A nonbinary friend of mine recently started hormone therapy to introduce testosterone into a formerly estrogen dominant environment. They mentioned a worry about losing their high voice and the joy of singing along to certain songs. Well, this little blog post is for Reid and everyone else out there who desires the “T” but has concerns about how it will affect their voices.
Disclaimer: I am a voice and singing teacher, not a doctor or health expert. I do not give medical advice. My expertise are in the voice and its related anatomy and physiology, but I don’t know you and all the wonderful history and experiences you bring to the table. Please speak to your own health care and voice team if you have specific questions about HT and your voice.
Let's start with basic physiology: how do we produce high pitches? Imagine guitar strings – thicker ones make lower tones and thinner make higher. Inside our larynx, we don’t have strings, but we do have tissue that can be stretched and thinned to vibrate at higher frequencies and slackened into its thicker state for lower tones. The highest frequencies require very thinned tissue, just the edges of the folds make contact and vibrate, and some believe that when in “whistle register” (that thing Mariah Carey does) they may not even touch at all! We all have varied ranges that are determined by the size and stretchiness of our vocal folds. Bigger and thicker folds can produce lower frequencies and can’t stretch as thin as those found in a smaller larynx, but even a larger instrument can still go VERY high with some practice and consistent training (foreshadowing much?).
So, what happens to the voice when you start hormone therapy? One of the first changes that will occur is that the stretchy tissue inside your larynx will thicken vertically and horizontally. The main illustration below shows the vocal folds if you were to peer down into your throat and see your larynx from above. The “coronal cross section” means you’re looking at that same tissue from the side, as if you could see right through the side of your throat while looking in the mirror.
The folds will thicken along the blue lines that I added to this lovely illustration. As this happens, your average speaking pitch range will likely drop. This is something you can track with an app like SingScope. I highly recommend it!
Source: Anatomy of the Voice, Theodore Dimon (with my chicken scratch overlaid)
The bulk of these changes happen in the first four months T, but those who are on very small doses may see changes over a slightly longer timeframe. In all cases, the voice will continue to evolve after that point as well. Swelling will also occur that will interfere with the normal vibratory patterns of the tissue. This will produce a husky sound and will TEMPORARILY reduce the overall range of your voice. I like to tell my students to expect the 3-6 month period after starting T to be tumultuous, unstable, and vocally limiting. Your range may be limited to a few notes maximum, the head voice may not work at all some days, and your vocal kinesthetic sense may go entirely offline, meaning you’ll have to reconnect with your instrument as thought it were entirely new in your body, which is kind of true. For those taking smaller doses, this unstable phase can last longer, and as Dr. Graham says in his recently published research*, the voice may have trouble fully stabilizing without increasing the dosage at some point (his research is behind a paywall, but he has encouraged me to share his work via DM, so reach out if you'd like access). If this becomes a concern, definitely talk to your provider about it. A very general timeline is noted below:
"SFF" stands for speaking fundamental frequency, which just means, the average frequency or pitch around which your voice centers its speech.
By the end of this transition period, your voice may have dropped by almost an octave. Some will drop less and a few (about 21%) won’t experience a change in their speaking range at all. They will still experience other changes though, such as the instability and differences in color and timbre. Whatever your experience may be, your instrument is still new-to-you in many ways, and you’ll have to get to know it a little better before singing will feel easy again. This includes the high part of your voice.
Now, to speak to the highest part of the range - what I might call the head voice or head extension and whistle register if we're talking REALLY high. With some practice, small, flutelike instruments can go quite high into what is usually categorized as an operatic range. (Again, Mariah Carey, Ariana Grande and others would disagree with that generalization.) While some number of testosterone-influenced larynges can reach those frequencies, most cannot stretch quite that thin. BUT, here’s the important thing to know – most songs don’t go that high, and most larynges, even the biggest bass voices, can travel high enough to sing along with the music that we hear on the radio and in popular music. It does take practice to access those notes that, in the past, might have been easy to reach, and it WILL sound different, so prepare yourself for that. But, generally speaking, the singers who are affected the most by a transitioning larynx are operatic sopranos, not pop stars.
I hope this crude illustration will help demonstration that the overlap of potential range loss and the type of music most people in this world want to sing is small. There might be some super high sopranos out there who will struggle for sure, but overall, it's very manageable IF you do the work to stretch and maintain whatever range you wish to utilize on a regular basis.
