This story contains references to suicide. If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at 800-273-8255 or text TALK to the Crisis Text Line at 741741.
When Fenix Cobbledick first speaks in an unfamiliar place, they are often scared.
They’ve spent countless hours and thousands of dollars on hormone therapy, laser hair removal and feminine haircuts to make their appearance more accurately reflect who they are.
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But even as they switched bodies, Cobbledick, a 31-year-old non-binary trans woman, felt unsafe when she opened her mouth to speak.
“I love my singing voice. It’s beautiful; it’s just deep. And maybe one day we’ll live in a world where I don’t have to hide that voice,” Cobbledick said. “But we don’t live in this world.”
Trans people are at higher risk of suicide and for become victims of violence. Though not for everyone, gender-affirming care can help trans people feel good about themselves and safe in the community, LGBTQ advocates say and say the researchers.
Voice therapy can be helpful in addressing the mental health issues that many transgender people experience. Like a common gender identifierthe voice can contribute to gender dysphoria — a discomfort that stems from the fact that his gender does not correspond to the sex assigned to him at birth.
“Voice is really a huge part of identity and listeners infer a lot of a person by their voice alone,” said Alyssa Giegerich, speech pathologist at Einstein MossRehab., who specializes in gender affirming voice therapy. “Our vocal goals are to align the way someone is perceived with their identity.”
Hormone therapy, voice coaching or surgery can help a person when their gender identity does not match the sex they were assigned at birth. They are part of the interventions known as gender-affirming care.
First on Cobbledick’s to-do list was laser hair removal about three years ago. While the process was expensive and painful, Cobbledick felt relieved by the removal of unwanted hair from his face. After that, they started taking hormones.
“It’s just small steps you take in the same direction,” they said. “It’s just going a little bit towards helping.”
Earlier this year, they started working with a speech therapist at MossRehab. The therapy is in partnership with the Einstein’s Pride program, where Cobbledick receives gender-affirming care.
Every two weeks, for 10 sessions, Cobbledick met with Giegerich in a small room on MossRehab’s Elkins Park campus for voice therapy. Covered insurance part of the cost.
First, Giegerich assessed Cobbledick’s voice and discussed what Cobbledick wanted to change about it. This therapy requires an understanding perceived barriers – for example, fear of public speaking that cracks a patient’s voice.
“You could just focus on the mechanics of the voice, and you’d be missing a lot of what it means to have an authentic voice, to really relate to your voice, because it’s so psychologically ingrained,” Giegerich said.
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During their sessions, Giegerich asks Cobbledick to repeat sounds or words, or construct sentences using specific spoken phrases. into a microphone. Together they listen to the recording for analyze the pitch, range, cadence of a phrase, and the inflection with which the phrase ends. They note the vocal characteristics that they liked.
“Airy” is the vocal characteristic that Cobbledick focuses on.
“Learning to expel air in a gentle way felt ‘airy’ to me and that’s where that term comes from,” they said.
More than half of transgender and non-binary people between the ages of 13 and 24 have seriously considered attempting suicide, according to a 2021 national survey by the Trevor Project, an LGBTQ suicide prevention nonprofit. About 1 in 5, according to the survey, made an attempt.
Other stressors come from fears of violence against trans people.
“If I was perfectly safe as a woman with just a deep voice, I wouldn’t have to do this,” Cobbledick said. “This trans affirmation treatment isn’t just to make me feel better.”
Last year saw a record of at least 57 murders of trans and non-binary people in the United States, according to the Human Rights Campaign, the nation’s largest LGBTQ rights group. The majority of the victims were black and Latina trans women.
Last month, a trans woman was beaten and her sister and friend shot dead in Kensington after the attacker allegedly shouted homophobic slurs. The incident is under investigation as a hate crime. At national scale, Pride month celebrations saw threats of violence.
READ MORE: Pennsylvania plans to ban trans athletes. Experts say it’s discriminatory and “anti-evidence.”
Naiymah Sanchez understands the fear of becoming a target in public. A trans woman, she fears that a recent wave of nationwide legislation targeting trans rights has increased the risks.
“A lot of times we don’t leave our house, we don’t talk, we don’t do anything,” said Sanchez, who is the trans justice coordinator for the ACLU of Pennsylvania. Being trans, she says, means taking protective measures: “Just so we can fly under the radar. Just so we can go home.
In Pennsylvania, lawmakers passed and the governor had to veto, a ban on trans athletes that experts say is discriminatory. According to an ACLU trackermany states are similarly considering trans-related restrictions — including about 20 states where bills banning gender-affirming care for youth have been introduced.
Sanchez says not all trans people want gender-affirming care, but for those who do, access offers a way to minimize harm.
Cobbledick hopes more cisgender people, whose gender identity matches their sex at birth, will support trans people — especially youth and young adults at risk of suicide. “Give them the care they need and make them feel accepted and heard,” they said.
The path is not always easy. Gender-affirming care is expensive, some procedures are painful, and therapy can have some uncomfortable moments.
For example, many people don’t like to hear their own voice, but for people with gender dysphoria, the experience can lead to tremendous distress.
Before speech therapy, Cobbledick grimaced at the male voice they heard on the recordings. They say getting the “airy” quality they want when speaking still takes a lot of effort, but they are learning to control and recognize their voice.
“I like hearing it a lot more now,” Cobbledick said.