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  • Writer's pictureTallulah Breslin, MS, CCC-SLP

What effect do tonsils and adenoids have on gender voice training?

Updated: Nov 28, 2022

This article is purely informational. If you are concerned about your tonsils or adenoids, please seek out medical care.

TL;DR Enlarged tonsils and adenoids can cause non-gendered, abnormal voice and speech changes. While these changes effect some of the same variables we use to modify to amount of first puberty testosterone exposure it sounds like we have had, they do so in unhelpful ways. Nasality, tongue root engagement, pronunciation, and our capacity to practice our voice can all be affected. Surgical removal can return our voice and speech to normal, improving our perception of our voice and making it easier to speak and practice. If we've had our tonsils and/or adenoids removed as children, any undesired sound effects have likely already been resolved, or are settled into a pattern that is separate from voice gender. Whether or not we have our tonsils and adenoids, we can modify our voice sex and gender.


In English, our nasal sounds are "m," "n," and "ng," the sound at the end of "ing" words, like walking. When we hear too much nasality, so that non-nasal sounds have nasal resonance, we are hypernasal. When we hear too little nasality, so that nasal sounds do not have nasal resonance, we are hyponasal, or have blocked nasal resonance.

With normal size adenoids, before puberty they help form a seal for some sounds, allowing for normal nasality (after puberty, the soft palate forms a seal with the pharyngeal wall instead of with the adenoids). When the adenoids are enlarged, that seal can be disrupted, causing hyponasality. Enlarged tonsils can also disrupt this seal by not allowing the soft palate to reach the adenoids, causing hypernasality. Surgery to remove the adenoids and/or tonsils can normalize nasal resonance, though it can take up to three months. If resonance has not normalized after three months, medical professionals can provide further guidance.

Nasal resonance is not inherently a gendered variable, but it is sometimes modified in the process of changing our voice gender. Adding a little nasal resonance can balance the sharpness of twang, oropharyngeal narrowing, creating a natural sounding bright resonance. Some desired accents include nasality.

Below you can see a side view of our tonsils, mouth, nose, and throat.


Knodel comes from the German word for a boiled dumpling shaped like a knot, as in there's a hot potato in our throat. Rebecca Black uses a knodel sound quality in her teen break out song "Friday."' Character voices such as Stitch or Gollum have exaggerated knodel sound qualities.

Very large tonsils can nestle between the soft palate and the back of the throat, causing a gap that traps air. This gap, called a "blind pouch," is a cavity that is closed at one end. They can result in a harsh, constricted, and inherently imbalanced "cul-de-sac" resonance. Removing enlarged tonsils can restore normal resonance.

In gender voice work, sometimes our tongue root is being an unhelpful helper, leading to the undesirable sound quality of too much knodel. To reduce knodel, we learn to relax our tongue root. Other times, we intentionally add a knodel quality to balance resonance, learning to engage our tongue root just enough to have a more natural sound. Intentionally manipulating the tongue to add or remove the knodel sound quality from our voice is different from cul-de-sac resonance.


To communicate intelligibly, we form clear and distinct speech sounds. This requires us to place our articulators in a specific, consistent placement that produces a constriction right where it's needed to form our desired consonant. When we produce our sounds differently from normal, our speech can be distorted.

Enlarged tonsils can take up space, forcing the tongue to move forward. This can cause a tongue fronting pattern where back sounds "k," "g," and "ng" are produced as "t," "d," and "n." Enlarged adenoids can cause open mouth breathing and hyponasality, distorting nasal sounds "m," "n," and "ng," thereby decreasing intelligibility.

In gender affirming voice training, we can change how to articulate to match the gendered pattern of our culture. Pronunciation changes require a lot of practice to avoid a slurred sound quality, as consonants need to be produced in a precise place to be understood as the target sound. Fortunately, articulation modification is often not needed during gender voice modification, as the more efficient acoustic resonance and vocal weight modifications are friends with pitch, changing the amount of first puberty testosterone exposure it sounds like we have had. But if we want to change our oral resonance, articulation modification is possible. But the goal is never to produce distorted speech the way enlarged tonsils or adenoids can.

In the American Midwest accent, what is commonly thought of as unaccented speech (it's not- we all have accents!), there are specific articulation patterns associated with different speaking genders. Masculine articulation patterns have more dull, tongue back, and less crisp but not sloppy consonants. Hard onset vowels are avoided, and a more staccato pattern with forceful onsets is used. There is reduced use of the voiceless "th," and sometimes phonemes are even dropped altogether. In contrast, feminine speakers articulate more clearly but in a light manner, very precisely and crisply with lighter contacts. Tongues are further forward, vowels are elongated, and onsets are easy.

Spoon Theory

Spoon theory quantifies mental and physical energy as spoons. Everyone's energy ebbs and flows throughout the day. Some activities add to it, building our spoon resource, while other activities use up spoons. If enough spoons are used, there can be little energy left to do anything else.

People often pursue modifying their voice gender because they're experiencing voice or communication dysphoria. Voice dysphoria is an intense, persistent discomfort with how the voice we hear relates to our gender identity. Trying to work on our voice when dysphoric can be very challenging, using up many mental energy spoons. Tragically, simply existing as trans* in a discriminatory, unsafe society can be emotionally draining, leaving few spoons left for everyday activities, much less practicing our voice.

Fortunately, we all have ways we can refuel our spoon supply! Self-care helps a lot, which starts with getting enough sleep. Enlarged adenoids and tonsils can cause obstructive sleep apnea, leading to daytime sleepiness, depression, difficulties with concentration, and loss of memory. It's much harder to have spoons for difficult tasks when we're tired, depressed, have poor focus, and don't remember to practice. If sleep apnea is resolved by surgical removal, allowing for normal rest, people can refuel their spoons, increasing their capacity to participate in spoon draining voice work.

In Conclusion

Enlarged tonsils or adenoids can cause non-gendered, abnormal voice and speech changes. These changes are different from the ways listeners determine how to code our voice sex or voice gender. Removing them can reduce or eliminate undesired sound qualities, improving how much we like our voice, and even make it easier to speak. If we've had our tonsils and/or adenoids removed as children, any undesired sound effects have likely already been resolved, or have settled into a pattern that is separate from voice gender. Whether or not we have our tonsils, we can modify our voice sex and gender. With practice and training, everyone can have a voice they love!

-Tallulah Breslin, MS, CCC/SLP (she/they)

Gender & Identity Affirming Voice Training @Harmonic Speech Therapy

Love your voice

P.S. My tonsils and adenoids were removed in first grade, and no difficulties with voice modification here :)

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