Testosterone therapy masculinizes speech and gender presentation in transgender men.


Hodges-Simeon CR(#)(1), Grail GPO(#)(2)(3), Albert G(2), Groll MD(4)(5), Stepp CE(4)(6)(5), Carré JM(7), Arnocky SA(7).
Author information:
(1)Department of Anthropology, Boston University, 232 Bay Stated Rd., Room 102-B, Boston, MA, 02215, USA. [Email]
(2)Department of Anthropology, Boston University, 232 Bay Stated Rd., Room 102-B, Boston, MA, 02215, USA.
(3)Department of Forensic Sciences, George Washington University, Washington, D.C., USA.
(4)Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA.
(5)Department of Biomedical Engineering, Boston University, Boston, MA, USA.
(6)Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
(7)Department of Psychology, Nipissing University, North Bay, ON, Canada.
(#)Contributed equally


Voice is one of the most noticeably dimorphic traits in humans and plays a central role in gender presentation. Transgender males seeking to align internal identity and external gender expression frequently undergo testosterone (T) therapy to masculinize their voices and other traits. We aimed to determine the importance of changes in vocal masculinity for transgender men and to determine the effectiveness of T therapy at masculinizing three speech parameters: fundamental frequency (i.e., pitch) mean and variation (fo and fo-SD) and estimated vocal tract length (VTL) derived from formant frequencies. Thirty transgender men aged 20 to 40 rated their satisfaction with traits prior to and after T therapy and contributed speech samples and salivary T. Similar-aged cisgender men and women contributed speech samples for comparison. We show that transmen viewed voice change as critical to transition success compared to other masculine traits. However, T therapy may not be sufficient to fully masculinize speech: while fo and fo-SD were largely indistinguishable from cismen, VTL was intermediate between cismen and ciswomen. fo was correlated with salivary T, and VTL associated with T therapy duration. This argues for additional approaches, such as behavior therapy and/or longer duration of hormone therapy, to improve speech transition.