Chapter 20. Discover the high pitch voice, peer pressure and life cycle of few puberphonia boys
Puberphonia is a type of voice disorder characterized by habitual using high pitched female voice after puberty in male. Based on 29 years of research work on puberphonia treatment with boys, the vital components in their lives, popularity friendship, cliques, social status, social isolation, loyalty bulling boy girl relationship and after school activities, cleanly indicates that peer power explore existing myths about creation of transgender. Voice and communication are crucial aspects of daily life for all humans. Within the puberphonia voice and communication are often brought to the forefront when the incongruence between gender identity and voice/communication style are greatest. Aspects of voice and communication are highly related to gender and culture. These include pitch, intonation, loudness and stress patterns, voice quality, resonance, articulation, speech rate, language, and nonverbal communication. Altering the aspects of voice and communication related to gender have been reported to reduce gender dysphoria while improving mental health and quality of life.
The estimated population Tamil Nadu (a state in India) estimated population in 2017 IS 79.788 million. Tamil Nadu has estimated population of 30,000 transgender people. The incidence of puberphonia in India estimated to be about 1in 900,000 population. This research paper chronicles the collaborative efforts of a team of ENT surgeons, speech language pathologist, mimicry artists, virtual reality therapist, psychologist, sex education and parenthood councilors, in cure of a puberphonia client’s vocal, physical, and behavioral transformation from a male to a female identity. It will detail the process of maintaining the client’s vocal health while adjusting pitch resonant focus, inflection pattern & articulation to create an identifiable male voice profile. In addition this research work will describe the body language and verbal communication practices that facilitate the client’s physical and behavioral metamorphosis. We have a strong desire to change the voice of transgender who like to revert to their original sex identity to live with the society.
Problems of puberphonia
When a young man is reaching the age of 16 (with some teens it starts at the age of 13 or younger) his voice must have changed to become more “manly ‘’voice –dropping down the pitch to the male voice range of tenor, baritone or bass. Adam’s apple will become widened as the system lowers anatomically ,making the vocal cord longer and the tone they produce lower(changing down from the child’s voice of about 400Hz to a man’s voice around 100Hz).
Some man do not go through this change and stay with a high pitched voice, creating a womanly voice output (around 200Hz) for them, making social encounters very uneasy for them, as their voices in high pitched women like while their appearance and behavior in a young male.
The present study provides input for further decision making.
There are many resources to help puberphonia people identify communication characteristics that may be targeted to develop more gender specific communication style. These may include vocal coaches, theater professionals, singing teachers, and movement experts. Specialty trained speech language pathologists are best equipped to facilitate overall vocal health and efficiency, in addition to behavioral changes related to voice and communication for puberphonia people. Otolaryngologists with subspecialty training in laryngology are skilled in vocal fold surgery techniques (phonosurgery) which may act as an adjunct to voice therapy. Puberphonia people may present with voice complaints related to quality change or fatigue that are unrelated to gender transition. This could be non-organic, organic, iatrogenic, or idiopathic in nature.
