Received my End of Semester Voice Analysis

[KathrynJulia]

As many of you are aware, I just spent the past Spring 2013 semester taking feminine voice therapy at the Speech and Hearing Clinic at the University of Missouri. This therapy proved very beneficial to me in that I experienced significant improvement in the quality of my feminine voice working with professional speech therapist.

Today I received a written analysis of my performance. I attended 24 one hour sessions that were filmed and recorded. These recordings will be used to train new therapist to work with future Male to Female clients wishing to produce a more feminine sounding voice in a manner that protects the vocal folds from injury through poor vocal performance. As my assessment documents, I made many of the same mistakes that we all make while attempting to improve our voices. So here it is.

I have redacted personal information that I do not wish to be traced back to me.

STATEMENT OF THE PROBLEM:

SEMESTER SUMMARY SPRING SEMESTER, 2013

self-referred

01/29/13

05/02/13

24 (50 minute sessions)

Kathryn is a 58 year-old biological male who presented to the clinic seeking voice therapy to alter the subjective aspects of vocal function to increase the feminine quality of her voice.

BACKGROUND INFORMATION:

While currently living as a man, Kathy indicated she was beginning her process of transitioning to be a woman. She reported she is taking hormones under the care of a doctor and indicated she intends to receive facial surgery over the summer; following that surgery she reported she will likely begin living as a woman day-to-day. Pending success of the required treatment process, Kathy plans full, surgical gender reassignment within the next few years.

Kathy works full time at the University. She has had no direct voice therapy intervention prior to coming to the clinic but reported using self-help programs, tailored to assisting MTF transgender individuals to adopt feminine pitch and vocal characteristics, for approximately one year. Kathy’s medical history includes. (Redacted)

In addition to estrogen, Kathy reported she takes multiple medications to manage her medical conditions, and that she has an insulin pump to manage her diabetes . She previously smoked for 12+ years, but has ceased smoking over 25 years ago. Her speech and language functioning (outside of subjectively male voice characteristics) were not areas of concern.

REPORT OF TESTING:

Subjective, instrumental, and behavioral measures were used to assess Kathy's vocal function prior to beginning treatment.

Vocal Hygiene Patient Questionnaire:

A vocal hygiene patient questionnaire was given to Kathy to help identify vocally-abusive behaviors. Kathy self-reported seasonal allergies for which she takes medication (allergy shots and daily antihistamine). She reported a history of mild asthma, for which she uses an inhaler. She

SEMESTER SUMMARY, Spring '13, Kathryn J.

Page 2 of6

reported that she has colds often, and takes over the counter medications to manage symptoms like frequent coughing, post nasal-drainage, and hoarseness. These symptoms cause her to cough and/or clear her throat frequently, which she feels exacerbates her hoarseness. She indicated she does not talk excessively or loudly on a regular basis, though her job requires her to talk often throughout her day, both on the phone and in person. She reported she does not scream or yell, imitate noises, talk loudly, or grunt while exercising. She indicated she does need to talk while she has a cold, which she feels is especially hard on her voice. Kathryn also reported she intentionally uses a higher pitch while speaking to achieve what she believes is a feminine sounding voice. Throat­ clearing and coughing, the need to "talk through" upper respiratory infections and the intentional use of a high pitch (as compared to her habitual pitch) were all potential areas of concern related to Kathy's vocal health.

Voice Handicap Index:

The Voice Handicap Index was administered to determine to what degree Kathy felt her present voice was a deterrent to her ability to communicate, and whether or not her voice negatively affected her life. Her responses indicated no negative feelings about her voice. She reported her voice never makes her feel incompetent or vulnerable. She estimated that 50% of the time when she is speaking on the phone, people assume she is a woman. She indicated she is patient with unfamiliar listeners and never experienced frustration when asked to repeat (which happens often while she gives instructions over the phone). She reported she did not talk less because of her voice.

