When Stephen Temmermand was in seventh grade, a school psychologist asked the New Jersey native to draw a self-portrait.
He drew a girl.
"That's when I realized I wasn't who I thought I was," said Temmermand, who legally changed her name to Caroline in September. "And it scared the heck out of me."
Forty years later, Temmermand began to transition from living as a male to living as a female. Despite the changes she made, Temmermand still felt there wasn't a congruency between how she looked and how she sounded.
"I dressed like a woman, but I sounded like a truck driver," Temmermand said.
To overcome this setback, Temmermand attended a session at the GW Speech and Hearing Center's voice training program in 2008. That started her vocal transformation.
Finessing the art of feminization
Twice a week for four semesters, Temmermand attends classes with speech pathology graduate students. Using a computer and a microphone in a space smaller than most students' dorm rooms, she learns how to speak, sneeze, cough and laugh like a woman.
During the classes - which cost $50 per session - clients perform exercises reminiscent of a choir practice, repeating sounds, words and phrases while the clinicians measure the frequency of the sounds electronically.
Professor Linda Siegfriedt, the clinic's supervisor, said the transgender program has seen unprecedented growth in the past few years.
There are currently 20 male-to-female transgender clients in the program, and a waiting list filled with others hoping to learn how to adapt their voices.
The center first began offering voice feminization treatments in the 1970s, and is one of the largest providers for transgender speech pathology in the Washington metropolitan area.
Siegfriedt said the program is benefiting from its long history.
"It's a more well-rounded, complete program because the clinic has been a staple of GW for such a long time," Siegfriedt said. "Clients love that they feel comfortable, they can come here and feel accepted. They don't worry about how they will be received."
The clients first learn to move the tone of their voice to the front of their mouth instead of holding the sound in the throat like men do, a difficult process Siegfriedt said.
Besides pitch, clients enrolled in the program learn to feminize their voices by focusing on resonance, intonation and nonverbal communication.
"Resonance is most difficult because it's so subtle," Siegfriedt said. "Resonance provides a voice with quality and identification, but it's challenging to monitor and control."
"I was scared to death"
When she began sessions at the Speech and Hearing Center, Temmermand wasn't "out to the world full-time" and she said her biggest hurdle was fear.
"If the world steps back every time you speak, it affects you mentally," Temmermand said. "I was scared to death about how people would react."
Like most clients, Temmermand, now a Maryland resident, heard about the program from transgender friends in the area. After hearing her friends' new voices, she said, "Oh my God, I have to sound like that."
Temmermand said before she began voice training, she would avoid talking on the phone because people misidentified her as a man.
"Now I can be me. People will listen to my ideas, not just my voice," Temmermand said. "This place has made such a huge impact on my life."
Temmermand said she hoped the classes wouldn't only benefit her; she needed to make sure her voice wasn't an issue in her personal or professional life.
"When I made the transition from male to female, my family, friends and coworkers were affected, too," Temmermand said. "I'm doing all I can for them to feel comfortable with the process."
A hidden identity
Rose Elizabeth Supan knew she was transgender when she was 4 years-old. When she told her father, his reaction convinced her she needed to hide her true gender.
For the next five decades, Supan masked her true identity, even from the woman who would later become her wife and the mother of her children.
By 2008, Supan was overwhelmed with depression and anxiety, so she told some friends and most of her family the truth.
Supan's wife left her shortly after.
She was crushed, but said her daughter has proven to be supportive during the transformation. Her daughter, who was 23 years old at the time, accompanied Supan to a transgender support group the week after learning of Supan's true gender.
"I'm still her 'Pop.' We still celebrate Father's Day," Supan said.
Supan is now in her second year of male-to-female transition and is just finishing her first semester of voice training.
"Psychologically, there was a huge block to changing my voice," Supan said. "I was worried that people wouldn't respect me, but I gained confidence here."
Supan faced an unusual problem when learning to feminize her voice. As a voice actor specializing in male voices, she had to maintain her male voice as well. She said she needed to sound like cowboys and mountain men in audiobooks after the training, but so far she has been able to sustain both voices.
The cost of a complete gender reassignment surgery, which can cost more than $13,000, prevented Supan from undergoing the procedure. She is still biologically male.
In the transgender community, she said, there is a substantial division between "ops" and "non-ops."
"They say we haven't had the same experiences as them. But we've struggled, too," Supan said. "I am a woman, even if my parts 'down there' don't reflect how I feel. My gender has always been my gender."
Siegfriedt said some of the clients don't take hormones and many do not have the surgery, either for personal or financial reasons.
"But they still feel like they're being true to themselves," she said.
As for the future of the clinic, Dr. Michael Bamdad, the clinic's director, said he hopes to integrate more disciplines into his clients' transition process.
"Our clients ask about things like attire and makeup. Who's working with them in these areas that they were never taught about?" Bamdad said. "We're speech pathologists - we can't go into other worlds."