Etiologies of Voice Disorders / Pathology Classifications (There is considerable overlap among these three groupings )
I. No structural changes in the vocal cord
1.Disorders of voice use •
Muscle tension dysphonia Vocal Fatigue Vocal abuse/misuse Ventricular phonation Puberphonia/mutational falsetto Transgender voice Conversion aphonia
2.Idiopathic voice disorders•
Paradoxical vocal fold motion Chronic cough Above are components of Irritable Larynx Syndrome along with Muscle Tension Dysphonia and Globus sensation Subglottic stenosis Laryngomalacia
Influences on the larynx and voice Pharmaceutical effects Growth hormone influences Thyroid function influences Sex hormonal imbalances Rheumatoid arthritis Allergies Candida Respiratory diseases Reflux disease
4.Neurogenic voice disorders
Unilateral vocal fold paralysis Bilateral vocal fold paralysis Adductor spasmodic dysphonia Abductor spasmodic dysphonia **Essential vocal tremor **Myasthenia gravis Multiple sclerosis Huntington’s chorea **Parkinson’s disease Amyotrophic lateral sclerosis *
5.Idiopathic voice disorders
6.Paradoxical vocal fold motion Chronic cough Above are components of Irritable Larynx Syndrome along with Muscle Tension Dysphonia and Globus sensation Subglottic stenosis Laryngomalacia
II. Structural changes of the vocal folds
*Nodules Polyps• Vocal fold hemorrhage/varix• **Reinke’s edema/polypoid degeneration• Laryngitis: acute/chronic• Granuloma/contact ulcer• Congenital/acquired cysts• Papilloma• Congenital/acquired webs• **Sulcus vocalis• **Presbylaryngeus• Leukoplakia and hyperkeratosis• VF carcinoma•
Personality-related Disorders. Identity conflict:
Dysphonia secondary to difficulty in establishing individual’s personality
High-pitched falsetto in post-pubescent adolescent Weak, juvenile, thin-sounding voice of adult female Increase in fundamental frequency in male-to-female transsexual patient
We are concentrating only disorders of voice without any structural changes, mainly and only puberphonia. It is important that a comprehensive voice evaluation is completed, including voice and communication needs related to gender transition, by a laryngologist and voice trained speech pathologist prior to initiating voice treatment. Evaluation should include a thorough laryngeal examination including videostroboscopy to assess the anatomy and physiology of structures related to voice production.
Make awareness of treatment available for puberphonia. It is curable and it should be corrected. We formed a puberphonia eradication program in SIVA ENT Hospital
The Voice Evaluation Team members•
Otolaryngologist Voice pathologist singing voice specialist with few Tamil Poets/ yoga masters Harmoniam music instrument specialist/ Neurologist Allergist Endocrinologist Pulmonologist Puberphonia and Transgender clients and activists.
Evaluation of Vocal Components•- no instrument required- record when we elicit the history.
Respiration• Diaphragmatic versus clavicular/thoracic focus Degree of upper chest/shoulder/neck tension Phonation• Qualitative disturbances Ability to maintain steady pitch Consistent versus inconsistent Resonance• Hypo/hyper nasal, cul-de-sac, etc. Pitch• Too high/too low Limited in range? Can patient vary the same? Does the voice change with changes in pitch? Intensity• Too loud/too soft Patient’s ability to vary intensity Any associated vocal changes with variation? Rate• Too fast/too slow, changes prior to evaluation, coordination w/respiration
Case study and approach to puberphonia patient
Puberphonia people may present only with voice complaints related to quality change or fatigue Evaluation should include a thorough laryngeal examination including videostroboscopy to assess the anatomy and physiology of structures related to voice production. The overarching treatment goal for puberphonia people who present with voice and communication complaints is to aid in achieving a low pitch voice in an efficient and safe manner. Treatment should be patient specific and can be accomplished through behavioral and medical/surgical intervention. Our principle of treatment UMAR.
Our aim is voice masculinization
More puberphonia males present for voice evaluation and treatment than few puberphonia females. This may be related to the Puberphonia which is not a rare disorder. We have come across many person, especially a male person having a female-like voice, and worse still, have you ever bullied or made a bad joke for his having such an adolescent voice? The person might be suffering from a more serious medical complexity. Don’t make it so difficult for the person; he is already having a hard life! If some one suffering from such a voice disorder, and is facing such awkward situations in your day-to-day life, then you are probably suffering from Puberphonia! Do not panic, as it can be cured completely, and you will soon be having an attractive voice, which everyone would love to hear!
100% of puberphonia men are identified as male by telephone. Pitch may be perceived as the most important factor for voice and subsequently gender identification. A strong marker for the perception of female voice is an average speaking pitch of 180 Hz in a range of approximately 140 to 300 Hz.The hormone induced pitch change is not always without problems and it remains unclear if it is in all cases sufficient for the speaker to be identified as male. Research supports that voice and communication should be targeted in voice therapy.With hormone therapy, final lowered pitch is achieved sometime after 1 year.
