We can answer that.

Mike MacKinnon (MM): Welcome to We Can Answer That. I'm your host, Mike MacKinnon. Each week, I sit down with an expert from the UCalgary Community to ask five questions contributed by our audience and to shed light on topics that matter to you. We often take the things we love to do in life for granted, whether it's a hobby, an artistic expression or a favorite sport. We work at them, we get better at them and they become a core part of who we are as people. But what if our identity got in the way of what we love to do? Not many of us are faced with that difficult decision. Today, we're talking with Ari Agha, who is a choral singer and a researcher with the City of Calgary. Ari was faced with that very dilemma when they began testosterone therapy, as part of their gender transition. They knew their singing voice could change dramatically and affect a core part of who they are. But they didn't know how much their voice would change or in what way, because there's next to no research on the subject. So they decided to become their own case study and to document their voice changes in a research project called Key of T, so that others in their situation would have more information to help with a life-changing decision. Ari, thanks for joining us.

Ari Agha (AA): I'm glad to be here, Mike. Thanks.

MM: Can you tell us about your research project and what led you to this decision?

AA: Sure. So I had been thinking about taking testosterone for a lot, a lot, a lot of years before I actually began taking it. And very early on when I started considering that possibility, one of the big questions, concerns, things I was unsure about was how it would affect my singing, because I love singing. And the narratives, the stories that were floating around in the trans community, among folks I knew and friends, and just people's experiences that you learn about was that testosterone could really negatively impact your singing voice, that it could ruin it, right? That you would lose your ability to sing. And it's not like you'd lose your voice totally, but it would just get really weak or scratchy or you'd lose control. And so the first thing I did... Is because I am a researcher, as you mentioned, I'm a sociologist by training, I said, "Well, let's see what the research says about this. Right?" And that's very much how I approach the world, right. Is like, "What do we know from the empirical-research world?" And learned that there was really very little. There was one big seminal study that had been done and it was fine and it gave us some information, but it included like six people and it was quite dated. And so I was really, really frustrated that we didn't have more solid information. And don't get me wrong, there's a lot of stories and narratives and first-person experiences in the world, and that's a really important source of information for trans folks, right? There's this thing called the Transition video that, if you look on YouTube or Google it, lots of folks document how their voices change and how their bodies change over the course of their transition and that's great. But it doesn't have the same sort of rigor that research would. So I was feeling frustrated and annoyed that we didn't know more. And I was expressing that frustration in fact to my partner who just happens to be a Women's and Gender Studies professor at Mount Royal, Kim Williams. And she said, "Well, why don't you do this study then?" And it was literally as simple as that. And I was kind of like, "Yeah, why don't I do this?" Right? By that point I had decided that this was something I was going to do. And it was this kind of amazing opportunity to combine parts of my life and identity as being a trans person, but also being an empirical researcher and having that skillset, those methodologies to apply to this question. And so it kind of seemed like a golden opportunity.

MM: And what was the biggest factor in your decision to potentially risk your voice?

AA: It's really hard to pin down what that deciding factor was. I think really it was just over time. Right? I was 39 when I did start taking T. When I was thinking about this and having conversations and doing research and reading and stuff, I was an adult and I had a career and a life and was used to being patient about things, not rushing into things and whatever else. And so I knew that there was this huge uncertainty, this huge risk. And the question is sort of, "Am I willing to take this step, not really knowing what the results are going to be?" And I thought a lot about singing, and as you said, I'm a choral singer, that's how I love to share my voice, and one of the things that makes my life worth living really. And I thought about like, "What is it about with choral singing that means so much to me and why?" All those things. And I think, honestly, it was just a matter of time that, just continuing to live with being misgendered over and over and over again, it just got to the point where I couldn't bear to keep living that way. So I am non-binary, I am genderqueer in particular and my pronouns are they and them. And even, I was completely out at work and at school, at universities I was involved in and among family and friends. And really, almost everybody still continued to treat me as a woman and think I was a woman, and that was just incredibly frustrating. And I got to the point where it was worth risking pretty much everything for, to try to get a little bit of relief from that dysphoria.

