female transsexuals. Laryngoscope, 113, 1157-1165.
Wolfe, V., Ratusnik, D., Smith, F., & Northrop, G. (1990). Intonation and fundamental frequency in male-to-female transsexuals. Journal of Speech and Hearing Disorders, 55, 43-50.
Since 1993, a modified cricothyroidopexy via miniplates, following Isshiki’s technique, has been performed at the ENT Department of the Martin-Luther University of Halle-Wittenberg. This procedure is based upon an approximation of the cricoid and thyroid cartilages resulting in an increase in the vocal cord tension. Combined with a chondrolaryngoplasty it allows for a reduction of the laryngeal prominence. So far 67 patients have undergone this surgical intervention. Laryngoscopy and a detailed voice diagnostics, as well as ultrasound and computer-tomographic examinations of the larynx are performed pre- and post-operatively in order to record the anatomical, physiological and functional data. So far good functional results have been achieved showing an average increase of the fundamental frequency by approximately five semitones.
Voice Training
The human voice is a complex mechanism and the "quick fixes" being thrown around the transgender world just don't work. Some of the most common vocal mistakes I hear TG women make include:1. Speaking too deeply The “fundamental frequency” (or pitch) of male voices typically ranges from 100 to 150 Hz, while female voice pitches range from 175 to 250 Hz. If your voice falls below 165 Hz (and I'll tell you how to find out your exact pitch in a moment), you're probably going to get read as male.2. Talking in falsetto
At the other end of the spectrum, many TG's try to compensate for a deep voice by speaking in falsetto. But this high pitched "head voice" sounds more appropriate for Minnie Mouse or Tiny Tim than any genetic woman. 3. Whispering
Another common tactic employed by transgender women is speaking more softly. However, lowering the volume of your voice does nothing to make your voice sound more feminine – it just makes it impossible to hear you.4. Upswinging your sentences
While it's true that genetic girls have more “melodic intonation” to their voices, upswinging the end of all your sentences just makes you sound like a ditzy Valley Girl. (Hardly the ideal female role model for anybody over the age of 18.)5. Pinching your voice
Males have a larger throat space than women, giving their voices a richer, deeper quality. While there are tried and true ways to reduce the throat space, constricting your throat too much can lead to a pinched sounding voice. (Think Pee Wee Herman or Kermit the Frog.)
Have you ever been shocked to hear a recording of your own voice? If so, then you know that the way you sound to yourself is completely different from the way the rest of the world hears you ...
That means you're probably not even aware of all the voice feminization mistakes you're making!
That's the bad news. The good news is that there IS a solution.
You may not believe it right now, but I'm here to tell you that anybody (including you) can quickly and easily obtain a passable feminine voice with little bit of the RIGHT kind of training.
The 9 Elements of an Exceptional Feminine Voice As I mentioned earlier, feminine communication is a lot more complex than most people realize. That's why you can't learn these techniques from just anybody.
As a Speech Language Pathologist, I have been trained in the science of the human voice. My years of caring for patients with voice disorders and working with professionals and companies have expanded my knowledge of the intricacies of speech and communication.
I have discovered that there are 9 elements of an exceptional feminine voice:PitchVoice qualityLoudnessResonanceArticulationPhrasingPacingMelodic intonationFluency
Here are just a few of the differences between male and female voices ...Pitch
Pitch is the most obvious difference between male and female voices, but it's only part of the picture. The pitch (or “fundamental frequency”) of male voices ranges from 100 to 150 Hz, while it ranges from 175 to 250 Hz in females. Using a chromatic frequency tuner, you can learn to identify your own feminine pitch.Resonance
Resonance is a tricky concept to get, but it's one of the most important aspects of voice feminization. Resonance has to do with the "ring" of your vocal tone. Males have a throat space that is as 1-1.5 times larger than women. This creates a larger resonating chamber which results in the voice having a fuller, deeper quality to it - even when the pitch is the same. Think of it as the difference between blowing through a tuba and blowing through a flute.Articulation
Generally speaking, women have more precise articulation than men and pronounce their consonants more clearly. Men tend to mumble more.Pacing and phrasing
Pacing refers to the speed (or rate) of speech, while phrasing refers to the number of words per breath. Men tend to speak in shorter bursts followed by pauses, whereas women speak in longer flowing sentences.Melodic intonation
Another difference between the sexes is that men tend to speak more monotonously. Women use more melodic intonation and vary the pitch of the voices within a phrase or sentence.
You also need to take the actual words women use into consideration. That's why understanding the “philosophy” of feminine communication is important (and that's why we cover this topic in the program).
Did you know that gender can even be determined through non-visual, non-verbal communication? Recent research discovered that authors of anonymous email and message board postings could be determined as male or female strictly through communication style (word choice, length of phrases, use of questions, and words of thanks).
Bottom line? Unless you get the full story on feminine communication, you could have a perfect feminine voice with perfect pitch, resonance, and pacing and STILL be read as male if your words and communication aren't in line with a woman's!
The Vocal Cords