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British Columbia’s Medical Services Plan currently covers male-to-female gender reassignment surgery, as well as female-to-male top surgery (mastectomy) and chest re-contouring. However, the province does not currently fund bottom-surgery for FTM citizens. Urge the British Columbia Ministry of Health to join the ranks of Ontario and Quebec in performing the surgery, and also to start including this surgery in their MSP guidelines.

Take Action! Sign the Petition.

It’s been about 3 years since I started identifying as transgender, and I recently noticed a trend in the acceptance I’ve received from my cis gender friends:

• Women seem more hesitant and awkward about my transition, and still cling to incorrect pronouns;
• Men have been more outwardly accepting, and this has been expressed by some rather humorous (and sometimes alcohol-inspired) displays of brotherly affection.

It’s as if the women are hesitant to “let me go” while the men are happy to have me “in the club.” If asked about this pre-transition, I probably wouldn’t have expected this outcome.

What about you? Have you noticed any difference between cis gender men and women regarding their acceptance of your transition? If yes, why do you think this is the case? Please leave your comments below.

Note: While this question is aimed at trans guys, comments from trans women are welcome.

One of the most desired effects of testosterone by transgender men is a deepening of the voice. This change is very helpful for assuming the male gender role. However, there’s an uncertainty to voice changes: testosterone doesn’t always drop the pitch low enough, and the changed voice can be persistently hoarse and weak. This can cause both personal and professional difficulties, but for singers, the “unpredictable and irreversible”¹ nature of testosterone’s effects on the voice is a terrifying prospect. The loss of singing ability is not inevitable for trans men though, and there are strategies for easing the transition of the FTM singing voice.

One of my biggest misgivings about starting on testosterone was my singing voice. Beginning as a teenager, I’d performed professionally as a vocalist and guitarist for more than 10 years. Singing was as fundamental to my identity as gender. Would it have to be sacrificed at the expense of transition?

In Body Alchemy: Transsexual Portraits by Loren Cameron, there’s a portrait of author and educator, Jamison Green. He’s posed with a hand drum, and in the accompanying text he explains that he lost his singing voice once he started hormone therapy.² Here was one of the most visible trans men admitting one of my greatest fears about testosterone! It wasn’t encouraging, so I set out to find some stories that were.

The first sign of hope I found was in Joe Stevens of the queer folk duo, Coyote Grace. Listening to Joe’s smooth, high lonesome vocal on “A Guy Named Joe” was clear indication to me that there could indeed be singing after T.

A Guy Named Joe, Coyote Grace

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By the time I found Joshua Klipp in late 2007, his music had already been featured on television and radio across the United States. His song “Little Girl” gained instant notoriety not only due to Joshua’s powerful performance, but also because it marked the first time in music industry history that a song featured a trans man’s pre-T voice alongside his testosterone-changed voice.

L1FE, Joshua Klipp

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Scottish folk singer Simon de Voil was the subject of the feature documentary Funny Kinda Guy. The film follows Simon through his early transition as he “irreversibly sacrifices his female singing voice to hormone treatment.”³ Although he couldn’t sing confidently for three years, Simon says that since then his new voice has “really grown into itself.”⁴

Clearly, it’s possible for trans men to continue to sing after starting HRT, whether that’s around a camp fire with friends or on stages around the world. While there’s a serious lack of research in this area, we can look to the science of voice for guidance about how to ease FTM vocal transition.

How Testosterone Affects the Larynx

The larynx, or voice box, is a hormone-dependent organ. In teenage boys, increased testosterone production causes the vocal folds (vocal chords) to thicken, lengthen and mature. The cartilage of the larynx grows, further influencing the tone of voice. It also tilts slightly, resulting in a bump on the throat—the Adam’s Apple. This is a process that happens over time as the teen matures.

Trans men conversely, are often started on the highest recommended dose of testosterone, bringing about changes that would normally occur over several years in a much shorter time. Testosterone therapy makes the vocal folds grow thicker but they are restricted in length by the size of the larynx (which is typically smaller in trans men than in bio-males.) Cartilage growth is said to only happen during puberty⁵, and early cartilage ossification caused by testosterone further limits the growth of the trans male larynx.

