The characteristics of your voice are one of the things that make you identifiable to others. A voice is nearly as distinctive as a snowflake because of the many different factors that affect a person's sound. There's the size of your voice box, the tension and thickness of your vocal cords and even the shape of your ribcage and mouth. In addition, your rate of speech and the degree of enunciation you use is an identifying feature of your voice.
But even with so many individual vocal traits, it is relatively easy to distinguish what most people think of as a man's voice from a woman's. That can pose a problem for a transgender person who no longer wishes to be identified by the sex they were assigned at birth, particularly for transgender women. In addition to the basic sense of a person's voice not sounding the way they'd like it to, trans women whose voices sound masculine may face harassment because of it.
Let's consider the anatomy of a voice. The male voice box is typically different from a female voice box in several ways. A man's vocal cords, for example, tend to be longer, thicker and less tense. Think of the strings on a guitar -- the lower notes are made by heavier strings while the thinner strings produce higher notes. Tighten or loosen those strings and the pitch will rise or fall.
For trans men, the introduction of testosterone into the body as part of a physical transition will naturally alter the muscularity of the body and bring the feminine pitch down into vocal range more often associated with a man. For a trans woman, hormonal treatments and voice therapy often aren't enough to move the voice into a higher register. This is where surgery comes into play.
While rarely covered by health insurance, an increasing number of trans women patients choose to go under the knife to transform their voices [source: Lesbian, Gay, Bisexual, Transgender Center]. We'll talk about what this involves on the next page.