"How can I help you?” Anita Kozan asks the woman sitting across from her.

It’s not a question, it’s a vocal exercise.

“How can I help you?” the client, Marie Fromm, repeats, imitating the breathy lilt of Kozan, a speech and language pathologist.

After years of practice, Fromm, who is transgender, has managed to coax a tender alto from a Seth Rogen-deep growl. The vocal transition, she said, was just as essential as the physical.

“Developing a voice that fits us lets the world see the person we are,” she said, “instead of the person we pretended to be.”

For some people who are transitioning from one gender to another, a significant part of the journey starts with finding their voices, literally.

Feeling mismatched with one’s voice can be disembodying, depressing, even dangerous, many transgender people say. And it can trigger feelings of being in the wrong body. But a unique group of speech and language pathologists are training transgender people to speak with a voice that channels their true identities.

The field of transgender voice modification is gaining prominence alongside transgender rights. Minnesota happens to be home to some of its leading experts, with a handful of specialists working in the state over the past two decades.

The practice brings to light all the details that make our voices indicate gender — how men speak slower, how women use more vocabulary, how men’s vocal cords resonate in their chests and women’s in their heads. By adjusting not just pitch, but intonation, enunciation, speed of conversation and even gestures, people who grew up absorbing the social cues of talking “like a man” can project an entirely different voice.

Before her transition, Fromm would suppress her otherwise outgoing personality because she was afraid of sending off signals that she was different. Part of that was staying quiet in social settings.

“My voice didn’t match the person I was,” she said. “I was literally silenced.”

The divide between body and self can shake a person’s world.

“For some people, it’s just not possible to change their voice,” said Katie Spencer, coordinator of the transgender health program at the University of Minnesota. “They don’t like to talk, because just talking is a trigger.”

Because of its inextricable link to identity, transgender voice modification is a delicate job, said Kozan, who has studied the process since the 1970s.

“It’s the hardest work that I do,” she said. “There’s the whole speech-language pathology piece, how that fits with them physiologically, and then there’s the psychological piece. ‘How am I judging myself? Do I put myself down? Did I make a mistake?’ There are huge areas of thought to be explored.”

While there are only a small number of speech and language pathologists around the country who specialize in this work, the field is growing. Clients have become more plentiful in the last five years, as transgender rights have gained some traction.

“It’s gotten much more visible, partly because the transgender community has become more outward in asking for help,” said Richard Adler, one of the nation’s foremost experts on transgender voice modification and a professor at Minnesota State University in Moorhead.

His book, “Voice and Communication Therapy for the Transgender/Transsexual Client,” is considered the singular clinical guide for practitioners. At Moorhead, Adler teaches a new crop of voice coaches to help the next generation of transgender clients.

First, more young people are seeking out voice therapy as they come out earlier — a change that is transforming the work coaches do.

“It’s easier to mold or retrain a voice when you’re in your early 20s, compared to having lived with a lower pitched voice an additional 30 years,” said Carol Rue, a speech and language pathologist at Park Nicollet Clinic who has been seeing transgender patients for two decades.

Second, growing acceptance of people who identify as neither male nor female creates more diverse vocal needs.

Avery Ewing sought help to “erase the gender markers from my appearance and expression.” Ewing went to Rue to learn how to incorporate more masculine elements into the feminine voice with which the college student was born.

Still, the largest share of clientele seeking voice modification is transwomen (male to female), who can have difficulty raising their pitches. Other techniques, such as opening the mouth wider and speaking faster, can help them feminize their voices.

Testosterone often does the work of lowering the voice for transmen, although some still find voice training useful.

Aaron, who asked that his last name not be used because some people do not know he is transgender, sought vocal help before taking testosterone in his transition from female to male. His singing voice, then a soprano, was a source of pride, and he wanted to protect it as it deepened.

“I had a voice that connected me with people,” said the avid synagogue singer.

He worked with Kozan to track the movement of his range; for every low note gained, a high note was lost.

What does voice say about identity?

The therapy relies on generalizations about what makes a voice male or female — for instance, a deep voice for men, a high pitch for women.

“We have to start with what we know to be gender norms in order to help somebody operate in the world,” said Christie Block, a New York City-based speech and language pathologist and expert on transgender voice modification. “But we are by no means promoting [gender norms].”

Instead, changing one’s voice raises this question: How does voice make us distinct as individuals?

“I feel like I have a unique spectrum of a voice,” said Mj Bernick, one of Kozan’s clients. “It’s all me, but it’s different parts of me. I’m just learning to work with it.”

Bernick is currently bringing her voice up from subterranean depths to something she feels matches her gender — not only for peace of mind but also for safety.

Once, when she accidently slipped into her old, low voice in public, “it was like a record skipping,” she said. “Everyone looked at me.”

Safety is one of clients’ top concerns when they come in for voice training, therapists say. Transgender people, especially transgender women of color, are frequent targets for violence. In a 2011 survey of 7,500 transgender Americans, more than half reported being harassed in a public place.

“I’m well aware that my voice would be a potential factor for my personal safety,” said Ellie Krug, a Minneapolis attorney. “In women’s restrooms, I will do just about anything not to speak. Just point and nod.”

Making an impression

In addition to running the nonprofit Call for Justice, Krug has made a career of public speaking about transgender issues, particularly within the legal system. But she also focuses on the basics — what she calls “Trans 101.”

From libraries to boardrooms, every speech begins the same way, with small-framed, long-haired Krug being introduced to her audience. Then she speaks.

“As soon as I open my mouth, I absolutely see on some faces how there’s a disconnect,” she said. “They expect a woman, and instead they hear this” — a deep, stereotypically masculine voice. (Krug worked with voice trainers for about a year, but complications from throat surgery thwarted her ability to raise her pitch.)

“It’s become a broken anchor dragging behind a ship,” she said. “My voice is my Achilles heel.”

Back in Kozan’s antique-stuffed Minneapolis living room, the speech pathologist is now working with Bernick. For an hour, Bernick repeats every word that Kozan says. Her voice is quiet and somewhat stilted by lips that barely move, but Kozan encourages Bernick to stretch her mouth more.

“Here’s what I think,” Kozan says, and Bernick echoes. Kozan tells her to speed up her phrases.

“Don’t you worry about a thing,” says Kozan, and Bernick mimics. More open and briskly now, she’s got it.

One more phrase, first Kozan and then Bernick, sounding confident in her new voice: “I’m not worried at all.”