Subjective Voice Assessment:

Kathy's voice was subjectively mildly hoarse with no diplophonia or pitch breaks in structured or unstructured tasks. Vocal intensity was judged to be unusually soft and Sherr voice had a breathy quality. Rate was appropriate. Her pitch sounded subjectively high, unnatural, and strained.

Instrumental Measures:

Speech samples were collected of Kathy reading a short passage, and speaking spontaneously. Samples were analyzed for the following:

Reading

Spontaneous

Average

Average

speech

(male)

(female)

Median Pitch (Hz)

161Hz

141 Hz

120 Hz

210 Hz

Mean Pitch (Hz)

181Hz

183Hz

120 Hz

210 Hz

SEMESTER OBJECTIVES:

Increase Kathy's subjective feminine vocal and speech characteristics.

1. Demonstrate forward focus in structured tasks in 90% of opportunities.

BASELINE: Kathy demonstrated forward focus in structured tasks in 10% of opportunities.

SEMESTER SUMMARY, Spring' 13, Kathryn J.

Page 3 of6

END LINE: Kathy demonstrated forward focus in structured tasks in 100% of opportunities.

1. Demonstrate feminine vowel prolongation in word level, and phrase level tasks in 90% of opportunities.

BASELINE:

1. Kathy demonstrated feminine vowel prolongation in word-level tasks in 0% of opportunities.
2. Kathy demonstrated feminine vowel prolongation in phrase-level tasks in 0% of opportunities.

ENDLINE:

1. Kathy demonstrated feminine vowel prolongation in word-level tasks in 100% of opportunities.
2. Kathy demonstrated feminine vowel prolongation in phrase-level tasks in 100% of opportunities.
3. Demonstrate feminine phrase inflection (prosody) at her phrase level in 90% of opportunities.

BASELINE: Kathy demonstrated feminine phrase inflection (prosody) at her phrase level in 0% of opportunities.

ENDLINE: Kathy demonstrated feminine phrase inflection (prosody) at her phrase level in 90% of opportunities.

1. Demonstrate feminine word stress patterns at her phrase level in 90% of opportunities.

BASELINE: Kathy demonstrated feminine stress at her phrase level in 0% of

opportunities.

ENDLINE: Kathy demonstrated feminine stress at her phrase level in 90% of

opportunities.

1. Maintain median pitch ofE3-F3 (164-174 Hz) at her word and phrase levels during structured speech tasks in 90% of opportunities.

BASELINE:

1. Kathy maintained median pitch E3-F3 (164-174Hz) at her word level during structured speech tasks in 10% of opportunities.
2. Kathy maintained median pitch E3-F3 (164-174 Hz) in phrase during structured speech tasks in 10% of opportunities.

ENDLINE:

1. Kathy maintained median pitch E3-F3 (164-174Hz) at her word level during structured speech tasks in 70% of opportunities.
2. Kathy maintained median pitch E3-F3 (164-174 Hz) in phrase during structured speech tasks in 45% of opportunities.

SEMESTER SUMMARY, Spring '13, Kathryn J.

Page 4 of6

PROCEDURE:

All of her above objectives were targeted in structured, clinician-driven tasks. The clinician explicitly taught techniques to achieve feminine vocal characteristics, and then provided direct models in intense practice drills with 1: 1 (one production-one response) feedback. Additional support was provided in her form of verbal and visual cues (i.e. gestures to demonstrate stress and intonation, visual pitch analysis software, etc.), and auditory cues using a keyboard. her clinician utilized a voice recorder with play-back features to enhance his ability to self-assess and monitor his own productions. To target forward-focus, her clinician directly taught and modeled forward-focus in drills, with her client cued to use tactile feedback (i.e., fingers placed on face to feel for vibration) to improve awareness and resonance. As accuracy in executing forward-focus improved, support was faded and Kathy was asked to generalize forward ­focus across tasks. Vowel prolongation was modeled and explicitly taught at her phoneme and word level, and her targeted at her phrase level. Feminine inflection was modeled, explicitly taught, and targeted at her word and phrase levels. Feminine stress (changes in pitch and prosody within an utterance to convey emotion/meaning) was modeled and She drilled at her phrase level. Appropriate feminine pitch was targeted in in single words and short phrases in structured tasks. her clinician provided one-to-one models, auditory cues (using her keyboard keys appropriate to target pitch), and introduced pitch analysis software to facilitate Kathy's self­ monitoring of his productions. Her clinician provided specific verbal feedback about her vowel productions, feminine inflection, feminine stress, and pitch in unstructured tasks was used throughout her sessions and across tasks to foster generalization. As her accuracy at all levels of production increased, the clinician offered fewer models and reduced verbal, visual and auditory cuing.

