Can the voice of a transgender woman smoker be feminized?
The first thing to take into account is the continuous aggression of tobacco on the vocal cords and the respiratory system in general. We are not only talking about a chemical aggression due to tar or other harmful elements, but we must also take into account the repetitive thermal aggression suffered by the vocal cords and the larynx area.
Indeed, in the face of these multiple aggressions, the vocal folds will protect themselves in two ways: through a hypersecretion of the mucosa of the vocal folds and of the attacked area, and by creating what is called an edema (the vocal fold swells with liquid) whose mission will be to protect the vocal fold itself.
If we talk about hypersecretion, we must think of all the smokers we know who have a constant need to clear their throat by throat clearing, even coughing, and sometimes even spitting. Due to this constant aggression, especially at the thermal level, the vocal cord and the larynx area will react with this hypersecretion to protect themselves especially from heat.
As for edema, in some cases, especially in women, we speak of Reinke’s edema, which consists of a thickening of the vocal cord (more specifically, of the Reinke’s space). This thickening will make the cord thicker, thus preventing the usual speed of vibration to be optimal, so that the voice usually has a lower pitch and a hoarser vocal quality. It is difficult for the vocal cord to vibrate especially when it is requested for the high tones, cases in which the vocal cord usually vibrates faster.
As a consequence of this continuous aggression of tobacco, we are faced with a hoarse voice, unclear or dirty, monotonous, with an aggravation at the level of the fundamental frequency, a hoarseness, and of course in the case of female voices, a reduction of the spoken femininity.
However, it is possible to feminize the voice of a woman smoker depending on the case. Indeed, smoking does not affect everyone in the same way. There are people who after 2 years of smoking have a significant vocal aggravation, and others whose voice has not changed much after 30 years. Therefore, as we always advise in the first place, before opting for a feminization of the voice, it is necessary to go to an ENT specialist to make sure that the larynx is in good condition despite the conditions of constant aggression of tobacco. An ENT diagnosis is important to be sure that there is no oral disorder, lesion or pathology.
Throughout my 15 years as a speech-language pathologist specializing in voice, I have worked with transgender and cisgender smokers who have never quit smoking and have achieved very good results with voice feminization training. In other cases, and these are the most common, the patient has quit smoking after 2 or 3 sessions when she saw the vocal potential she had to feminize her voice.
Of course, as a voice specialist, the first thing I will always recommend to my patients is to stop smoking, not only because of the effect it will have on the voice, but also because of the effect it has on overall health.
Another important point to mention is that, even if today we manage to feminize the speech of a smoking patient, this does not guarantee that her voice will not continue to degrade over the years until it loses all of its femininity and even, sometimes, to the total extinction of the voice.
In short, each patient reacts differently to the aggression of tobacco, but the best option is of course to stop smoking. In the opposite case, it is advisable to visit an ENT specialist before seeing a speech therapist. In the case of undertaking vocal training for voice feminization, if you are a smoker, it is important to know that the results will depend on each patient and cannot be guaranteed beforehand.