In his groundbreaking study however, Alexandros Constansis revealed that his 39-year old larynx had indeed grown wider within the first year of HRT.⁶ Working with a group of FTM singers, Constansis noted that the most common characteristic among study participants was what he called “entrapped vocality.”⁷ The symptoms—persistent hoarseness and the inability to access and control certain areas of vocal range—were attributed to an inadequately enlarged larynx, due to age and the early onset of laryngeal cartilage ossification. (In some people, this ossification actually improves their singing voice, as the “hardened” larynx is better able to support the vocal folds.)

A professional singer himself, Constansis approached his own HRT conservatively, opting for a low starting dose that was gradually increased over a one year period. He reasoned that “abrupt changes are rarely beneficial to the vocal instrument”⁸ and suggested that the vocal difficulties experienced by teenage boys could only be aggravated in trans men due to the quickened hormonal changes.

It took about 3 years for my voice to finally settle where it is now. During those years there were several times when I thought ‘Okay, this is my new voice’, and then it would continue to change in subtle ways. I sang professionally for years pre-T and I still sing professionally now. I don’t have quite the range & sustainability that I once had, but anything I lost, I gained in terms of finally being able to own and identify with my voice now. I have no regrets! — Radford Bishop

Recommendations for Trans Male Singers

Throughout his paper, Constansis advocates that trans male singers who are starting testosterone proceed slowly, beginning with a low dose that’s gradually increased over time. While this is likely to slow virilization, it also produces more gentle changes to the larynx, and may be a more significant factor than age with regards to growth of the laryngeal structure.⁹

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.

For trans men who have already had several years of testosterone therapy, vocal coaching can still be beneficial. Learning proper techniques for breathing, and opening the diaphragm and larynx, can substantially improve singing abilities.

If you choose this route, look for a SLP who has experience working with transgender people. Not only should they possess in-depth knowledge of speech/voice science and speech masculization treatments and therapies, but the ideal SLP also understands transgender basics (terminology, trans sensitive-protocols, etc.)¹⁰

I had been singing all my life, singing is a big part of my family, and songwriting became an integral part of my mental health. When I realized that transition was my path, my voice was the only concern. I set out to find some information about it, and found none. My doctor had nothing conclusive, and most of the transguys I found said that they no longer sang… Not encouraging. But my gut told me that if I could carry a tune before, I could carry one after, and hopefully the tonal quality would be easy on the ears, and I had to move forward. When the voice dropped, the fun began. What I learned is that you just have to keep singing. I had 23 years of muscle memory built up, and that’s a lot for any brain to re-learn. It takes time, but it’s mostly about finding where your new notes are, which can be fun, funny, frustrating, embarrassing – but you only have to do it once, and in the grand scheme of things, it’s a relatively short period of time. Keep singing. If you stop singing, then you won’t sing. Simple as that. The world needs our trans voices, and so do our brothers and sisters, and everyone in between. Sing out! — Joe Stevens

T-Voices

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I made a personal decision that I would not let the fear of losing my singing voice obscure my path to transition. Instead, I chose to get excited about how the confidence gained from pursuing my true male identity would positively impact my vocal performance skills. I started with a low dose of testosterone: 50mg every two weeks, increased by 50mg every three months. I knew that testosterone would deepen my range, and I was also prepared for some temporary loss of control. I would need to retrain the muscle memory in my larynx, since shaping the vocal folds and flexing the laryngeal muscles in a familiar way would not necessarily produce the same tone as I was used to. I was advised that practice and patience would help my voice adjust.

Now after 20 months of HRT, the tonal quality of my voice sounds “whiskier” and sometimes I think this has sacrificed clarity but it’s also more rock ‘n’ roll sounding. I didn’t expect the loss of projection that I’ve experienced, but it’s returning with practice. Overall, the most difficult aspect of changing my singing voice has been gaining confidence with it again. It’s a mental adjustment that encompasses more than just my voice—it’s about confidently expressing my new (and not yet fully familiar) identity. All good things in all good time.

Learning to sing again post transition isn’t easy, but it can be done. Strengthen and stretch your vocal cords at a comfortable pace. Most importantly, however, be patient and kind with yourself and your voice.
– Joshua Klipp

Photo credit: Amos Mac, 2009

The “unpredictable and irreversible” effects of testosterone on voice can inject significant doubt into the decision of whether or not to pursue HRT. If testosterone is in your cards, remember that the “no guarantees” clause applies both ways: it’s not inevitable that you will lose your singing voice! Gradual administration of T, speech-language therapy, vocal exercises, maintaining good vocal health, and regular practice will all help ease the transition. And who knows? This woman claims that testosterone is the reason behind her incredible 8-octave range. Maybe you’ll be just as lucky!