DISUSSION:

Kathy met her semester goal of demonstrating forward focus in structured tasks.

Initially, Kathy demonstrated forward focus in structured tasks in 10% of opportunities. Most productions exhibited a low, "chesty" or "throaty" quality that was subjectively masculine. The clinician explicitly taught forward focus by demonstrating phonation directed toward the nasal and oral cavities, creating a lighter, more feminine resonance. Kathy practiced forward focus during vocal warm-up drills, with verbal feedback by the clinician, and biofeedback (i.e. placing fingertips on cheeks to feel forward resonance).

At the end of her semester, Kathy demonstrated forward focus in 100% of structured tasks.

Kathy met her semester goal of demonstrating feminine vowel prolongation in word and

phrase-level tasks.

Initially Kathy demonstrated vowel prolongation in 0% of opportunities. The vowels in word and phrases exhibited subjectively clipped, masculine characteristics. The clinician explicitly taught feminine vowel prolongation and prompted Kathy to produce single words with longer, relaxed vowels. Kathy was most successful when provided direct models, and with verbal and recorded auditory feedback. Later in the semester, during self-assessment tasks, Kathy frequently identified vowel prolongation as a characteristic to increase her feminine quality of words and phrases.

At the end of the semester, Kathy demonstrated feminine vowel prolongation in 100% of word level tasks, and 90% of phrase-level tasks.

Kathy met her semester goal of demonstrating feminine inflection at the phrase level. Initially, Kathy's phrases did not exhibit appropriate, subjectively feminine intonation.

,

SEMESTER SUMMARY, Spring13,

KathrynJ

Page 5 of6

In her

months of individual practice leading up to the therapy, Kathy had practiced an exaggerated, "sing­song" prosody resulting in unnatural intonation patterns and pitch shifts not appropriate for feminine-sounding speech. Kathy imitated clinician models of appropriate inflection in phrases, and used pitch analysis software to monitor changes in intonation during phrase level tasks. Verbal and recorded auditory feedback and use of the keyboard to indicate appropriate pitch range consistently improved Kathy's productions.

Kathy also met her semester goal for feminine word stress at the phrase level.

Initially Kathy produced phrases with feminine word stress in 0% of opportunities.

Like her initial intonation, Kathy's initial phrases either lacked feminine word stress characteristics (i.e. words were flat, without increase volume, duration, or pitch on stressed syllables) or were characterized by unnatural, "sing-song" word stress. Kathy was most successful imitating direct models, using the pitch analysis software or the keyboard as feedback. At the end of the semester her phrases included feminine word stress in 90% of opportunities.

Kathy made progress toward her semester goal of using subjectively feminine pitch in words and phrases.

At the beginning of the semester, Kathy produced words and phrases demonstrating appropriate, naturally-feminine pitch in 10% of opportunities, but she frequently used her "home practice pitch" of 220 Hz.

Vocal strain and fatigue were observed and this pitch sounded unnaturally high. A target of 164-174-Hz (E3-F3 on the keyboard) was established as a more realistic and natural-sounding feminine pitch for her. She was most successful in tasks incorporating multi-modal cues, including a piano keyboard (for auditory cueing), and a pitch analysis I-Pad application (for visual cueing of real-time pitch in hertz). By the end of the semester, Kathy demonstrated naturally appropriate feminine pitch (between 164-174 Hz) in 70%

of single words, and 45% of phrases.

