This is Your Voice on Hormones

I recently got the privilege to see Laura Jane Grace perform live. Grace is the founder, guitarist, and lead singer of the band Against Me! who made headlines for being the one of the most high-profile musicians to come out as transgender. She was actually a last-minute addition to the show I came to see, and as a result had no backup band — it was just her, a couple of acoustic guitars, and an audience. If you thought, as I did, that punk music couldn’t be performed solo, you were dead wrong. The performance was intense and moving, and Grace was personable with the audience without letting them get too uppity (“Oh, that song? I already have my capo on, I’d have to move it for that song,” she said at one point, wryly denying an audience member his request.)

But watching her got me thinking. Like many trans people, she’s on hormone replacement therapy (or HRT) to help what’s on the outside better match her identity. With all the changes that HRT brings about, it’s got to do something to your voice, right? What happens when a trans singer begins hormone therapy?

I decided to find out. It turns out that yes, HRT does affect the voice, and it affects it differently depending on whether you’re transitioning to male or female — but not necessarily in the ways you might think.

(It’s worthwhile to mention here that if you’re not familiar with the trans community, you might want to take a few minutes to brush up: GLAAD’s Transgender 101 page is a nice primer, and their media reference guide has a great glossary of terms.)

The Larynx

To understand the next sections, we’ll need to get a quick primer on the larynx. Also known as the voice box, the larynx is a structure in the neck made out of cartilage that forms the scaffolding for the vocal folds. (Vocal folds are more commonly known as vocal cords, but that label isn’t quite accurate and anyway, you’ll be so much cooler in singer circles if you call them by their rightful name.)

Consider the vocal folds like the strings on a guitar. If you were to compare the high E string to the low E string, you’d notice that the lower string was much thicker than the higher string. That thickness gives it a rounder, richer tone. Let’s keep this analogy going: if you were to put your finger on the first fret and pluck, that tone would be lower than if you put your finger on the fifth fret. That’s because the fifth fret makes the string shorter than the first fret does, and a shorter string creates a higher tone.

Besides the fact that you’re moving air instead of physically plucking, that’s precisely how the larynx works. Different people have different vocal fold thicknesses and therefore different vocal qualities, and those cartilaginous structures in the larynx stretch and release the vocal folds to create different pitches. You can watch the vocal folds in action in the following video, which uses a laryngoscope placed up the nose and down the throat in conjunction with a strobe light to see them work:

So, how does this fun little structure change with the introduction of hormones?

The Female-to-Male Transitioning Voice

When a cisgender boy or trans girl hits puberty, their body ramps up the production of testosterone. This causes several things to happen: the vocal folds lengthen and thicken and the larynx grows. This is a very gradual process that happens over a period of years.

Testosterone therapy in adult trans men, on the other hand, is often (but not always) designed to get the desired result as quickly as possible, so the amount of testosterone administered in HRT can be far beyond what a teenage cis boy would get in the same time period. A trans man on testosterone gets longer, thicker vocal folds, but his larynx stays the same size, preventing the vocal folds from growing as large as they might in a person who went through male puberty. Testosterone also causes ossification, or hardening of the cartilage, making the larynx less flexible.

This can create problems: namely, a condition called “entrapped vocality” where the voice sounds permanently weak and hoarse. For a singer, this spells disaster. There is hope, however, which I’ll explain later on.

Joe Stevens, folk singer and trans man. Hear his music here.

The Male-to-Female Transitioning Voice

According to everything I could find, the voice is unaffected by estrogen therapy. For many trans women, this is actually kind of a bummer. In a perfect world, the hormones would make everything more feminine, from their bodies to their voices. To get around this, trans women will often physically train their voices to sound higher. Some even undergo surgery to shorten the vocal folds, though that can be quite expensive. That’s one thing you can say about estrogen therapy: at least it doesn’t cause the vocal problems that testosterone therapy can.


There is a phenomenon known as premenstrual voice syndrome, in which people who have periods experience a boatload of vocal symptoms with the unwelcome burst of estrogen around that time of the month: less vocal clarity, less efficiency, and an inability to sing higher notes are a few. Earlier in the menstrual cycle when there’s also a lot of estrogen being produced, the vocal folds suffer from fluid buildup and there’s a higher risk of acid reflux, which can permanently damage them.

Nothing I could find said specifically that trans women undergoing HRT experienced these symptoms, but with the large amounts of estrogen it makes sense that they would.

Tips for Singers Who Want to Transition

Many of the vocal problems transitioning singers experience seem to come from too much, too soon. Alexandros Constansis, an opera singer and researcher who’s been studying this topic since 2002 — just before he began his own transition — found that by starting on a low dose of hormones and ramping up gradually, he was able to control and adjust to the changes in his voice because his larynx changed more slowly.

Vocal training is also important. Constansis has a regimen of vocal exercises he recommends. Joshua Riverdale, the author of this phenomenal article about testosterone and the trans male voice has these recommendations for singers transitioning to male, though many of the tips are great for those transitioning to female as well:

In addition to independently pursuing vocal exercises and maintaining good vocal health, trans male singers may also benefit from speech and voice therapy. A speech-language pathologist (SLP) or vocal coach can develop a custom vocal training program that’s centered around their clients’ goals. They can also identify limitations of the changing voice, helping clients recognize the symptoms of vocal fatigue. While it’s important to continue singing through the first year on T — cracks and all — it’s even more important to avoid doing damage to the developing voice.

I’ll leave you with a few singers who came through the transition successfully, with rich voices that are, most importantly, true to their identity.

This song by Joshua Klipp made headlines a few years ago for being the first to feature a trans man’s pre-transition voice alongside his current voice (listen to the backing vocals!). This is SO. COOL.

This heartbreaking video is by Mina Caputo, the lead singer of metal band Life of Agony who came out a few years before Laura Jane Grace.

Massive thanks to Benny and Danielle Price for lending their expertise for my first ever post about a trans issue!

Photo of Laura Jane Grace by KMeron
Photo of Joe Stevens by Dan Tappan


Ashley Hamer


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