It’s not your typical doctor’s office. There are no needles or hazardous waste disposal containers. No cotton balls or stethoscopes. Instead, there are small, isolated rooms. In some, one wall is made entirely of TV monitors, several sets of headphones, VCRs and several large dials for tuning in audio and video.
The TV monitors project live feeds from the analyzing rooms where patients explain their weekends to graduate clinicians before their voice therapy begins.
Undergrads come and go as they observe the process in preparation for future graduate work. There are offices with computer programs designed to create an actual shape of the human voice. There are conference rooms where diagnostic learning takes place. There are children scurrying through the hallways on their way to speech therapy. There are men in the process of transforming into women.
Most importantly though, there is talking – lots of talking -because the way language sounds is one of the primary focal points of Temple’s Speech-Language-Hearing Center.
Located on the first floor of Weiss Hall at the corner of 13th Street and Cecil B. Moore Avenue, TUSLHC observes a wide array of unique speech and hearing cases. Transformation of a male voice into a female’s is just one of its many areas of research and therapy.
“The cases that we see primarily are male to female transitions,” said Dr. Reinhardt J. Heuer, who has been conducting transsexual voice therapy and research at Temple since 1972. “They’re usually older, deciding to make the transition after living as a male for many years.”
Gender dysphoria is the technical term for someone who is uncomfortable with his or her birth gender and makes steps to transition between genders. There are three different types.
Transvestites are men who dress as women on occasion due to the erotic high it gives them. Cross dressers can be anyone from engineers to CEOs to podiatrists to ex-police officers, Heuer explained.
“In some cases they’re married and have children,” Heuer said. “And they just can’t tolerate being a man anymore.”
Transgendering is another type of gender dysphoria.
“Transgenderists are people who don’t just want to cross dress, they want to live as women all the time,” Heuer said. “But they’re pretty happy with their bodies.”
Transsexuals, on the other hand, physically and mentally feel that they are in the wrong body, Heuer said. Such as a man who feels he is actually a woman and, through a biological mishap, is in the body of the incorrect gender.
“They’re a woman trapped in a male body,” Heuer said. “It’s a real matter of having to change everything.”
According to Heuer, most of the patients who come to TUSLHC are transsexuals.
“We treat a few cross dressers and transgenderists, but most of our patients are transsexual,” Heuer said.
Heuer said that each transsexual involved in the program at the TUSLHC is at very different points in their transition. Because of this, each case becomes extremely individualized and must be treated in its own unique way.
This was evident in three different video analyses, which this staff writer was permitted to view on strict confidentiality terms.
One client still remained completely masculine. His elbows rested on the table, his posture was slouched, and a low voice still projected. Heuer stressed that these are all qualities that need to be addressed and changed in order to achieve a thorough transition to the way a woman converses.
“Appearance is obviously an important factor that we focus on in our work with clients in transition as well,” Heuer said.
Another client was much further along in her transition. A bit older, her light gray hair was tightly permed and had a tint of white running through it.
She sat very neat on the chair, legs crossed, and it was evident that she had mastered the feminine hand gestures of “low and to the side” as opposed to the more masculine “straight out in front.” The voice was still in the process of becoming a female voice.
A third client of Heuer’s had the complete look of a woman, yet still needed to revise her masculine slouch and sound.
“You’ve got to match it,” Heuer said. “It needs to look like a complete picture. We’re working on a lot of things here: dressing, hairstyle, right down to voice and word choice.”
Relatively well known, the pitch of a male voice is much lower than that of a female’s. Heuer noted that the size of the resonating tubes and larynx in a male’s throat is much bigger. Because of this, it is much harder to convert a male voice to female than it is to convert a female’s voice to a male’s.
“The resonating tubes won’t shrink,” Heuer said. “But they can grow through hormones.”
Females can take hormones in order to increase the size of their resonating tubes and larynx. Because these structures will grow due to hormone usage, the pitch of their voice will naturally decline. Therefore, it’s much easier for them to attain a lower pitched voice without therapy.
On the other hand, males in transition between genders must either receive surgery or therapy in order to achieve a desirable voice conversion.
Voice therapy is the alternative to surgery. Through the TUSLHC’s analysis, observation and exercises, patients receive a visual image of how their voice is structured. They can then learn how to manipulate and change that structure through the correct methods.
Heuer noted that one of the reasons he and his students are conducting research on changing characteristics of pitch and the resonating system is because without therapy, trying to change the melody of one’s voice through the wrong methods can potentially produce actual voice disorders. People sometimes have a hard time hearing what their voice sounds like. That’s why Heuer and his graduate clinicians use visual data in their voice therapy processes as well as in their research.
In one study the TUSLHC conducted on voice melody, a bar graph was constructed in order to visualize the syllable structure in different male and female voices. Between 50 percent to 60 percent of one male’s voice syllables dropped off at the end, and between 10 percent and 20 percent of those syllables were flat.
Most females in the same study used very few dropping and flat syllables.
“To observe things like this is statistically significant in our research,” Heuer said. “It fits with what people have observed.”
Another method Heuer and his clinicians use during voice therapy is video analysis. The client is videotaped during one session and in the next meeting, Heuer, the clinician and the client sit down in order to rate different characteristics of the client’s voice on a sliding scale.
“For example, we examine things such as pitch,” Heuer said. “We distinguish if the pitch is more masculine or feminine, or if it is somewhere in the middle. Loudness and rate of speech are other characteristics that we rate as well.”
Once Heuer and his graduate clinicians have this information, they more accurately know what type of approach to take in therapy regarding each case.
“The TUSLHC was designed to give students an experience that’s not available in any other field,” Heuer said.
Graduate clinicians involved in this experience deal with many different cases including children with articulation problems, language delays and foreign accents. That work is very heavily supervised by the clinic, Heuer and many other supervisors on staff.
The American Hearing and Speech Association requires that 25 percent of every therapy session must be observed by a certified speech-language pathologist.
“I benefit from this type of work because if I was just a therapist, I could only see one client every hour,” Heuer said. “[At Temple] I can see up to four people every hour. This way I can do more good and also train students for their future profession as well.”
Dawn Winstead, a graduate clinician at the TUSLHC, said that she came to the program because she was interested in treating children, but said enrolling has expanded her interest.
“I came into the program thinking I was going to be treating pediatric patients,” Winstead said. “But it’s such a huge field and everything is interesting about it. The diversity is really great. You can work within a variety of disorders and age groups.”
According to Winstead, each student involved in the clinical program at the TUSLHC is very inspired to do this type of work. Winstead also noted that her biggest motivation in her graduate studies is her son.
“I initially came to the field because my son was having trouble with speech,” Winstead said. “So that was my original inspiration.”
No matter what the inspiration is for any individual sharing in the experience at the TUSLHC, it undoubtedly offers an atmosphere that is dynamic, unique and available for anyone interested in studying and working with the complex system of the human voice.
“As the saying goes,” Heuer said, “Our voice is the mirror of our emotions.”
Visit the HLS Center at Room 110 in Weiss Hall or visit their Web site at www.temple.edu/commsci.
T.C. Mazar can be reached at tmazar@temple.edu.
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