MM: Key of T led to a live performance with UCalgary School of Creative and Performing Arts, as well as a short documentary film that recently screened at the Calgary International Film Festival. When you were describing this in the film, you said that the way you were living before T was unbearable. Has the testosterone therapy helped alleviate any of that?

AA: Yeah. Oh, it's definitely, it's definitely. It's changed things, yeah. Yes, for sure. So the dysphoria that I am experiencing now is far less than it was before. I feel more comfortable in my body than I did before, for sure. And I still continue to be misgendered quite a lot. So it's not sort of a magic pill or injection or whatever that just fixes everything about your life. But it was a relief. And it's an interesting question that I get a lot. Being non-binary and using they, them pronouns, it's like, Well... People used to use she, her pronouns and if you take T aren't they're just going to, sort of go the other way and start calling you, he, and isn't that just as bad? And, he, is not right, for sure, but it's less wrong if you will, than she. I think because I've spent so much of my life trying to get people to acknowledge that I'm not a woman and I'm not, she. And while, he, is not right, it's less troubling than, she, even though, they, is really only the right one for me. So yeah. Yeah, I don't regret it. Overall things have gotten better for sure, and they're different in a lot of ways

MM: We've been focused very much on the specific factor of your voice. So how much has your voice changed over the course of your therapy and how do you feel about it?

AA: It's really interesting. I think it's changed a lot, but it's also stayed very much the same in a lot of ways too. So what I'm really, really grateful for and what I was quite worried about before is that the testosterone would somehow make me into a different person, that something fundamental about me would be changed. And I didn't want that. I still wanted to be myself and sound like myself. You and I know each other, I have a very distinctive laugh. Things like that about me that I didn't want to lose. It was a big part of my identity. So my voice has absolutely gotten deeper, my speaking voice has. The range of my singing voice has shifted down, about a fourth or so. So I lost about a fourth, which is a little less than half an octave at the top of my range. And I gained about a fourth at the bottom of my range. So it just sort of did this parallel shift down. And that's actually not... I don't know, I guess in my head, I sort of imagined this super dramatic, black and white, and it's just not like that. Almost all of the notes I could sing before I started taking T, I can still sing now. There's a few extras at the bottom that mostly sound pretty low and gravelly, and I've lost the very tippy top of my range. The notes I can sing aren't all that different. What has changed quite a bit is the sort of tone or timbre. There's another term that's used, the sort of quality of my singing voice. And I didn't anticipate that. I didn't think about... I mean, I guess I knew it would happen, but I didn't really think about what that would be like, and what that means for folks that sing. The quality of my head voice, those higher notes became a lot richer and more complex and a bit darker if you will. I used to be described as having a very youthful sounding, upper range, and that's not the case anymore. And then what was cool about the lower part of my range is actually not really the new low notes that I gained because I don't... I think at least I know I don't sing those very low notes really hardly at all. But what's been super cool and fun is that the lower part of my range, I have far more capacity and far more resonance and it just sounds really different. And so that's been really cool and really fun. The notes then changed. I can say I've changed some, the timbre has changed quite a bit, but it still does to me sound like me. Folks that I haven't seen in a long time and see me again, a couple of people have said that, "You still sound like yourself." And that just makes me so happy and brings a huge smile on my face. That... I don't know what it is. Quality of who I am is still there. I think a huge part of why I'm able to hear that difference too, is because of the research, because we've had so many recordings of me. Right? We had been recording my singing lessons, this whole project has been with Laura Hynes who's in Voice Faculty at U of C. And so we were recording every week. So we have all of these recordings of my voice, but that's one thing I would encourage anybody who is thinking about their voice, or wanting to change it, changing it whether it's through hormone therapy or anything else, to record yourself, because it's really hard for us to hear those kinds of changes. And being able to go back and listen to what my voice sounded like, even a week ago or a month ago, let alone four years ago, is pretty remarkable. And you do have those moments. Laura, my voice teacher and partner on this called my voicemail a couple of years ago, and this was after my voice had started to drop, and she was like, "Ari, you have to call your voicemail." And the recording was from, way before I started T and I was like, "Whoa, that sounds so different." But it's still me, it still very much sounded and felt like me. So that was pretty awesome.