Increased 'chest resonance' is suggested as a goal in voice therapy. Achieving balanced resonance during voice production contributes to overall vocal efficiency and may play a role in the reported improvement in voice complaints for puberphonia men following voice therapy. Few reports suggest a primary role of resonance in perceptual identification of the speaker's gender. However, our study reports that a combination of both pitch and resonance are found to contribute to perceived masculinity and should be addressed.[
Puberphonia had fewer upward and more downward intonation and decreasing pitch variation. It occur while avoiding monotonicity for puberphonia men
Lower vocal intensity contributes to voice feminization, it may be considered that reducing breathiness and avoiding a soft voice may be perceived in puberphonia.
While pitch is primarily addressed through hormone therapy and secondarily by voice therapy, the other components of voice production are primarily addressed through behavioral voice therapy.
Breath of fire breathing and nasal resonant voice training are two common voice breath therapy techniques. Breath of Fire is a breathing exercise used in Kundalini yoga. It involves passive inhales and active exhales that are quick and powerful. In normal speech the vocal folds function only like a reed,whose vibration produce the vocal tones of speech. In an effort to eliminate puberphonia high pitch voice, we recommend that the puberphonia should make a breath of fire as he tackles a block with the thought that this would keep his vocal cords open and relaxed which would enable him to move more easily through the block. This is somewhat similar to the recommendation that a puberphonia make or breathe a uvula vibrating “k” or ழ (La) sound at the uvula. Such techniques can work, as they will help release wards at the level of uvula.
Flow phonation targets the balanced exhalation of airflow during voice production using respiration as the power source to achieve vocal efficiency. Nasal resonant voice therapy focuses on achieving easy phonation while experiencing the energy or vibration of sound in the nasal cavity. The combination of these techniques can work to maximize voice production targeting pitch, resonance, intonation and intensity for puberphonia men.
Data collection include questionaries’ on motivation for treatment, post-treatment experience and standardized measure of psychological symptoms, body image, self-esteem, sexuality and quality of life. It is important to disease these thoughts with all. No youngster should ever be forced to endure this kind of psychological trauma, but it is important to understand that it was this terribly devastated young mind to begin desperately (perhaps unconsciously) seeking a newer, better identity.
As that time of new culture of worldwide interest availability women in general were becoming increasingly sexualized. Pornography was becoming more common and explicit. Nothing in the world seemed more popular than the hyper sexual female. Even thoughts boys did not yet understand that sexuality, they see in the internet, television and in magazine that everybody loved a pretty girl. Nothing for a puberphonia boy made him acceptable as a female, so he began obsessing on the image of the other such girls and then began experimenting with feminizing himself.
Just dreaming up regularly like girls may not have indicated anything other than an unusual fascination and formal of escapism, however after dressing like a girl, he would then go out walking around town like this.
Nothing a teen boy can do will change their biology from male to female. Male will never grow ovaries and females will never grow testes and neither will ever have the actual genitalia of the opposite sex.(5). XY chromosomes will always be XY chromosomes.
Ones DNA will always be the sex you were born. One can play the part of a woman but you cannot be one unless you were born one. According to our study; 1 in 26 transgender adult later said; they regretted transiting; while others drifted into psychiatric morbidity and suicide attempts.
Society should not be catering to delusion notation that people are either trapped in the wrong body or would be better off as another sex ; instead, we should be reinforcing positive “nerd” images and encouraging them to accept their biology, since that in reinforcing reality.
When young person go through a gender transition, they take all the stress that comes with a major life change. Many biological male and female take the gendered parameter of their voices for granted. Fear of misidentification and social isolation are the common problems with transgender.(2). Male to female transit patient most often do not achieve adequate voice change through hormone therapy.
