In August 2017, Riley Grace was a senior at Rhodes College in Memphis weighing two life-altering decisions — which law schools to apply to and how to begin her gender transition. 

Transition can include social and medical changes like dressing differently, switching pronouns or undergoing gender confirming surgeries. Grace’s transition has included longer hair, a new name, hormone replacement therapy, coming out to family and gender therapy to help guide her journey to living full-time as the woman she’d always known herself to be.

And in August 2018, she started voice therapy at the Memphis Speech and Hearing Center, located at 4055 North Park Loop on the University of Memphis South Campus.

Grace is part of the center's Transgender Voice Development program. Founded in 2016, the program helps trans people craft a voice that aligns with their identity. It focuses on vocal hygiene like avoiding smoking, vocal exercises and proper breathing to create a signature sound.

“Voice dysphoria has probably always been one of the worse things for me dealing with being trans,” said Grace of the distress some feel when their voice doesn’t align with their gender.

Grace and program director John L. Sandidge said the reasons people seek voice therapy vary. Many want to stop being misgendered on the phone. Most want to reduce their voice dysphoria.

“My voice and the quality of it is very important both for dysphoria but also for me operating in my profession,” said Grace, who starts law school this fall but is still deciding which offer to accept. “I want to have a successful career; I don’t want my voice to be an impediment.”

Most clients want to be able to pass as someone who is not transgender, but Grace and Sandidge emphasized that not all trans people want to pass or pass at all times.

Unfortunately, the ability to pass is often a survival skill, and having a voice that doesn't align with a person's presentation can be a giveaway.

“Me just operating as a trans person in 2019 America, it’s very important for my personal safety to have a voice that’s passable,” said Grace. “It could be the difference between someone literally killing me or not.”

Despite the myriad of reasons people join the TVD program, Sandidge said ultimately, voice therapy is about affirming a person’s true nature with a voice that feels right.

“The voice is said to be the mirror of the soul. Our voice carries our emotion. Our voice carries our identity. You talk to someone and they know it’s you,” said Sandidge. “That is the primary reason that people cite for [joining the program]. 'This voice is not me. I want the voice that fits me.'”
 

More Than Noise

The voice is produced when air is pushed from the lungs, over the vibrating vocal cords and out of the mouth.

“If you didn’t breathe, you would not have a voice,” said Sandidge, who works with all of the TVD clients as the program’s dedicated speech pathologist.

The qualities of the sound like pitch and volume are based on how much and how fast the air moves, the shape of the vocal cords and the shape of the mouth. Many people think pitch — the frequency of the sound — is the most important thing, but Sandidge said resonance or how the sound is projected out of the mouth is much more important for manipulating the voice. Pitch, breath and resonance together make voices sound more masculine or feminine.

“Once we start working on the resonance aspect, [clients] are amazed,” said Sandidge.

Cadence, inflection and word choice also combine with pitch and resonance to make up the prosody or overall melody of a language.

Murals of ear, nose and throat structures like the larynx decorate the halls of the Memphis Speech and Hearing Center. The center caters to a wide range of patients with a variety of communication challenges. (Cole Bradley)

Why Trans Women?

To date, all of the TVD clients have been trans women. Sandidge said the lack of trans men as clients is due primarily to the physiology of the throat.

During puberty, vocal cords exposed to testosterone morph into a v-shape and lengthen and thicken. This is what forms the visible larynx or Adam’s apple. Like a guitar string, the thicker the cord, the deeper the sound it produces.

When trans men take testosterone as part of hormone replacement therapy, they experience a sort of second puberty and their vocal structures change. Most achieve their desired voice within a year. Sandidge said voice therapy could help trans men hone their voices, but trans women have a more significant need because their vocal cords were permanently altered by testosterone during their teenage puberty.

“Once the vocal cords have developed in length and mass, they don’t reduce. That’s why the voice remains,” said Sandidge.

But Sandidge also said there’s a misconception that all women’s voices are high pitched when, in fact, they run a range of octaves. Most trans women can easily produce the most common pitches and work with Sandidge on more complex aspects of voice.

