Speech therapist Heather Gross

One speech therapist specializes in the transgender voice

DAVID TAFFET | Senior Staff Writer

Leanne Sherred co-founded the practice Expressable to address the many types and reasons for speech therapy. Her therapists work online, overcoming geographic barriers to receiving care.

“We envisioned a better way to deliver care,” Sherred said, a way that would address accessibility for all aspects of communication.

When we think of speech therapy, we usually think of a child with a lisp or a stutter. But therapists at Expressable address a long list of issues, including accents, aphasia, apraxia, autism and delayed speech, as well as what comes under a general category of voice disorders that includes pitch, resonance or volume that are inappropriate for their age, gender or cultural background.

Heather Gross, one of Expressable’s therapists, specializes in pitch, resonance and other such attributes of the voice, especially as to how those things affect her many transgender clients.

She explained that how we look is important, but the importance of how we sound is often overlooked.
Gross said one of the common complaints she hears from trans people who are discussing therapy with her is misgendering on the phone. She said she sees the excitement from a client who’s been called “sir” on the phone too many times the first time they are “ma’amed.”

Hormones make some difference in pitch and resonance but don’t suddenly turn a male voice into a female voice. Adding testosterone will deepen the voice of a person transitioning from f to m, Gross said. But removing testosterone and adding estrogen usually won’t change the voice much.

“There’s not a huge impact,” she said.

To adjust the pitch, Gross begins by asking where her clients feel sensations of the voice — in the chest, in the throat — and she works on exercises from there.

To change resonance, she works to bring the voice forward in the oral cavity. Exercises include using sounds and syllables with different vocal placements that open or close the throat. Bringing the tongue back brings the larynx down to achieve more resonance.

How someone creates vowel sounds changes the sound from more masculine to more feminine. A “wide E” shape has a higher frequency than a round “O shape.”

But will these exercises work on everyone? “Everyone can find a voice,” Gross said.
While everyone is different, on average, Gross said, she works with clients for three to nine months. Each person’s therapy program is individualized, and change is gradual.

If her client tells her she’s not comfortable speaking at a certain pitch, Gross said, they’ll adjust the current goal to just a few notes above what feels normal. Then with daily exercises and a morning warmup, the higher pitch will become more natural and they’ll work to achieve a few notes higher until the client is happy with where they are.

“Voice impacts our confidence and empowerment,” Gross said, adding that volume, intonation and dealing with the rise and fall of the voice and articulation are other aspects addressed in therapy. More detached or relaxed articulation using hard or light emphasis are features of a more masculine or more feminine voice.

Adjusting the volume of the voice, Gross said, is tricky. It’s harder to maintain feminine aspects of the voice when speaking louder, but you don’t want to speak too softly. Rate of speech also can be tricky because speaking slower deepens the voice, but you don’t want to speak too quickly, either.

But voice isn’t the only part of speech therapy Gross helps her clients change. Nonverbal communication can make a difference in how the person comes across, too.

Gross said she’s heard back from clients who said once they felt more comfortable speaking up and asking for what they need, they were promoted at work. Others became more confident to interview and thus were able to change careers. Having a voice that matched who they were allowed them to apply comfortably for a new job as themselves.

There’s no one time that speech therapy has figured into her clients’ transitions, Gross said. For some, she said, it’s the last piece they’re working on. For others it’s the first. She said she’s worked with clients who transitioned years ago but are now just getting around to working on their voice.

Dallas therapist Renee Baker, who is transgender and specializes in working with transgender people, agreed that speech therapy is important for some trans men and women. She said while every trans person doesn’t have to sound like a cisgender person, it’s important to be your authentic self.

When she wants to be gendered correctly on the phone, Baker said she may put on a musical tone when she’s answering the phone.

“Most people feel affirmed when they’re gendered correctly,” Baker said. And she added that for some people, speech therapy is a medical necessity.