SUBJECTIVE OBSERVATIONS:

Initially, Kathy used self-help programs and frequent practice using a subjectively high

pitch at home and at work. Hard vocal on-set and hoarseness, with notably increased laryngeal tension, was evident at her early sessions. Explicit instruction about the need for good vocal hygiene and the importance of warm-up and relaxation exercises, easy-onset, and practice using a comfortable pitch was provided to reduce risk of damage to her vocal mechanism. Kathy reported that She used the relaxation exercises as needed throughout her day when She noticed vocal strain or tension, and focused on using a comfortable pitch with forward-focus, and feminine inflection and word choice.

To improve Kathy's awareness and ability to self-monitor feminine vocal characteristics,

the voice recorder was used and a pencil-paper tracking system was introduced for Kathy to self-assess each phrase-level production. Although this was not designed as a specific task, her ability to monitor and critically assess each production, with clinician input, proved beneficial for Kathy. Initially, she accurately judged her productions in 50% of opportunities; with utterance ­by-utterance, specific feedback, Kathy increased her ability to self-monitor her productions to 86% of opportunities by the end of the semester. While breakdowns persisted when attempting sentence level productions, some generalization of feminine speech characteristics and improved pitch variations within utterances was observed at conversation speech levels.

SEMESTER SUMMARY, Spring '13, Kathy J.

Page 6 of6

REPORT OF FINAL CONFERENCE:

An end of semester conference was held to discuss Kathy's progress toward semester goals.

The clinician discussed recommendations for at-home practice of functional phrases, vocal hygiene techniques, and exercises to reduce laryngeal tension. Kathy indicates that She is happy with the progress She has made, and intends to return next fall, following facial surgery this summer.

RECOMMENDATIONS:

It is recommended that Kathy continue voice therapy at the MU Speech and Hearing clinic to address the following:

Increase Kathy's subjective feminine vocal and speech characteristics:

1. Target forward focus in vocal warm-ups, conversation, and functional speech tasks.
2. Target easy-onset in vocal warm-ups, conversation, and functional speech drills.
3. Target vowel prolongation in conversation and functional speech tasks.
4. Target feminine inflection in conversation and functional speech tasks
5. Target appropriate, feminine pitch in functional phrase and sentence level tasks.
6. Target subjective feminine conversation habits, like feminine word choice, active listening, and feminine gestures.

_~en Nolan, S, CCC-SLP Clinical Instructor

[Guest otter-girl]

Wow. This is great Kathryn. This really shows the benefits of proper speach therapy. Congrats on your progress and thank you for posting. Its given me a lot to consider.

Hugs

Rachel

[Guest]

Atta girl! Wow! it is so much good imformation too. Hug. JodyAnn

[Guest Kaylee234]

Sounds like the program was a real benefit to you!

Are you going to continue next semester?

~ Kay

[Charlize]

How come i can't hear the changes in your post? Seriously what a great deal of work but with good results. You should feel so good about yourself. You give me a lot to think about.

Hugs,

Charlie

[Cyndee]

Congrats Kathryn on such a detailed report on your progress. This is good stuff.

Hugs

Cindy -

[Guest rowyn]

Kathy, on page 2 of the report, the voice therapist said that intentional use of a high pitch was a potential area of concern. Do you know why that is? I've been working on my voice for a while and have tried many methods. What I've been doing lately, though, is talking as much as possible with a higher pitch voice. I don't speak in falsetto or micky mouse voice, just a slightly (but noticeably) higher pitch. Any information would be great, as I really don't want to do any damage to my vocal chords.

[KathrynJulia]

Hello

By using self help CD's, they all try to raise pitch up to the median range of A3 which for many of us we can reach with work, but it strains the vocal chords for us to use that pitch range. I would speak around A3 for half a day and find my voice becoming hoarse and breathy from the strain. I was told that this will over time lead to vocal lesions that can cause temporary and even permanent damage, along with the need for outpatient surgery to remove them.

