Gender and Voice Dysphoria
Everything we do that affects another person is communicative. Even if we do not make a conscious choice to communicate, humans are a social species. Regardless of intent, others interpret our actions and extrapolate meaning from them. As we move through public and private spaces, the way we move through these spaces and interact with others indicates a lot about who we are.
However, communication can be so much more than the simple conveyance of information. By communicating, we can share and empathize with one another which can lead to forming mutually rewarding relationships or close emotional bonds. At the very least, communication can provide the pathway towards mutual understanding. For some, communicating with others is easy; their comfort with their communication translates to navigating social engagements with ease. For those who have negative feelings about their voice or communication, however, difficulty with communication can severely negatively impact their quality of life in many areas (Murry, Medrado, Hogikyan, & Aviv, 2004; Hancock, Owen, Siegfriedt, Brundage, 2009; Hancock, Krissinger, & Owen, 2011).
Others can harshly judge someone if their communication habits fall too far outside the boundaries of what's considered socially acceptable, particularly if these habits transgress gender expectations. If a man is perceived as feminine, or a woman perceived as masculine, this can result in microaggressions (i.e. crossing the street to avoid contact, judgmental staring/comments to others, denial of service), verbal harassment, and physical violence.
To those who identify as transgender or gender nonconforming, this is not a revelation; a large portion of our community has experienced this violence firsthand.
According to The Report of the 2015 U.S. Transgender Survey (USTS; National Center for Transgender Equality [NCTE], 2016), 30% of transgender people who responded to the survey had experienced workplace-based discrimination in the past year. In that same time period, 47% of respondents were verbally harassed. These discriminatory attitudes and actions take a serious toll on transgender people's mental health. In the month prior to taking the USTS, 39% of respondents had experienced inordinate psychological distress–a deeply worrisome statistic, particularly when compared to the 5% of the general US population. Even starker is the statistic that 41% of respondents had attempted suicide (compared to 1.6% of the general US population; NCTE, 2016).
These negative psychological effects present differently based on one's experiences; however, they all fall under the umbrella term, gender dysphoria.
Gender dysphoria is a difficult term to define in its entirety. This is due to several reasons, the primary being that dysphoria means different things to different people (read here for more discussion of definitions) and manifests in such different ways between various transgender and gender non-conforming people. The Diagnostical and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) does a nice job at providing a succinct definition; they define gender dysphoria as "the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender" (APA, 2013, p. 451). An important nuance in this definition which is often ignored or misunderstood is this:
Gender dysphoria is not required in order to identify as transgender.
The APA reaffirms this by further stating "not all individuals will experience a distress as a result of such incongruence" (APA, 2013, p. 451). However, for those who do experience this distress, it is important that this diagnosis exist so transgender people can receive additional specialized support from healthcare professionals.
As previously discussed, dysphoria can be fueled by external factors, such as facing transphobia for breaking gender norms of communication and movement. Dysphoria can also be sourced to internal feelings of discomfort centered around primary sex characteristics (gonads, genitalia) or secondary sex characteristics (features which manifest during puberty). This includes features such as one's voice, which tends to drop significantly during puberty in assigned-male-at-birth (AMAB) people and slightly in assigned-female-at-birth (AFAB) people. These negative feelings about one's voice and communication are informally referred to as 'voice dysphoria'.
"[Regarding presentation,] I feel ok until I open my mouth."
"My voice is triggering especially when I hear recordings of it. Hearing how I sound [makes me] feel like giving up."
"I feel detached from [my voice and body] a lot of the time because neither feel right."
These are just a few of the sentiments too often voiced in transgender circles. By and large, more frequent avenues of transition such as hormone replacement therapy (HRT) and various surgeries do little to affect these negative feelings about one's voice. As always, this is not universal; there are those whose hormonal transition and/or surgeries result in a voice that works better for them, and our website will be updated with a page to discuss these options in the near future. There are also many transgender people who transgress gender norms and are proud of it. I've met many transgender women who love their rich, deep voices, or who make no conscious choice to communicate using more widely accepted models of femininity. These people are incredibly brave and should be respected and protected, as every person deserves the right to be comfortable with themselves and express their identity as they see fit.
The other side of that coin is that some trans people find their comfort in moving through social spaces by adapting social norms they want to explore or play with. Sometimes this is driven by wanting to be misgendered less by others; other times it is driven by simply wanting to feel comfortable in the movement itself. Regardless of the origin of the discomfort, if one doesn't like their voice quality or communication style, their quality of life (QoL) will decrease (Murry, Medrado, Hogikyan, & Aviv, 2004; Hancock, Owen, Siegfriedt, Brundage, 2009; Hancock, Krissinger, & Owen, 2011). For this subset of the trans population, it is essential that resources are made available to them so they can increase their quality of life, and build a more positive relationship with their voice.
Some transgender people are very successful in experimenting with their voice on their own. For others, changing deeply ingrained habits of voice production and communicating can seem insurmountable. Luckily, there are speech-language pathologists who specialize in working with transgender people to discover what their voice is capable of and developing a method of communication which is more comfortable for them to utilize. We call this work transgender vocal training.
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Hancock, A. B., Krissinger, J., & Owen, K. (2011). Voice Perceptions and Quality of Life of Transgender People. Journal of Voice, 25(5), 553-558. doi:10.1016/j.jvoice.2010.07.013
Hancock, A., Owen, K., Siegfriedt, L., & Brundage, S. (June, 2009). Relationship between self perception, listener perception,
and acoustic measures of femininity in transgender voice assessment. WPATH Presentation, Oslo, Norway.
Murry, T., Medrado, R., Hogikyan, N. D., & Aviv, J. E. (2004). The relationship between ratings of voice quality and quality of life measures. Journal of Voice, 18(2), 183-192. doi:10.1016/j.jvoice.2003.11.003
Pickering, J., & Baker, L. (2010, November). Effect of voice feminization therapy on listener and client perceptions of gender and vocal communication for mtf transsexuals. Poster session presented at the ASHA Convention, Philadelphia, PA.