More Trans Male Singers

• Geo Wyeth, Jive Grave
• Katastrophe is a San Francisco based rapper and producer.
• Alexander James Adams is an American singer, musician and songwriter in the Celtic and World music genres.
• Michael Woodward sings lead for Too Much Information.
• StormMiguel Florez is a Mexican American singer/songwriter.
• Alex Davis, Los Angeles native singer/songwriter.
• Paige Elliot Phoenix, an Aussie singer who in August 2011 won over the judges on Australia’s X Factor reality show.

Choirs with Trans Men

• Transcendence Gospel Choir of San Francisco was the first trans choir in the world and features trans men.
• One Voice Mixed Chorus used to have a trans choir. Presumably, there are still trans men in the main choir.

Additional Resources

How the Body Works: Speech and Voice – video

Anatomical Tutorial During Trans-Nasal Endoscopy – video

Changing Speech, Shelagh Davies and Joshua Goldberg, Vancouver Trans Health Program, 2006 (420K PDF)

Transgender Speech Feminization/Masculinization: Suggested Guidelines for BC Clinicians, Shelagh Davies and Joshua Goldberg, Vancouver Trans Health Program, 2006 (844K PDF)

Voice And Communication Therapy for the Transgender/transsexual Client: A Comprehensive Clinical Guide, Richard K. Adler, Sandy Hirsh, Michelle Mordaunt, editors, 2006

The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, Radical Musicology, Vol. 3, 2008

Voice problems in female-to-male transsexuals, J. Van Borsel, G. De Cuypere, R. Rubens, B. Destaerke, International Journal of Language & Communication Disorders 2000, Vol. 35, No. 3

Effects of Testosterone Replacement on a Male Professional Singer, Austin King, Jon Ashby and Charles Nelson, Journal of Voice – December 2001 (Vol. 15, Issue 4)

How To Protect Your Singing Voice

Speech-Language Pathologists with Transgender Experience

Shelagh Davies – Speech-Language Pathologist, Clinical Associate Professor in the School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada.

Sandy Hirsh – Speech-Language Pathologist, co-author and editor of Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide. Sandy is based in Seattle, WA, USA but provides distance training using Skype video conferencing.

Anita L. Kozan – Dr. Kozan’s doctoral work focused voice care for singers and actors. She is a specialist in the development of the voice for persons who are transgendered, and her chapter on the singing voice in Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide has been recognized as the first of its kind. Her private practice is in Minneapolis, MN, USA.

Footnotes

1. Medical Therapy and Maintenance for Transgender Men: A Guide for Health Care Providers
   R. Nick Gorton MD, Jamie Buth MD, Dean Spade Esq., p. 59
2. Body Alchemy: Transsexual Portraits, Loren Cameron, p. 38
3. Funny Kinda Guy
4. Simon de Voil
5. Changing Speech, Shelagh Davies and Joshua Goldberg, p.6
6. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 17
7. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 29
8. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 9
9. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 29
10. Changing Speech, Shelagh Davies and Joshua Goldberg, p.20

Acknowledgments

Thanks to Radford Bishop, Joe Stevens, Joshua Klipp and Lucas Silveira for contributing to this article. Special personal thanks go out to Joe and Lucas for providing me with very helpful advice and inspiring me to keep singing.

Last updated: September 6, 2011

Aesthetic Plastic Surgery Institute, PA
12651 W. Sunrise Blvd., Suite 102
Sunrise, FL 33323
Phone: (954) P L A S T I C
Web: www.drgarramone.com

Procedures: FTM top surgery

Dr. Garramone is regarded as one of America’s top plastic surgeons and an expert in chest masculinization. His results with the double incision method are excellent. Furthermore, his office staff are trained in all aspects of FTM health care, and can help you find therapists, endocrinologists and other resources.

Please contact Dr. Garramone’s office for information about current costs, payment procedures, surgery requirements, and scheduling.