Preserving Your Singing Voice Through Transition
Different kinds of vocal issues can crop up during this transition and it's good to be prepared. For instance, many trans men will attempt to push their speaking range lower than their voice can comfortably reach and develop issues with strain during this transition. (This issue won’t be directly addressed today since the original question was about preserving the high range, but many of the exercises below can still be helpful for this kind of problem!) Those who rely on their voices in their work, public speakers and teachers for instance, may feel embarrassed by the cracking and instability and try to “fix” it through rigidity or pushing the sound into one kind of voice quality vs another. They may also complain that they’ve lost the capacity to project and be heard in a room. It’s important to know from the start that these symptoms are temporary. Because the laryngeal tissues are swollen, they aren’t vibrating as well and can’t connect with as clean and firm a closure as they used to, so more breath leaks through during the vibratory cycle. And because they’ve changed size and shape, the muscles and nervous system have to relearn how to coordinate the fine-motor function required for vocalization that had been habituated over a lifetime, hence the cracking and instability. It’s important to accept that the instability and reduction in quality is a part of this process, especially during the most unstable phases. Don’t try to fix or clean up the sound with effort. Compensatory muscle effort during a time like this can damage the delicate tissues and prolong your problems or create new ones. Instead, allow the breathiness and keep your singing and speaking light and easy. This is also not the time to push your limits or do any big, intense singing for long periods of time. Don’t join that gospel choir if you weren’t already in one. Wait until things feel a bit more stable. Second, do something therapeutic for your voice regularly to encourage coordination and efficiency. Here are a few examples:
Easy humming in a comfortable range (don’t push limits) and try to describe where you feel those sounds. Are they in your chest? Behind your nose? In the back of your head? Etc.
Sing through a regular diameter straw (not too wide) on a neutral vowel. The straw takes pressure off the vocal folds and can help reduce inflammation.
Use the same straw or bigger to sing while blowing bubbles in water. Just a few inches of water in a cup or bottle is fine. The straw should be 1-2 inches submerged in the water and you should attempt to blow a steady, small stream of bubbles while vocalizing. Don’t splash yourself.
Sing in that flutier, higher head or falsetto voice when it’s comfortable to do so. If you feel any pain or strain, stop. Keep checking in with how things feel as you explore. Blowing bubbles is a great way to develop the top range as well. Go as high as you can with ease and comfort, and without pushing or squeezing. Slide up and back down without sustaining any of the high notes at first.
Drink a lot of water! Hydration can improve symptoms of inflammation and speed up recovery, but it takes at least 2 days for the water reach your vocal folds, so think of it more as an ongoing hydration goal vs a one-off when you feel dry. 64 ounces of water is the minimum you need to drink per day to prevent dehydration. Consider more if your medications are drying, if you are a caffeine drinker, if you are an occupational voice use (singer, teacher, public speaker, etc) or if you are very active and sweating on a daily basis.
Steam before any event where you expect to use your voice a lot. There are personal steamers like MyPurMist that you can hold over your face for a few minutes. The nebulized solution will give you at least 15-20 minutes of hydrated, healthy tissue that performs better despite any swelling. If you don’t have one of those, sipping some hot tea and letting the steam rise into your nose and mouth can also help a bit.
As your voice begins to stabilize sometime after month six, you can start to stretch your voice back into the higher range more confidently and regularly. Here’s how:
Blow bubbles again! This is such a great exercise which encourages consistent airflow, gentle and holistic physical engagement. Try bubbling up and down small intervals. And then bubble your way up and remove the straw for the slide down.
Siren up and down, or from top to bottom on a “hoo”. The h should be light and sound more like an exhale than a loud /h/ sound. Think of it as exhaled breath that precedes the sound, vs a hard consonant.
Hum or wuh from the top down on an arpeggiated chord
(I made this little tutorial super quickly this morning to demonstrate the exercises listed above. It is truly slapdash.)
These exercises will ensure that your folds will continue to stretch to their thinnest length regularly and you’ll have access to those highest sounds. Voice lessons can also help with accessing those notes and with integrating the high range into the rest of your voice. Most importantly, keep exploring and enjoying your new instrument.
Let’s finish with some inspirational and perhaps aspirational singing! Here are just a few testosterone-influenced instruments absolutely rocking their soprano range in a variety of styles.
"Sempre Libere" sung by Dennis Orellana This is a male sopranist / countertenor. Most countertenors are baritones, meaning they have average sized larynges relative to others in a testosterone-influenced environment. Traditional classical audiences prefer the warmer, richer tones of their soprano range to tenors and other higher voices.
"Think of Me" sung by Donovan
I've followed this amazing mezzo-soprano for a while but their Instagram with all of the singing videos was recently shut down. SO - all we have now is this America's Got Talent appearance. It's a nice comparison to Dennis's younger and smaller instrument.
SugarCrash! by ElyOtto
This recent trans phenomenon performs hyperpop music, which now I love.
"The Most Beautiful Girl in the World", by Prince
I mean, obviously... but also, check out at 2m 50s where you can hear him sing lower than his usual range. Clearly, he has a large instrument. And then, almost immediately after that he pops into his extension and rocks it.
"7 Rings", by Kurt Hugo Schneider
Skip right to minute 2 to hear this baritone riff in his falsetto! This is a great example of someone who has access to a high range but likely hasn't developed the strength and stamina to sustain it for any length of time. He could learn to do so if he desired.