Overdevelopment of vocal folds in an undescended, small larynx can result in a condition named "entrapped vocality" with permanent hoarseness, and lack of passing. In testosterone replacement therapy vocal folds change faster than larynx. Voice masculinization therapy can help to further lower the pitch of transgender men and address voice problems associated with hormone therapy. However, testosterone replacement therapy does not always deepen the voice to the person's desired level, and others choose to not undergo masculinizing hormone therapy at all. Voice therapy is generally not required for transgender men as the effects of testosterone on the larynx result in a deeper pitch. Voice modifications for transgender men typically involve the lowering of the speaking fundamental frequency. Other characteristics that have been explored include intonation patterns, loudness, speech rate, speech-sound articulation and duration. The changes with the greatest effects towards feminization, based on current evidence, are fundamental frequency and voice resonance. What is considered a feminine or a masculine voice varies depending on age, region, and cultural norms.
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However, each person might have different perspectives regarding speech and voice, and therefore the salient characteristics, and their relative impact on femininity, can vary from person to person, and many people are not satisfied with only a change in fundamental frequency. Raising the fundamental frequency can help towards voice feminization. Fundamental frequency, closely related to pitch, was initially thought to be the characteristic most effective in voice feminization. Therapy has been shown to be effective in voice feminization, and the modification of certain voice characteristics, such as fundamental frequency and voice resonance, can help in that effect. Transgender women trying to feminize their voice represent the largest group seeking speech therapy services, therefore, most studies regarding transgender voice have focused on voice feminization, as opposed to voice masculinization. It is considered an essential part of care for transgender women. Voice feminization refers to the perception of voice change from masculine to feminine. 5.5 Transition in childhood and adolescence.