For some transgender Minnesotans, voice training with a vocologist makes all the difference

CATHY WURZER: Like it or not, the sound of your voice says a lot about you. Trust me, I know this. I'm a radio host. And for some transgender people, a key part of their journey is getting their voice to reflect their identity. Those who use hormone therapy to change their appearance and voice to affirm their gender and even those who don't may want some tips on how to get more comfortable with their voice. Some doctors even say that it is medically necessary to do so.

That's where M Health Fairview ocologist Lisa Butcher comes in. Lisa is dedicated to helping her clients, many of whom identify as transgender or gender nonbinary, through the journey of finding their true voices. She's also a former opera singer. And she's here to talk about how our voices are part of our identity.

Hey, Lisa. Good to have you here. Did I screw up? Are you a vocologist?

LISA BUTCHER: I am actually a vocologist. I hold a certificate in vocology from the Summer Vocology Institute, which is actually out in Utah now. And I will be a guest lecturer there this summer.

CATHY WURZER: Well, nice to have you here. Thank you for taking the time.

LISA BUTCHER: Yep, thank you for having me.

CATHY WURZER: I know you worked with the Minnesota opera for a long time.

LISA BUTCHER: I have.

CATHY WURZER: How did you get into working with transgender clients on their voices?

LISA BUTCHER: Yes, so we started the clinics in-- or, sorry, the Comprehensive Gender Care program back in 2018. And I was a founding member of that. I was seeing clients prior to that time.

But this is a wonderful program that opened us up to all of the providers in the M Health and Fairview network, connecting in order to provide kind of a one-stop shop. We want to help our clients navigate through the health system. And, as many of your listeners might even know, it is a very big challenge for those who identify as transgender and gender nonbinary, gender diverse to have trust in the health-care system and to get the services they need. So I was a part of that.

CATHY WURZER: So tell me, I mean, I understand that the voice is kind of like a window into one's soul, in a sense, given what I do, as I say, for a living. Tell me about why the voice is so important for some people to feel like themselves gender wise.

LISA BUTCHER: I think of it not even just as like themselves, but to actually be themselves, to find their authentic self. And I think that, even in our day-to-day conversations as cisgender people, we are often talking about how we're trying to find our voice. And that is really the calling card. It is, for many of my clients, the number one thing that creates a gender dysphoria or feelings of an incongruence with who they are. And so they are really seeking to put that final piece together that makes them feel whole.

CATHY WURZER: So how does one find their true voice? I'm going to assume that for your trans clients, using hormone replacement therapy, testosterone, estrogen, that will also-- that's going to have to affect the voice to a certain degree, right?

LISA BUTCHER: For clients who are transitioning and seeking a feminine voice, estrogen can work for some anecdotally, but we have not found research that actually proves that it makes significant changes in the voice. For those who are seeking a masculine voice, we have found that testosterone can be effective, but not for everyone. And so my work is really to help guide the individual into finding a voice that matches what they are seeking.

And so I kind of think of it as I'm going on a journey with them. I do a lot of work in that very first session to make them feel very comfortable because it is a very vulnerable thing to explore your voice. And it's amazing how many feelings can come up when we start to work on our voices.

CATHY WURZER: See, I have a little bit of audio that I'd love to play for folks.

LISA BUTCHER: Oh sure.

CATHY WURZER: This is an example of what you do. Let's play that.

[AUDIO PLAYBACK]

- So let's try some semioccluded vocal tract exercises. We're going to use some water. Can you take a breath and give me just a really nice, comfortable blow? No voice first, just kind of a nice, easy blow?

[BUBBLES GURGLING]

Yep, and feel that resistance with the air. It's kind of fun. Now let's see if we can add our voices. So can you give me a "whoo"?

[HUMMING GURGLING]

Thinking high and light and easy, yep, putting a lot of breath into it. Can you draw your sound a little bit more forward towards the front of the face? Mhm. You should feel vibrations for your lips are touching that straw.

Mhm. Now can you take a breath for me, and let's go to a gentle hun sound. So can you give me a nice, easy hmmm.

- Hmmm.

- Hmmm.

- Hmmm.

[END PLAYBACK]

CATHY WURZER: Oh, I've done that one myself. So tell folks, what were we just hearing?