Puberphonia boys step by step change to TRANSGENDER :
A boy with puberphonia left him highly emotional insecure and prone towards bulling easily by friends relative and neighbors. The bullies in school tuned in their weakness very early and took great pleasure. As few children are not cared and look after well by parents, they felt rejected out worthless. In terms of sexuality; puberphonia boys were used sexually by older body, teachers and friends. Every time the puberphonia boy was convinced (bribed actually) to prefer oral intimacy or anal intimacy by the male partner. The puberphonia boy actually cannot say that he had recognized the sexual experiences as “trauma” per se, they just seemed exceedingly strange to him and left in him a sensation skin to being hunted. In any case, the exploitation probably at least played a role in “grooming” this sexual identity, albeit arguably unintentionally. Day after day, week after walk month after month it was the same. So desperately they want a new identity as transgender. Once a boy finds out a new identity and left he enjoys oral and anal intimacy with other male. Anal intimacy is more pleasurable as it provide a change for increasing the time of intimacy. The mechanism of action of anal intimacy is of two folds.
1. A natural sphincter constricting ring is available in the anal aperture, where the conscious sphincter action and constriction of the introduced penile shaft is carried out voluntarily. It helps in delaying the ejaculation.
2. The lower alimentary canal is a vacuum tube. It helps in suction and lengthening of the penile shaft, introduced in to the anal canal.
Some prefer anal intimacy to avoid pregnancy and AIDS and many more psychological factors.
Once someone accept identity as female, the life continue as for as possible. In the old age they are left out of society and they are dejected in life.
The puberphonia boy spent almost the entity of adulthood in a perpetual state of rejection and fear almost at every turn. He thus began turning in wards for escape. He began compulsively feminizing himself. Initially there was no consciously sexual impulse driving it, although that would change after puberty kicked it.
75% of transgender identified adult have male biology and this incidents may suggest to all that is has been (my opinion) primarily driven by sexual/ psychological the world around them. Males are biologically much more susceptible sexual imagery which has been confirmed by the fact that pornography industry was built almost entirely on male clientele. This susceptibility to the many sexual symbols in our environment, would also explain why transgender inclination have increased as society itself has become increasing sexualized.
Nothing a teen boy can do will change their biology from male to female. Male will never grow ovaries and females will never grow testes and neither will ever have the actual genitalia of the opposite sex. XY chromosomes will always be XY chromosomes. Ones DNA will always be the sex you were born. One can play the part of a woman but you cannot be one unless you were born one. According to their study; 1 in 26 transgender adult later said; they regretted transiting; while others drifted into psychiatric morbidity and suicide attempts.
On December 10, 1948, the General Assembly of the United Nations adopted and proclaimed the Universal Declaration of Human Rights, wherein Article 16 (i) states that “Men and Women of full age without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and its dissolution”. The founding fathers of the UNO are the real defenders of nature. Hence they affirmed and declared the above statement. The UNO has declared male and female only not the third gender. The so-called third gender is a new innovation of crooked persons.
Some crooked fellows have occupied highest position in over all governments and they are trying to demoralize the society, demoralizing the whole system. 70 years have passed from the formation of UNO, still we have not been achieved the 4 main purposes of its formation. The first second and fourth purposes are about peace among nations and the third purpose is lives of poor, hunger and disease. UNO must be keen to achieve its four main purposes. But, the UNO is going the other way. UNO is going beyond the objects. UNO is detracted and detached from its main object. The inspirations and Will of the Founding Fathers of the UNO must be achieved in the world and we have the duty bound to fulfill their wish and ambition and not go beyond.
Print media as well as visual media are perverted and propagate negative impact on social behavior and psychology among people. If the world is going against natural order and moral order, then there is no peace in the world. Consequently chaos and confusions will prevail.
Lastly, I am not against the protection given to the transgender or given a reservation for them in all places or the bathroom. But I want to tell that the transgender peoples are having the defect by birth and it is curable as per the experts cited reasons in Annexure. The government must take care of the transgender and given them proper care and treatment and give suitable atmosphere to live as an ordinary man or woman.
Most people understand the bullying, exclusion, and violence that puberphonia youth sometimes face from people in their wider community. But something many people don’t know is that the pressure to look and act certain ways that teens experience from their peers can be just as damaging to their wellbeing.
