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Starting Testosterone and how it affects the Voice for FtM Transgender People

Voice masculinization is one of the most important components to individuals who are going through ftm transition.1 The voice is a powerful signifier of gender, and successful transformation can be the key to affirming gender identity. For some trans men, voice masculinization will involve testosterone hormone therapy. Testosterone will produce a physical change in the vocal folds, causing the voice to deepen. The results of hormone therapy are different in every person, and not all individuals will experience a complete deepening of the voice. However, with or without hormone therapy, complete vocal masculinization is possible. Read on to hear more about the effects of testosterone, as well as non-medical methods for achieving vocal masculinization.

So, when does your voice change on testosterone?

Research in the field of transgender healthcare is vastly limited compared to other fields. However, we can look at a study 2 published in 2021 to get an idea of testosterone’s timeline. This study, done at a single university-based transgender clinic in Thailand, surveyed 39 trans men over the course of 2 years. They found that 72% of participants experienced some deepening of the voice in 6 months, with 97% experiencing this at 12 months, and 100% at 24 months. However, it’s important to remember that not all trans men will experience a complete deepening of the voice. One scientific report 1 from 2021 found that 17% of its participants felt “neutral” or “extremely dissatisfied” with their voices after hormone therapy, likely due to incomplete vocal masculinization. In addition, previous studies have logged a 12-16% dissatisfaction rate, with 25% of trans men reporting that they were still perceived as female over the phone.3,4 Furthermore, 31% of the participants expressed a desire to further their vocal masculinization with voice training.

The voice is a vital component to the health and happiness of many transgender people, and its importance cannot be underplayed. A second 2021 study 1 in testosterone therapy found that vocal masculinization was the top priority for participants, who ranked it higher in importance than 8 other masculinity traits. 5 For this reason, it can be a wonderful experience if you love your results from T therapy, and it can be equally disheartening if you don’t. The important thing to remember is that hormone therapy is only one part of the journey for many female to male people. For those who want further results, trans voice training answers the call.

Trans voice training for vocal masculinization is a non-medical process that transforms the gender presentation of the voice with physical exercises. This training method is often used in conjunction with testosterone therapy, because it addresses aspects of masculinization that cannot be achieved with hormone therapy alone. Some individuals may even choose to forgo testosterone altogether, and use voice training as their sole method of vocal transformation. Below, we will discuss the effects of testosterone therapy and voice training in detail. Read on to discover which of these options is best for you!

Testosterone therapy

Testosterone therapy is only available with a prescription. For some trans people, this process begins by getting a referral note from your therapist and taking it to your primary care doctor. If you’re unsure about whether or not your doctor provides hormone treatment, you can go to your local Planned Parenthood for support. You can also check out our resources page at for more information about what services are available in your area.

There are three main factors that affect the gender presentation of the voice: your speaking fundamental frequency (SFF), the average & variation of your speaking frequency, and your vocal tract length.1 Below, we will define each of these terms, and explain how testosterone therapy affects them. 

Speaking fundamental frequency is your central tendency in speech. Your voice is created by the vocal folds, which are inside your neck. When you speak, air passes through the folds and causes them to vibrate. The folds can create a wide range of vibration sequences; the sequence that you use most frequently is your SFF.5 When the vocal folds are exposed to testosterone, they will sometimes grow thicker. This change in mass will cause the folds to vibrate differently, thus creating a deeper and more masculine SFF.1 However, these results will vary widely from one individual to another. 

The second vital component is the average and variation of your speaking frequency. As we explained above, the vocal folds can perform many different vibration sequences, each of these creating a different tone of voice. Average/variation of speaking frequency measures how wide your range of frequency use is. If your SFF is in a masculine range, but you have a wide variation, that means that your voice may be moving in and out of masculine presentation.  For successful vocal masculinization, it is vital that both the SFF and the average/variation of speaking frequency stay within a range that is more masculine. Testosterone therapy will have a similar effect on the average/variation as it will on SFF. If the vocal folds thicken, the average/variation of the speaking frequency will drop into a range that is similar to cis-men,1 though these results will vary from one individual to another.

Vocal tract length (VTL) is the final factor that contributes to the gender presentation of the voice. The vocal tract is the area inside your body where your voice is produced. It is a passage that starts at your vocal folds, and goes all the way to the tips of your lips. The average vocal tract length of a cis-man is 10% to 20% longer than that of a cis-woman. This difference in length causes the cis-female voice to sound higher, lighter, and more feminine, and the cis-male voice to sound deeper, richer, and more masculine.

Testosterone exposure has been shown to partially lower the position of the larynx, thereby extending the length of the vocal tract.1 One study found that trans men taking testosterone developed VTLs that were significantly longer than cis-women, however their VTLs were still shorter than the average cis-man. This discrepancy in length can cause the gender presentation of the voice to retain qualities that lean towards femininity. Studies have shown that 12-16% of participants are not fully satisfied with the masculinization of the voice after testosterone therapy 3,4 leading some researches to suspect that insufficient change in VTL may be the cause.1

That leads us to our next segment. What do you do if you experience incomplete vocal masculinization? Or, what if you want to transform your voice, but you’re not interested in taking testosterone? That’s where the power of voice training comes into play.

