Transgender Woman Finds Her Voice with Vocal Therapy

For many transgender women assigned male at birth, helping them align the sound of their voices with their gender identity can be a big step toward gender affirmation. That was the case for Jacqueline Griffiths of Lakewood, Ohio. In 2020, Jaki, as her friends call her, began hormone therapy, and started making physical changes to present as a woman. But as she approached the one-year mark, she felt something was off.

“I’ve always been able to manipulate my voice to do characters like in Dungeons and Dragons, but it was different when I tried to sound more feminine,” says Jaki, now 32.

“I was making public appearances and had my name changed on my driver’s license, but I was still self-conscious about my voice.”

Her gender care doctor referred her to the Cleveland Clinic Voice Center in the Head & Neck Institute, where speech-language pathologist Michelle Adessa, MS, CCC-SLP, reviewed Jaki’s relevant medical history, evaluated her vocal health, and discussed options. While some patients opt for surgical procedures for voice feminization, Jaki decided to do vocal therapy.

“Vocal therapy is a very patient-driven course of treatment,” says Michelle. “It was about understanding Jaki’s goals, developing her skills and providing tools to help her practice.”

Michelle and Jaki worked with the semi-occluded vocal tract exercise of straw phonation to warm-up Jaki's voice. Michelle utilized acoustics software to provide feedback on the sound of Jaki's voice.

Jaki described her ideal voice as being “both strong and feminine.” And she had supportive friends and family and her fiancée, Alison, to help her practice.

“With resonance and pitch being markers of femininity, we started by exploring how sound is shaped and getting it out of the throat and into the mouth and elevating the pitch,” Michelle explains. “We also went over articulation, or how much pressure to put on the lips, tongue and teeth when talking.”

“At first, the muscles of my neck were sore from holding my mouth differently,” says Jaki. “It takes practice to hold the pitch and speak smoothly.”

Michelle provided strategies to reduce the tension. She would have Jaki repeat vowels and consonants as well as phrases and words to get used to saying them in a more feminine way. To make it as simple as possible, Michelle used throat diagrams, sound recordings and biofeedback, to help Jaki hear and see how to work with her voice.

To help between sessions, Jaki says Alison started giving her a signal — a hand gesture pointing up — so she would remember to raise her pitch.

Over the course of 14 sessions, Michelle added new components of speech to help Jaki sound and speak in a feminine way. These components included volume, speech rate, intonation and word choice.

“We also went over nonverbal communication, which I didn’t expect,” Jaki says. “Michelle made me think about my presence and how I want to be perceived. I have to say, my posture has improved greatly.”

“It takes time to build stamina so that you can talk for longer periods throughout the day without thinking about your voice,” Michelle says. “Jaki did so well. She is good with language and was so receptive to therapy. It makes me happy to see patients living their best lives.”

“I really enjoyed Michelle’s method,” says Jaki. “She broke speech into parts and simplified it, which gave me the building blocks to find my voice.”

Jaki with her fiancée Alison.