Grace said that for her, it was important to develop a sound that fit her specific life and aesthetic. She’s tall and athletic, has a no-frills style and wants to command courtrooms. She doesn’t feel like an especially high pitched voice is right for her.

“Voice is important for how you are perceived but it’s not the only thing,” she said. “Your entire presentation, there’s a lot of things that can add or take away from [it]. Voice is a part of that.”
 

Safety, Identity and Perceptions

Martavius L. Hampton — media liaison for OUTMemphis LGBT resource center located at 892 Cooper Street — noted that transition options like voice therapies can help shape self-image, other people’s perceptions and personal safety.

In addition to workshops to help with legal name and gender changes, OUTMemphis hosts three transgender support groups and a group for parents of trans youth. It also publishes a Trans Best of Memphis guide with trans-friendly businesses from bars to doctors.

“We are always supportive of other resources in-house or out-of-house that will help people in our trans community feel comfortable in their identity,” said Hampton. “For those who are in the process of transitioning, this is yet another feature that someone could access to complete their transition or help with their transition.”

One in four trans people experience physical violence because of their gender, and each year the number of transgender murder victims hits a new high. The overwhelming majority of victims are trans women of color. In 47 states, a person can use a "trans panic defense" to justify murdering a trans person.

“I could meet someone just randomly walking down the street, at a bar, going out to get groceries,” said Grace. “And let’s say that they see me and they think one thing and then they hear me … People get seriously hurt or killed.”

In February 2019, Tennessee became the first Southern state to include violence against trans people in its definition of a hate crime.

An estimated 94,700 LGBT people in Tennessee lack workplace protections. The City of Memphis does include gender identity in their employee non-discrimination protections, but in 2011, Tennessee Governor Bill Haslam signed a law prohibiting municipalities from requiring contractors and affiliates to provide protections beyond those at the state level. State laws do not include gender identity. Tennessee is also one of the only states in the U.S. to explicitly forbid trans people from changing their gender marker on their birth certificate.

Ginger Leonard, board chair of the statewide LGBT advocacy group Tennessee Equality Project, said TEP is currently opposing HB 563, which cleared the state's House Commerce Committee in February. The bill states that municipalities cannot deny eligibility for public funds, contracts or partnership to businesses that explicitly discriminate against LGBT clients and employees.

Grace said her pre-law training taught her that perception and likability are important, and as her look becomes more feminine her voice has to match or juries, witnesses and judges will be more likely to act with prejudice.

“It’s very important for me, I think, to be able to have a voice that is more consistent for the average onlooker and how they see me,” she said. “That’s just going to make me much more approachable, accessible to them and make me generally more likable to them.”

Riley Grace (far left) jokes with staff members Marqwesha Carr-Lewis (L) and Erin Frazier (R) as she checks in for voice therapy at the Memphis Speech and Hearing Center. (Cole Bradley)

Growing the Program

Grace is not the Memphis Speech and Hearing Center’s typical client. The TVD program is still small, and most of the clinic's clients work with its team of audiologists and speech pathologists to overcome broader communication challenges like stutters or regaining speech after an injury, stroke or illness like throat cancer.

Since the TVD program was founded in 2016, it's grown from one to two transgender clients annually to seven current clients.

Clients work directly with Sandidge over an average of 12 to 16 sessions, which start in fall or spring following the university’s semester calendars. The center accepts insurance. Without it, sessions are priced from $16 to $80 based on income.

Grace previously tried online resources like meeting with a voice coach via video chat, but she found the in-person experience to be superior.

“Being able to work with people in person lets you have someone who’s able to help you craft a voice that’s more in line with you, your presentation, [movements], how you look,” she said.

Graduate students from the University of Memphis School of Communications Sciences and Disorders with an interest in transgender voice therapies also work with clients alongside Sandidge.

“I must say, in the last couple years, the students coming through, many many people have a great interest in this area,” said Sandidge. “I find [them] to be much more accepting of everyone. This is a new and exciting avenue for a student to become familiar with and possibly later use what they learn to help other people.”

For her experience, Grace said she’s happy with the service she received and what she’s achieved. On recent law school visits, she was able to present herself with a more confident and authentic voice and pass when she wanted to.

“That made me feel wonderful!,” she said, her voice pitching up with excitement.