Every day, June Contreras feels like she’s wrestling with different versions of herself. There’s the version she presents to the public, and the real her inside.

As a 30-year-old transgender woman in El Paso, she’s been exploring ways to bring her inner version closer to the outside. In January, she began hormone therapy and last year started attending the Gender Affirming Voice Laboratory at the University of Texas at El Paso.

People assume she identifies as a man partly because of her voice, and it makes her anxious to have to correct this assumption, she said.

“The thing that causes me the most existential dread is the fact that the bridge between my brain and yours is our words,” Contreras said. “If it’s in written form, that’s fine. … But in person, you’re constricted to what is perceivable through the five senses.”

The speech-language pathology program is preparing to start in about a month its next semester of gender-affirming voice therapy – private training sessions to help transgender and non-binary people develop a voice that aligns with their identity. The university also offers group voice therapy in the summer.

UTEP provides one of the few, if not only, gender-affirming voice clinics in the area. Other places that offer voice training include the New Mexico Gender Voice Center more than 250 miles away in Albuquerque, though the center has plans to expand services to Las Cruces, according to its website.

Led by clinical associate professor Patricia Lara, the El Paso clinic is free and open to anyone. People can sign up for private sessions, which are offered in the fall and spring semesters. Speech-language pathology students get clinical training by conducting sessions under her supervision, and slots are limited to around 10 participants during the year because of Lara’s teaching schedule.

Pat Lara, associate professor of speech pathology at UTEP, at the BLOOM Trans Health Education workshop on May 19. (Corrie Boudreaux/El Paso Matters)

Lara said she started the clinic in 2016 after receiving a call from a distraught parent. The parent was worried her transgender daughter would try to commit suicide again and asked if Lara could help with “accent therapy.” 

“As a parent, when she started crying, I thought, ‘If somebody could at least try to help me, I would want them to,’” Lara said. “I can’t even imagine the feeling. I knew I needed to do whatever I could to try and help.”

Many participants have discovered the voice clinic through word-of-mouth referrals from health care providers and organizations that support the transgender community. This year, Lara and her team joined a series of transgender health care workshops in El Paso.

While the clinic receives a few transgender men, their length of therapy tends to be shorter than transgender women who make up most of the participants. The different effects in taking estrogen versus testosterone explain that ratio, Lara said.

Pitch doesn’t drop for transgender women on hormone therapy because estrogen does not affect the vocal folds, the tissues in the larynx that vibrate to make sound. In contrast, testosterone does increase the mass of vocal folds, allowing voice to deepen and drop in transgender men.

During each session, participants work on pitch, resonance, communication style and exploring with what kind of voice they want to express themselves.

Contreras said she came into voice therapy not knowing what exactly she wanted to sound like. While Contreras recognized actresses with “beautiful voices,” she began questioning in the clinic why she wanted to sound like them.

June Contreras, a trans woman, sits at UTEP’s Campbell Building, where she has attended vocal modification therapy to develop a more feminine voice. (Corrie Boudreaux/El Paso Matters)

It took her about a year before she realized she wanted to sound similar to her mother.

“I want to sound like my mom because there’s a lot of comfort for me,” Contreras said. “I like the idea of being able to comfort myself.”

Growing up in Northeast El Paso, machismo culture in her community made her feel uncomfortable with being herself. She preferred playing with girls rather than roughhousing with boys. She tried on her sister’s clothes and wanted to cry openly when she felt she needed to.

That’s not to say girls can’t play rough or men can’t cry, she said. 

“I understand that I don’t have to follow it,” Contreras said on machismo. “But when you live around any culture, you learn to tie your value as a person to those cultural values.”

The paradigm of what’s feminine and what’s masculine is outdated anyway, she added.

While her family doesn’t quite grasp the difference between sex and gender, they want her to be happy and having that unconditional support has made a “huge difference” in her life, Contreras said.

“I feel very privileged, actually, because I have the support I need and the home base,” Contreras said. “If anything happens, I have a shell to go into for protection and there’s a lot of trans women who don’t have that.”

Contreras said her family supports the physical changes she’s wanted to make for herself in recent years. She didn’t attempt voice modification on her own before attending therapy because she feared growing nodules on her vocal cords from misusing her voice.

Participants in the BLOOM Trans Health Education workshop create a word cloud on health topics important to them. (Corrie Boudreaux/El Paso Matters)

Drastic increases in pitch from one week to the next can damage the vocal cords and even cause a vocal hemorrhage, Lara said. The vocal cords can become swollen and irritated, making a person sound hoarse.

“We talk about realistic goals,” Lara said. “Some of our patients want to sound like Britney Spears and have a really high pitch, but we have to take into account the anatomy as well. … The biggest challenge for patients is that they need to be patient. It’s not something that is going to happen from one month to the next.”

For pitch, clinicians use a piano and ask patients to try to match the note. Once they’re able to master that, they move on to words and maintaining pitch in sentences, Lara said.

Patients also work on using tongue placement to change tone, articulation and inflection.

Men, because their vocal tracts are longer and wider than women’s, create tone more from the chest area, Lara said. Their tongue placement is further back. Women create tone more toward the front of the face and have more forward tongue placement.

“Tone is the sound that we make based on the size and shape of our oral cavity and nasal cavity,” Lara said. “Think of a cave. If you’re in a cave that has a high ceiling and it’s really long, the echo that you make is the tone. It’s going to be different in a small cave with a short or low ceiling.”

Making voice modification – guided by science and research – more accessible in the community can reduce the risk of both short-term and permanent injury, Lara said.

Contreras plans to continue voice therapy in the coming school year while continuing her Ph.D. studies in interdisciplinary health sciences. People can contact Lara for questions or to sign up for voice therapy at plara2@utep.edu.

Priscilla Totiyapungprasert is a health reporter at El Paso Matters and Report for America corp member. She previously covered food and environment at The Arizona Republic. You can follow her on social...