Top Surgery Show & Tell

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Patient Vlog: SEANnLANI

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Patient Vlog: BAlvord78

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Patient Vlog: AidenDanielLIVE

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Learn more about Dr. Garramone:

• Dr. Garramone’s YouTube Channel
• Dr. Garramone on Twitter
• Photos of Dr. Garramone’s patient results at TransBucket.com
• Dr. Garramone patient experience ratings @ Vitals

Have you had top surgery with Dr. Garramone?
Leave a comment below about your experience and upload a video.

Advanced Center for Plastic Surgery
12205-12207 Tullamore Rd.
Timonium, MD 21093
Phone: 410-308 4700
Fax: 410-308-4704
Web: www.beverlyfischer.com

Procedures: FTM top surgery

Dr. Fischer is one of the better known surgeons doing FTM top surgery in the United States, and it’s public knowledge that this is one of her favorite surgeries to perform.

Dr. Fischer uses one of two approaches for trans male mastectomy:

1. Peri-areolar: Suitable for B-cup and smaller chests;
2. Double incision: Popular, results in excellent contour.

Request information about current costs, payment procedures, surgery requirements, and scheduling.

Top Surgery Show & Tell: Dr. Fischer

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Patient vlog: charlesasher

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Patient vlog: kade512

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Learn more about Dr. Fischer

• Article by Dr. Fischer describing chest surgery procedures, results and challenges.
• Photos of Dr. Fischer’s patient results at TransBucket.com
• Patient blog: Luke
• Older photo gallery at The Transitional Male
• Discussions on LiveJournal tagged Dr. Fischer
• Dr. Fischer patient experience ratings @ HealthGrades
• Dr. Fischer patient experience ratings @ RateMDs

Have you had top surgery with Dr. Fischer?
Leave a comment below about your experience and upload a video.

Does pumping work? Yes! There are numerous accounts of trans guys who have increased the size of their penis with a daily regimen of pumping. However, success with pumping depends on a high level of commitment and patience. For best results, pump twice a day, morning and night.

Measure Up

To measure the length of your penis, hold it straight out from your body and measure from base to tip. To measure the girth of your penis, wrap a soft tape measure around it to get a circumference measurement, or wrap a piece of string then measure that length against a ruler.

Cylinder Selection

Select a cylinder twice as long as your flaccid penis, and about 50% more in girth. (Example: If your penis is 1″ long and 1/2″ in diameter, then use a 2″ long, 3/4″ diameter cylinder.)

Warm Up and Get Pumped

Warm up by wrapping your penis in a warm towel for a few minutes. Simultaneously, soak the cylinder in hot water.

Dry everything off, then amply apply lube to your penis, as well as a small amount to the inside of the cylinder.

Position the cylinder to ensure a good fit and seal.

Pump to five pounds. Keep the pump on for as long as it takes for your penis to become fully engorged.

This shouldn’t cause pain or fill the cylinder completely. Check yourself frequently to make sure you’re not blistering or bruising badly (slight bruising is OK.) If you’re experiencing any pain, blistering or significant bruising, disengage the cylinder immediately. These symptoms aren’t the sign of permanent damage but you will need to take a week or so off pumping to heal up.

Advanced Pumping

Once you’re comfortable with basic pumping, you can experiment with increasing the pressure on the pump to achieve more length. Take a cautious approach, always being aware of any pain and bruising.

If you have a second, larger cylinder, you can try the Two Stage Pumping Method: complete the basic pumping technique, then increase the pressure to 15 lbs, disengage the smaller cylinder and attach the larger one.

Where to Buy Pumps

• TransGuys Enhancer Pump Kit
  Excellent 5-star package for just $98 USD. Includes high quality pump with pressure gauge, 3 cylinders, and bonus bullet vibe.
• Find more pumps and cylinders in the TransGuys.com Store.
  
• PumpToys.com Store
  A large selection of seals, tubes, pumps, toys and accessories.
• Boston Pump Works
  Pumps, cylinders and accessories. Order by phone.
• NaughtyThings.com
  Get the pistol-style Magnum Pump for $54.95 USD, recommended by Dr. McGinn.
• Dr. Kaplan Pumps
  Dr Kaplan’s Enhancement Pump is an affordable kit at $69.99 USD. PayPal accepted.
• Vacu-Tech
  Cylinders and pumps. In business for more than 25 years.
• GFH Pump Kit
  Pump with pressure gauge, two cylinders, bonus vibe. $140 CAD.

Videos About FTM Pumping

Let’s talk about junk

FTM Pumping

Cheap ‘n’ Easy Transman Penis Pump