Ashley Abenoso, a speech pathologist at the Lancaster General Health Suburban Outpatient Pavilion, helps patients recover from voice injuries and is a teacher, singer, and other people who use voice frequently in their careers. Provides guidance to.
Avenoso is also the only LGH linguistic pathologist to provide gender verification tasks to help transgender individuals speak in a gender identity voice. LGH launched a speech-language pathology program to confirm gender in 2017 when Avenoso joined the staff.
“It’s really great when they start using new voices, everything starts to work and they’re more confident,” says Avenoso. “It’s very exciting to go on that journey with them.”
Avenoso spoke to LNP | Lancaster Online reporter by phone about working with transgender people to find a real voice.
Can you tell us what you are working on in the program?
Gender training is actually client-led and is different from other voice-impaired tasks. My job is to hear how clients want to be perceived and what it is about their voice that contributes to their gender identity so that they can reach their goals. So I like being empowered to learn the science of voice at a basic level and understand why voices sound that way and how we can change it. is. Of course, pitch is the main focus of the voice, raising and lowering it, but we also work on how to speak, speed of speech, intonation of speech, and techniques for brightening the voice. It usually matches the female voice or becomes darker and matches the male voice.
What are some of the techniques used in the program?
One of the first things we do is to work on their resonance, make sure they are using a healthy voice, and develop a voice that can withstand eight hours of work. Play on the pitch, stretch your voice, and slide your voice up and down. Being able to stretch the muscles of that voice is very important. Sometimes we do something like a lip trill that feels stupid, but again, it’s voicing. Some of the things we play with are the position of the tongue in the mouth, how round or flat the lips are on the face, and how open the mouth is. Just practicing yawning can lower your voice or brighten a small space in your mouth. Coughing, laughing, and clearing can be more difficult to reproduce in a therapeutic environment, but are part of the training.
All of the voices are that we never think of it as muscle or science, but these are the ones singers always use. You think of an opera singer with its really rich, completely dark sound and a Broadway singer with its really bright sound. These are techniques that singers and actors always use outside of gender.
Can you talk about the science of voice?
Speech science helps us in making speech more masculine or feminine when we use them in speech. When male puberty begins, those androgens thicken their vocal cords. The thicker they are, the lower they are. Considering a vocal cord like a guitar string, a thick string is a bass and a thin string is a treble. Therefore, when puberty begins, the vocal cords thicken, and changing hormones does not change their body composition. You need to do more voice training work to make the pitch change feel more natural.
What should I keep in mind when working with transgender people?
Not everyone who comes in wants the same cookie cutter voice. I am constantly educating myself more and more about the community. There are non-binary people who just want to sound neutral. We must participate to do that and do not try to lead in any way based on what we think it should be. It’s about what really affirms the client.
I think the big thing is to learn pronouns. Especially in the health community, we don’t feel uncomfortable asking which pronouns our clients like, so we don’t assume it based on their favorite name. We are open about using ours. I think it’s really important. The whole process is not universal. Each experience is individual, so don’t try to fill in the blanks and ask where you are.
Does insurance usually cover this program?
Some insurance covers voice training as part of an approved transgender service. Unfortunately, many are not. They consider it a cosmetic product. So that’s what we’re navigating as we get more referrals and come across the situation. It definitely needs to be considered medically necessary by insurance. I think health care has made great strides overall in the last few years, but I think there is much more to be desired in the area of insurance and compensation. We just have to continue advocating and researching.
Can you tell us about your experience working on vocal training with transgender people in the Gender Affirmation Program?
I love when they use their voices with new listeners and share stories that have been affirmed in their experience. Overall, it’s not about me. I provide them with tools and strategies. It’s really exciting to see it start as an exercise or technique, incorporated into their personality, help them live the life they want, and be affirmed in their voice.
What are some of the reactions you have heard from people?
I’m thrilled when I can’t even remember my old voice, and when I was told that it was difficult to stop by or lift a voice I was using before. That it really seamlessly becomes part of their identity. You just have the experience of going out, calling, talking to people, and not making a mistake in your gender. Especially on the phone, when there is no physical presence to shake the listener. Gender identity can be really unpleasant for them, especially during the years of transition, so this service allows them to live seamlessly with their matching gender identity without hitting the road. It’s very important.
LG Health Speech Therapists Help Transgender People Train Their Voices [Q&A] | Health
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