A good vocal range for me was E3 to F3 range. With occassional increases in higher pitches way up into female ranges. That doesn't strain and wear out your vocal chords. What they taught me is that at a range of E3 to F3 with vowel prolongation, the voice sounds much more feminine sounding. They also taught melodic intonation. Male voice tends to start lower and go up. Female voice starts in mid range and go up and down. Up when asking a question, down when making a statement. I also learned to critique my speech and determine for myself what sounded feminine and what did not.

Part of the training was also centered on feminine gestures and feminine facial expressions, and area that young woman assimilate as they grow up. My therapist, Loren was outstanding in teaching me gestures and expressions. And considering that she is pioneering a whole new aspect of Speech Therapy to be taught at the University of Missouri, I really commend her. My therapy was and is the beginning of a new chapter of therapy in Speech Language Pathology taught at MU. It is felt that in the coming years, more and more Transsexual MTF and FTM patients will seek Speech Therapy as a faster method to transition the voice to the gender they are moving to.

Am I planning on returning in the fall? You better believe it. My best friend who knows that I am transitioning, called my cell phone three times and reached my voice mail message, hesitated to leave a message for me because he did not recognize my voice in female mode. When he hesitantly left a message on the third try, he appologized if he was leaving a message to the wrong phone number. When I returned from voice therapy, my voice was in total feminine mode one day and I answered the phone. My Personal Assistant who has worked for me for over 7 years did not recognize me. She came down a little later and asked me who the woman was answering our phones was. I had coffee coming out of my nose on that one.

Seriously, I recommend professional speech therapy. 24 sessions cost me $26.25 per session and I attended twice a week for a 50 minute session. I recorded 18 of my sessions on my iPad as an MP4 with amazing clarity and they comprise of 20 to 25MB files that I will use all summer long to keep my voice in solid shape. I hope my experiences are such that I can pass on some of the recommendations that I learned. Too high a pitch can damage your vocal folds. For most of us, speaking in a median female range is too high to do all the time as a natural pitch. We need to drop a few notes below A3 to E-3 to F3. That is still a very feminine range. Start out speaking softer and prolong the vowel sounds. Get away from breathy sounds. Most womens voices aren't breathy sounding. Take care, Kathryn

[Guest rowyn]

Thank you for all the information, Kathryn. I'll have to find something that plays at an E-3 to F-3 range, and determine if my voice was any higher than that.

[Guest LizMarie]

Congratulations, Kathryn. It sounds like you made wonderful progress!

[Guest CassieX]

Congratulations Kathryn. It sounds like you are rocking the course! I just got done with my first semester in a similar course here in Virginia and enjoyed it immensely. It really helped me with learning feminine body language/mannerisms, and correct intonation and pitch and has been a real life enabler in transitioning. I'm not quite as high as you in conversational speaking but am improving the more I practice. Two things that helped me immensely was my singing background and a diagnostic tool they use called Visi Pitch. The singing background helped me maintain pretty much prefect pitch all the time and maintain vocal hygiene but I had to unlearn some habits as I tended to start singing in some of the voice exercises when I reached a certain point.. I cured myself of that by the end of the semester though, lol!

Visi Pitch is an awesome diagnostic tool that lets you record and see where you are at in terms of your conversational range and how you are speaking. Googling the name will bring all kinds of technical stuff that I couldn't hope to explain here, but suffice to say I loved using it!

Only a couple more weeks to go and I'll be back for the summer semester. I can hardly wait!

Hugs!

Cassie

[KathrynJulia]

Hi Cassie:

I have to say that my speech therapy was worth every penny that I spent. I was helping load software on our Department Chair's computer today and his Admin Secretary comented that she was impressed with the change in my voice. She brought it up out of the blue. But it was a nice complement.

The feed back really helped me from my speech therapist plus the mannerisms and speech differences between male and female speech was also extremely useful. I know that my voice coupled with mannerisms, gestures, proper pitch, melodic inflection and vowel elongation has helped me imensely sound and be more feminine. Someone working one on one with you can spot things that you miss when doing it on your own.

It's not for everyone, but professional voice therapy can elevate your voice to the next level for sure.

Kathryn