There is a lack of research into transgender peoples of minority stress and resiliency particularly the impact of transition related intervention on suicidality. Trasgender,29% attempted suicide in the in life time. These findings may be may be useful in creating targeted intervention that take into accurate the alarmingly high rate of suicidality in the population. It is a social cause. Awareness is the first towards helping this great social stigma. We have to identity all puberphonia and trans genders. Those who want to come out of this social stigma; they should be helped .Particularly changing the voice to the required gender helps them. Public will target their past lives with the recognition of their voice quality. Voice of both (transgender and puberphonia) has to be corrected according to their wish. Make them to live with the parents and society. Communities seem unprepared and uneducated to smoothly integrate these people in our societies.
The purpose of this paper is to summarize the transgender have to deal with, in order to survive and merge into society, identify the main reason for the low public awareness, discuss the current situation and provide potential solution in reducing the stigma among them.
Future research in voice therapy – virtual reality:
To develop the next stage in virtual reality therapy; is modeling the aerodynamics of larynx and pharynx. A computed tomography scan of the larynx and pharynx was converted to provide three dimensional (3D) models based on the actual anatomic structure for use with a computation flow dynamics program. The model is compared to normal to determine the changes in the dynamics plays and laryngeal air flow. With the head set and sensor voice care virtual reality therapy can be given.
Our Lord Jesus Christ has said "Who answering, said to them: Have ye not read, that he who made man from the beginning, Made them male and female? And he said: "(Mat.19:4). God created the human as male and female and also animal and botanical too.
The body constitution of a man is different from a woman. The male flesh is different from female flesh. The body of the male is having hairs but the female is not like that. The genital part of the male is entirely different from a female. God created as male and female in animals also. "Two and two went in to Noe into the ark, male and female as the Lord had commanded Noe. (Gen.7:9) We have seen male and female in Palmira tree also. The female Palmira tree gives fruit but the male Palmira tree is a barren one and it is unable to give fruits. So, nature itself is made it clear that every living creature is male and female only.
The so-called transgender, the man/woman has a defect by birth, likewise the dumb, blind and lunatic. It's important to remember that if someone is transgender, it does not necessarily mean that he or she has a "third gender." Most transgender people do have a gender identity that is either male or female, and they should be treated like any other man or woman. “The exceedingly rare disorders of sex development (DSDs) including, but not limited to testicular feminization and congenital adrenal hyperplasia, are all medically identifiable deviations from the sexual binary norm, and are rightly recognized as disorders of human design. Individuals with DSDs do not constitute a third sex. The statement points out that such gender confusion should be treated as a psychological disorder called “gender dysphasia” and is “a recognized mental disorder” in the most recent edition in Nov. 2014: of the “Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V).”
It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Many transgender people live in a society that tells them that their deeply held identity is wrong or deviant. Some transgender people have lost their families, their jobs, their homes, and their support, and some experience harassment and even violence. Transgender children may experience rejection or even emotional or physical abuse at home, at school, or in their communities. These kinds of experiences can be challenging for anyone, and for some people, it can lead to anxiety disorders, depression, and other mental health conditions. But these conditions are not caused by having a transgender identity: they're a result of the intolerance many transgender people have to deal with. Many transgender people – especially transgender people who are accepted and valued in their communities – are able to live healthy and fulfilling lives. The group is most concerned about the regimen of drugs that are given to children to block puberty. “Children who use puberty blockers to impersonate the opposite sex will require cross-sex hormones in late adolescence. Cross-sex hormones (testosterone and estrogen) are associated with dangerous health risks including but not limited to high blood pressure, blood clots, stroke and cancer.”
For many transgender people, recognizing who they are and deciding to start gender transition can take a lot of reflection. Transgender people risk social stigma, discrimination, and harassment when they tell other people who they really are. Parents, friends, co-workers, classmates, and neighbors may be accepting—but they also might not be, and many transgender people fear that they will not be accepted by their loved ones and others in their life. Despite those risks, being open about one’s gender identity, and living a life that feels truly authentic, can be a life-affirming and even life-saving decision. Transgender people should be treated with the same dignity and respect as anyone else and be able to live, and be respected, according to their gender identity.
