frequency (SFF) (the average frequency produced in a connected speech sample) because they typically perceive a feminine voice as using a higher pitch. Although pitch is not the most essential element of voice change for these individuals, it is necessary to raise the SFF to a gender-appropriate pitch to help with vocal feminization. A speech-language pathologist will work with the individual to raise their pitch and provide therapeutic exercises. The first step in therapy is determining the habitual speaking fundamental frequency of the individual using an acoustic analyzing program. This is accomplished through several tasks including sustained phonation of the vowels /i/, /a/ and /u/, reading a standardized passage and producing a spontaneous speech sample. Then the therapist and the individual determine what the target pitch should be, based on the gender acceptable range for cis women (i.e. a socially acceptable pitch based on the average woman's vocal pitch range). When therapy begins, they establish a starting frequency to work on, that is slightly above the individual's SFF. The point is to choose a starting pitch that can be produced without strain or excessive vocal effort. As therapy progresses, the target SFF will gradually increase until the goal has been reached. Progression moves from using the target pitch in a sustained vowel to using it in a 2-5 minute conversation. Semi-occluded vocal tract (SOVT) techniques may be used to facilitate voice production in the higher pitch range. SOVT techniques include phonating into straws, lip or tongue trilling, and producing multiple speech sounds such as nasals /m/, /n/, voiced fricatives (i.e. /z/, /v/), and high vowels such as /u/ and /i/. There are two exercises that are often used: producing a pitch glide that goes from the middle of the pitch range to the upper pitch range; and a messa di voce exercise, where the voice goes from soft to loud to soft again. SOVT techniques have the individual prolong their voice at a higher pitch, which may help make voice production at a higher, non-habitual pitch easier and more efficient. Pitch can also be altered through voice resonance modification. The length of the vocal tract affects the resonance of the vocal tract, which in turn affects the pitch. Cis men tend to have vocal tracts that are 10-20% larger than those of cis women, and therefore cis men have a lower vocal tract resonance, and a lower pitch, than cis