MM: Now, you mentioned working with Dr. Laura Hynes, who is a voice professor at the University of Calgary. Do you think that working with a voice coach mitigated some of the changes or made them less dramatic or . . .?

AA: Well, yeah, I think they made the process less scary for sure. I think it made the transition smoother, I guess, is the best way to say it. Laura... And she'll tell you this as well. She hadn't had any experience with working with somebody whose voice had changed with exogenous testosterone. But she's a voice teacher, she's a professional and she knows what happen to voices and what sounds right and what doesn't sound right. And can provide guidance and advice about like, "Okay, it's cracking, it's breaking. That's okay, don't be afraid of that. Keep singing. This is normal or this maybe isn't normal." And if something is hurting or feeling uncomfortable, she certainly could give advice about that. So I think that that was absolutely invaluable. As a voice teacher, as a pedagog, she deals with changing-voices all the time. Right? People's voices change throughout their lives, throughout our lives, and especially young adults. Right? In university settings they're, 18 to 24, their voices aren't done maturing yet. So a changing-voice, this particular kind of change maybe was something she hadn't worked with before, but she's a professional. So there's no question that she was hugely helpful in that, yeah.

MM: And, last question, how will other people who are considering this therapy benefit from your research?

AA: Well, first let me start by saying, we've been sharing my experience in a lot of different ways. The most sort of research-like will be journal or articles and academic journals. So we are working on submissions for those. They're not out yet, but hopefully they will be fairly soon. So we'll have that sort of really rigorous documentation available. And then of course, there's the film and there's our website, Keyoft.com. All those places have information about my experience. But really my hope is that it's just... This is a case study, this is one example, so I can share what my experience was like, what it felt like, what it sounded like, where I started, where I ended. And this is not going to necessarily give anybody a roadmap for like, "Here's what you can expect." But it is an example of a human who went through this transition, and I'm still singing and I will still love singing and I'm still able to do it. One of the biggest changes we actually haven't mentioned so far is just that my voice does get tired a bit more quickly than it did before testosterone, that is slowly getting better. And that's probably been the toughest thing of all, but I'm still singing and I still love it. So at the very least, to know that there is a person that has done this and has gotten through it and can relate and can sympathize. There is other research happening now, too, right? There's a couple of other similar sorts of case studies that have been published, just tracking individual people's experiences. Right? And we don't really have enough yet to be able to say like, "Okay, you have a 10% chance of having a serious problem with... We don't have those kinds of population-level statistics yet. And that takes quite a bit of information to be able to make those kinds of statements. But we do have lots of examples of folks who have taken exogenous testosterone and continue to sing and what kinds of things they ran into, what their process was like, that sort of thing. So I hope mostly just that, that it's possible that you can do it. Things like, continuing to sing throughout the process is really important, working with... If you're a singer, if singing is something you want to do, working with a voice teacher is really great. Working with a speech language pathologist can be really helpful. Those kinds of things I think is what we hope. And really just that, there are other people that are doing this, that are going through it, you're not the only one, you're not alone and certainly, there's a community of us now.

MM: And that's such an important message, I think, to people who are considering these sorts of life-changing decisions. This has been, We Can Answer That. We've been talking to Ari Agha, a choral singer and researcher with the City of Calgary, about their experience with testosterone therapy and potentially risking a major part of who they are, as a result. You can subscribe to, We Can Answer That, on Apple, Google, or Spotify, or by visiting ucalgary.ca/podcasts. Follow our social channels to see which one of our experts will be featured in our next episode and to send us questions you'd like them to answer. We Can Answer That is a production of the University of Calgary. Thanks for listening.