Finding the answer in trans voice training

While many trans individuals will experience positive outcomes from testosterone, others may be left wanting more. This is where trans voice training comes in, and in some ways, gets the leg up on hormone therapy! Do you remember how testosterone had limited effects on the vocal tract length? Well, this is exactly where voice training excels. Learning to extend the VTL by lowering the larynx is a common method used by singers to cultivate more fullness and power in the voice, and it has been used for generations.

So how does it work? The larynx has the ability to move up and down inside the neck, and it will do so constantly as we speak, or sing. However, most people will have a general range that their larynx operates within. Some of this is due to genetics, but a large part is determined by the voices we hear as children. Kids learn to speak by mimicry, and they don’t only learn words, they learn tone, pitch, accent, and intonation among other things. All of these qualities will affect the position that the larynx learns to maintain. However the larynx is a free agent, and can be trained to change its position at any time. In trans voice training for masculinization, individuals will learn to lower the larynx. This new position is reinforced with consistent practice. Over time, it becomes the “new normal,” and can be sustained with confidence and ease. If this seems hard to fathom, imagine a trained singer like Ariana Grande. Her incredible range and vocal fluidity is made possible by having a well-trained larynx position. Do you think she would wake up one morning and forget how to sing? No, because her vocal training is so deeply ingrained that it has become second nature. In the same way, systematic training of the larynx will help us to confidently and consistently extend the vocal tract length.

Below, we will discuss the specific training methods that are used in this process.

Voice training for ftm people

As we’ve discovered from our discussion above, many trans men will seek to complete their vocal masculinization with voice training. Voice training is a powerful method that allows individuals to learn and sustain a new way of speaking and singing. While many trans men will combine hormone therapy with voice training to achieve their goals, some may choose to forgo hormones and pursue vocal masculinization through voice training alone. So, how does it work?

The foundation of ftm voice training centers on the idea of expansion. Inside your head and neck, there are three chambers where your voice will resonate (vibrate). These chambers have the ability to change in size depending on how we use them, and their size will determine how the voice sounds. R1 is the chamber located inside your neck, and it is often called the primary gender control knob of the voice, because its position will have the greatest impact on whether a voice is perceived as masculine or feminine. The size of R1 is controlled by the position of the larynx, a cartilage box that contains your vocal folds (sometimes called the voice box). The larynx has the ability to move as we speak and sing. If you place your hand gently around your throat and swallow you will feel the larynx move.

For trans voice training, the position of the larynx is extremely important. When the throat (R1) is expanded, the larynx will drop into a low position. Causing the voice to sound richer, lower, and more masculine. By contrast, when the throat is constricted, the larynx will move into a high position, causing the voice to sound brighter, higher, and more feminine. Learning to achieve and sustain a low larynx is foundational to masculinization, and it has been suggested that this vital component cannot be fully achieved by testosterone therapy alone.

Additional masculine vocal traits

While the core of ftm voice training will focus on the use of the resonance chambers, there are some additional layers to the masculine voice that help complete the picture. Vocal fry is a subtle raspy quality that is often associated with the male voice. You may have experienced it early in the morning, or perhaps when you’re getting over a cold and you notice that your voice sounds more rough and rugged than usual. When used correctly, vocal fry adds a warm, rich quality to the speaking voice. A great example of heavy vocal fry is the voice of Vin Diesel, while a more subtle use of fry can be heard in the speaking voice of Bruno Mars. The amount of fry used will be different for each individual. Some female voices will already incorporate fry (Scarlet Johansson, and Sophia Bush are great examples), so adding a heavier vocal fry to increase masculinization may feel natural and authentic. By contrast, if you’re starting with a voice that has no vocal fry in it, it may feel better to add only subtle amounts. It’s important to exercise caution when doing this, because forcing too much vocal fry into the voice may cause fatigue or hoarseness.

Another hallmark of the male voice is a monotone speaking quality. Monotone means that the voice will have very little movement in pitch. In contrast to female voices, which tend to incorporate a wide range of pitch change, male voices tend to remain anchored to a consistent low tone. Early on in the process of voice training, individuals may find that they can achieve their desired tone, but they can’t sustain it. This is very common. With careful practice, you can learn to stay consistently in your desired tone, as well as learning to keep reactionary sounds (coughing, sneezing, yelling), all within the masculine range.

The way forward

Vocal transformation is a unique journey for each trans individual. And while this work can be challenging, it is also full of immeasurable gifts. The path before you is daring, exciting, and beautiful, and in reading this article today, you have already taken your first bold step. If you’d like to learn more about voice training for masculinization, click here to connect directly with the staff of Seattle Voice Lab.

  1. Hodges-Simeon CR, et al. ‘Testosterone Therapy Masculinizes Speech and Gender Presentation in Transgender Men,’ Scientific Reports, 2021; doi: 10.1038/s41598-021-82134-2
  2. Korpaisarn S, et al. ‘Effects of Testosterone Treatment on Transgender Males: A Single-Institution Study,’ SAGE Journals, 2021; doi: 10.1177/20503121211051546
  3. Van Borsel J, et al. ‘Voice Problems in Female-to-Male Transsexuals.’ Int. J. Lang. Commun. Disord, 2000; doi: 10.1080/136828200410672
  4. Damrose EJ. ‘Quantifying the Impact of Androgen Therapy on the Female Larynx. Auris Nasus Larynx. 2009; doi: 10.1016/j.anl.2008.03.002
  5. Backen, R J, & Orlikoff R F. ‘Clinical measurement of speech and voice (2nd ed.), Singular Thompson Learning, San Diego, 2000.