Testosterone thickens and lengthens the vocal folds and enlarges the voice box, so the voice drops permanently, usually settling over a year or two. Oestrogen does not reverse that change, so trans women who went through a testosterone puberty rely on voice training, and sometimes surgery, to change how the voice is used.
Why do hormones change the voice at all?
It comes down to the vocal folds, the two bands of tissue in your throat that vibrate when you speak. Thicker, longer folds vibrate more slowly, and slower vibration is a deeper sound. During a testosterone puberty, or when a trans man starts testosterone, the folds thicken and get longer and the voice box itself grows. That is the whole mechanism.
It is also why a voice does not simply follow whichever hormone you take now. It follows what the tissue has already done. If testosterone puberty has happened, the folds have changed. If it has been paused or has never happened, they have not. Everybody's voice box is made of the same cartilage, the same muscles and the same folds; hormones change their size, and training and surgery can change how they are used.
What happens to your voice on testosterone?
For trans men, and for non-binary people who take testosterone, the change usually starts within the first few months and settles over a year or two. People tell me the in-between stage is the part nobody warns them about: a voice that cracks, wobbles and surprises you in the middle of a sentence. It is the same thing every teenager goes through in a testosterone puberty, and it passes.
The change is permanent. If you stop testosterone later, the voice does not climb back up. That is worth knowing before you start, because it is one of the changes that cannot be undone, and some people feel delighted by that while others want a moment to think it over. Either is fine. The decision is yours, and it is better made with the facts in front of you.
If you want to start testosterone, or you are already taking it and want help with dosing, blood tests or monitoring, GenderGP can help with access to affirming medical care and prescribing.
Does oestrogen raise your voice?
This is the one that catches people out, and it is unfair. Oestrogen changes a great deal: skin, fat distribution, breast growth, how your body feels. It does not thin the vocal folds back down once testosterone has thickened them. So for trans women who went through a testosterone puberty, hormones alone will not change the voice, and it needs a different approach.
In many places, voice work is also the part of transition that public health services cover least, with long waits or nothing at all, so people end up paying for it themselves. That cost is the real difficulty here, much more than anything about the voice itself. It is a gap in provision, and you did nothing to cause it.
For trans women who are given puberty blockers before a testosterone puberty, or who otherwise do not go through one, the voice does not drop in the first place. Another reason the right puberty at the right time matters so much.
What is voice training and does it work?
Voice training is the first and most powerful option. It is learning to use the voice you have in a different way, and it works because pitch is only part of the picture. Resonance, which is about where the sound seems to come from, matters enormously, along with intonation, rhythm and the way we shape words. Think of how much a voice carries beyond how high or low it is: the melody of a sentence, how much it lifts at the end, how softly or crisply the consonants land.
That is why raising pitch on its own often does not give people the voice they were hoping for. A higher note with the same resonance and the same rhythm can feel strained and still not sound like you. Training works on all of it together, and it takes practice, like learning anything with your body. Many people work with a speech and language therapist or a voice coach who knows this area, and many use that guidance to build their own daily practice.
It is also worth asking what the goal actually is. Plenty of women have low voices and plenty of men have high ones, so there is no single sound a woman or a man must make. The aim is a voice that feels like yours and that you are happy to use on the phone, in a meeting, or ordering a coffee. Some people want a very different sound; others want a few small shifts. Both are reasonable, and nobody has to meet a standard set by somebody else.
What does voice surgery involve?
For those who want it, there is voice surgery. In a glottoplasty, the front parts of the vocal cords are joined together, so a shorter length of fold vibrates and the pitch rises. Other operations tighten the folds or reduce the size of the voice box itself.
Results vary from person to person, and surgery works best alongside voice therapy rather than instead of it, because surgery changes pitch while resonance, intonation and rhythm still need training. Surgery on the vocal folds is also not something you can easily reverse, so it is worth finding out in advance what a particular surgeon's results look like and how the voice tends to feel afterwards, including how it copes with long days of talking. I can't give you figures for that and I would not want to guess at them; a surgeon who does this regularly should be able to show you what they see.
What if you are non-binary or want something in between?
The biology is the same whatever words you use for yourself. If you take testosterone, expect the folds to thicken and the voice to drop. If your body has not been through a testosterone puberty, a voice that sits comfortably in the middle, or moves between registers, is something you can build with training. People have all sorts of reasons for wanting a particular sound, and none of them need defending.
Where does that leave you?
It leaves you with options rather than a verdict. Testosterone deepens the voice for good. Oestrogen does not undo that, and training and surgery can change how the voice is used. I find it fascinating that something so personal comes down to a few millimetres of tissue. If you are working out what you want from your voice, you can talk it through with Sammy here, whether that is how to start practising or what to ask before you consider surgery. Good luck, and be patient with yourself: voices change slowly and they respond to practice.
If there is a topic that you would like me to cover, just let Sammy know.
Dr Helen Webberley, Gender Specialist and Medical Educator
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