LISA BUTCHER: This would actually be a great warm-up exercise for you too, Cathy. But what's wonderful about doing the bubbles, So Dr. Ingo Titze, known as the father of vocology, has done a lot of research into this. And what I love about the bubbles for especially my clients is that a lot of them do come in with gender dysphoria, again, that very uncomfortable feeling of not feeling like their authentic selves.

And so oftentimes, if they're having a hard time making sound, I can have them focus on the bubbles while I get to focus on their voices and drawing the sound towards the front of the face. And this is where I start to introduce them to the idea of forward resonance if we're seeking a feminine voice versus a more masculine kind of rich, kind of back sound. And so we'll work towards something that we don't want to sound too bright, too twangy, but we want something that sounds comfortable and rich and easy.

CATHY WURZER: I understand. I understand it completely as to what you're talking about. And for folks, it's-- how can I ask you this question? It's not all about the vocal pitch, right? I mean--

LISA BUTCHER: Right.

CATHY WURZER: --there are other aspects of our voices, our gendered voices to work on.

LISA BUTCHER: Yeah, and the prosody, the intonation-- even as I think about how lovely your voice sounds on the radio, it's not pitch, right? It's not that you sound very high in pitch, but that there's this really nice forward resonant sound. And so we talk about that a lot because not only do we do some excellent care-- myself, my colleagues, Leighann Colin and Dan Weinstein, but we also have-- sometimes we work with pitch elevation surgery as well. And Dr. Raluca Gray, who I work closely with, will do that.

And we stress that it really isn't just about the pitch, that we need to find that kind of feminine pattern. And that would be very different than if I was talking in more of a monotone and very abrupt, right, or short phrases. And then if I take my voice kind of low and down, right, this would, all of a sudden, sound much more masculine. And so I do do some gentle work to help them explore that and bringing them to that really nice, again, easy, forward, kind of flowy speech, which is kind of singsongy, too, right? A feminine voice has more of a singsongy pattern to it.

And then as we progress in our therapy, we find that we need to start working on different emotions. And sometimes I hem and haw about how stereotypically I feel like those who speak with a feminine voice tend to always sound happy. But sometimes we have to sound-- we have to sound aggressive. We have to sound sad because those are our emotions. And so we will work on that as well to find that ease for them.

CATHY WURZER: Is it a little bit easier to work with a transgender male on getting his voice where he wants it?

LISA BUTCHER: Yes and no.

CATHY WURZER: OK. Mhm.

LISA BUTCHER: Yeah, I think that there are some that come in. And, it is, again, working on just a low resonance. For some of them, they can find that. Or my gender nonbinary clients or some of my agender clients are also looking to have elements that can sound masculine but still have a feminine flow to it. And so we'll work with that.

But I do have some of the transmasculine voiced clients who they do struggle. And I think sometimes it's also about that gender dysphoria and that sometimes it feels like we still haven't quite found the right voice. And so, again, it's a really strong, trusting relationship because I will clearly say to them, this is what I'm hearing. What are you feeling? And we have to work off of that.

It is hard because no matter what we do, there are always going to be people that sometimes hear a voice, and they want to out the people, the person, or make them feel unsafe. And safety is a big part about voice for me, too, and the work that I do. I want people to be safe. And in our climate of the world and the country these days, safety is a huge issue with voice and matching the identity that you're seeking.

CATHY WURZER: Final question for you, Lisa.

LISA BUTCHER: [INAUDIBLE].

CATHY WURZER: Oh. As you work with your clients and you come to maybe the end of your work together, how much confidence does changing their voice give your clients?

LISA BUTCHER: We were just at Pride yesterday. And I had a wonderful client come. And that was something that she said, is the confidence that she is feeling now in her voice has been amazing.

And I do feel that a lot of the work we do is bring that confidence to them. Again, considering that health care for transgender, nonbinary, gender-fluid folks, health care is an area where there hasn't been a lot of trust. And so creating that trust has been paramount for me. And when we can do that and then go that much further to build their confidence, you see their face light up.

I start to get away very quickly from us calling our-- having the client speak to themselves as transgender female. You're just a woman. You're just a man. You're just a person. You're human. And I think when we get away from labels and we just go for what feels authentic, that's where confidence really comes in. And then they achieve the goals that they are looking for.

CATHY WURZER: I've enjoyed the conversation. Thank you for your work.

LISA BUTCHER: Thank you. Thank you, Cathy.

CATHY WURZER: We've been to talking to M Health Fairview Vocologist Lisa Butcher.