It was a winter day in New York City when Alice Gorelick stepped into a sandwich shop on Wall Street.

"The guy called me miss as I walked up to the counter," Gorelick says. "But when he was making my sandwich and I had to tell him what I wanted, he started calling me sir."

As a transgender woman, this wasn't the first time Gorelick had been misgendered because of her low voice.

"It's kind of like the world doesn't see you the way you want to be seen. And just like, you can't even talk," she says. "You feel speechless."

Gorelick is 23 and has thick rimmed glasses and brown hair. She's always disliked her voice, but that feeling grew more intense after coming out as transgender. In January, she decided she was going to do something about it.

The science of vocal therapy

Vocal therapist Christie Block's office is on the 8th floor of a high-rise in Manhattan. It's a cosy space with a wall of books and, above her desk, an anatomical poster of the mouth and throat. This is where she sees her clients who come to New York Speech and Voice Lab for vocal therapy.

Today, more than half of her clients are transgender — mostly women like Gorelick. 

That's because people who transition to male have the option of taking testosterone, which lowers their voices permanently. But people who transition to female typically have thicker vocal folds and deeper voices, and hormones like estradiol don't change that.

Block looks at the voice the way many look at gender: It's a spectrum. There's no one "male voice" or "female voice." Instead, she helps her clients make their voices "more feminine" or "more masculine," depending on which end of the spectrum they want to move toward. She does so by adjusting their pitch, intonation, and resonance.

"Primarily it's about pitch," Block says. "Pitch is like the note you play on an instrument. And so, which note you pick might be in the feminine range versus the masculine range."

Then Block teaches her clients that the way they deliver a sentence can also make them sound more feminine or masculine. A more feminine intonation is generally higher, more legato, with more variation. A more masculine intonation is more staccato and moves downward.

 And finally, Block addresses the concept of resonance, or the placement of the voice inside the mouth.

A masculine resonance comes from the back of the mouth, using the full space inside to make the sound deep and round, versus a more feminine resonance, which is further forward and uses less space in the mouth to produce a brighter, more nasal sound.

"It's playing the same note on a violin versus a cello, where the violin has a smaller body, and the cello has a bigger body. The violin sounds much more tinny, and bright, and smaller, and the cello sounds bigger and darker sounding," Block says.

Pitch, intonation and resonance are the recipe that make our voices what they sound like, and Block's job is to adjust each like a dial to help her clients find their own unique voices to match their gender identity.

voice

Alice Gorelick sits with Christie Block at her office in New York City. (Paige Pfleger/WHYY)

The price of change

Not every transgender person is interested in changing their voices as a part of their transition. For those who are interested, however, seeing a vocal therapist can be monetarily out of reach, because it's usually not covered by insurance.

The transgender population simultaneously has disproportionate rates of poverty and higher out-of-pocket costs for medical care compared to the general population.

"That's the nature of being transgender, I suppose," says Ryan Collins, a transgender woman who lives in the Boston area. "It's just a continual drag of an intermittent body horror nightmare kind of thing with lots of medical bills thrown around."

Collins was determined to make her voice more feminine on her own.

"If I didn't have to pay anyone to get the results that I wanted to, then I really didn't want to, because I do not have a lot of money," she says.

So she practiced talking to herself in her car on her commute, pushing her range higher and higher until she was satisfied with how it sounded.

There are a lot of people like Collins who practice voice techniques on their own, or they turn to technology. 

An app called EVA, or Exceptional Voice App, was created by speech pathologist Kathe Perez. It offers step-by-step instructions to make a voice more masculine or feminine for about $5 per lesson, and is specifically geared toward the transgender population.

And there's a slew of Youtubers who make videos to offer tips and advice about voice change. Many of them are transgender women. A few are cisgender men (men whose gender identity agrees with the gender they were assigned at birth) who make their voices sound more feminine on video game voice chats to trick other players. 

The videos are a free resource, but vocal experts warn that the voice is a muscle, and it can get injured or strained if not used properly.

Alice Gorelick says she tried out videos before she went to vocal therapy.

"I think what I was using from Youtube could have been unhealthy," she says. "Some of the strategies they taught were like lifting up the Adam's apple and really tightening your throat, and that kind of hurt."

Gorelick says she likes the structure of seeing a vocal therapist — she enjoys the exercises she gets assigned as homework, the face-to-face feedback, and tracking her progress.

A new sound

In Christie Block's office, Gorelick adjusts the microphone of a Britney Spears-style headset she's wearing.

Block presses "record" on her computer, and Gorelick recites an all-too-familiar passage. She usually reads it when she visits the office. As she reads, a sound wave appears on the computer screen in front of her, measuring her average pitch.

"Very good," Block says as she stops the recording. "Now, let's listen to you reading the same rainbow passage back in January 2017, before training."

With a click of her mouse, an older version of Gorelick's voice plays on the speakers. It's monotone and deep — lower than average for a cisgender male.

"Wow," Block says, pleased with the contrast of the two voices. "You've come way up into feminine range. Bravo!" 

Gorelick smiles and thanks Block. She says she used to feel nervous about speaking in public, speechless even. Now, with her new voice, she feels like herself.

Music in this story is courtesy of Diederik van Wassenaer and cellist Keeon Guzman. It was recorded by Andy Beargie at Blockhouse Studios in Bloomington, Indiana.