It’s not the 'trans' people. They are not much of a problem, because they are suffering from a biological-medical condition-mostly hormonal-and they know it. Children are born with genetic heritage all across the spectrum, most of which are suitable for membership inhuman social civilization. A youngster's gender identity normally results from this natural selection process.
The main forces behind this are:
i. False "Feminism".
ii. Aggressive Atheism disguised as "progressive science".
iii. Homosexuality and all other forms of rejecting Natural Sexuality;
iv. Sexualized persons. These people’s activities are always sex and sex is their hidden agenda
It is not that we'd hate homosexuals and others. 'Trans' people, for instance, suffer from biological-medical conditions - and little is known of abuse from their side. But LGB (lesbian, gay, bisexual) people (who only use the 'trans' people as decoy, because they do have a good reason for how they are) are so arrogant in their narcissistic-exhibitionist ways of "pride" parades etc. "Pride" - for what? Is it for being aside of Nature?
So sad that children are not allowed being children. They are either male or female there is no transgender child in the world. "And God created man to his own image: to the image of God he created him: male and female he created them"(Gen.1:27). And hence there is male or female no in between. Their idea of gender identity is so scrambled, that God gave them over to a reprobate mind.
Just because a boy likes to have long hair, doesn’t mean he is suddenly a girl. And just because a girl likes to play outside, climb trees, and run around, doesn’t mean she is a boy. The adults who adopt the transgender lifestyle need counseling and recovery, not encouragement to continue down a dark path.
The outcome of this study is three fold :
1. To illustrate the powerful psychological force that shaped puberphonia to transgender on their identity or inclination.
2. To explore the serious dangerous and implications of promoting transgender in children.
3. To illustrate a non-invasive method of treating puberphonia.
Limitations of this study :
1. This study is concentrating on puberphonia. We have worked on 68 cases of puberphonia. We have invented a new method of treatment for puberphonia.
2. This study has to be done world wide
3. These study it self-limited by sexual privacy revealing.
4. More work has to be on the post-traumatic stress reaction of transgender.
5. Step by step, the other causes that initiate the transition should be identified.
6. Speech therapy needs virtual reality therapy with simulation.
The strength of the study :
1. The society should help transgender at the same time stop developing new trans genders
2. The post-traumatic stress reaction of transgender; 80% of the transgender die early.
3. In puperphonia to genetic and hormonal causes are completely ruled out.
4. Voice analysis in puberphonia and transgender are recorded and almost have similar pattern.
1.Adams noah, histomimeaya, and moody Cherie transgender health April 2017, 2(1): 60-7 5vol 2 issue 1 April, 1 2017. Varied report of adult transgender sociality synthesizing and describing the pees reviewed and gray literature.
2.Cho.w.hong,j,and park .h real-time ultrasonography assessment of true vocal fold length in professional singers.
3.Emily many, North Eastern University, Boston, Massachusetts.USA
The male to female transgender voice most salient voice parameters in perceived – gender identification 2014 publication.
4.Hatagak is Ge, karasan, cook j, sehlossm, davisgh
Structure in children Int.J.Pediatrotorhinolaryngl 2003;67(4) 373-81
5.Narayanareddy D.Life (Youir –in Tamil language) Vikadan publishers Nov 2012.757 Anna road, Chennai- 600 002.
6. SudhakarVaidya 1 and G. Vyas1(2006).Puberphonia: A novel approach to treatment .Indian J Otolaryngol Head Neck Surg. 2006 Jan; 58(1): 20–21.
7. Su.M.Eyeh, T.H.Tan, ctetal.Measurement of adult vocal length J.Laryngolotol 2003;116:
8. Peer Pressure and ‘Transgender’ Teens, Sept. 9, 2018 4:25 pm ET, WSJ Live, Ideologues try to suppress a study on the increasing prevalence of ‘rapid onset gender dysphoria.’ By Jillian Kay Melchior.
9.Fast Track Treatment for Puberphonia - Lupine Publishers