Voice and Stroboscopic Characteristics in Transgender Patients Seeking Gender-Affirming Voice Care

Laryngoscope. 2021 May;131(5):1071-1077. doi: 10.1002/lary.28932. Epub 2020 Aug 4.

Abstract

Objective: Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire (TVQMtF )-and reports incidence of abnormal stroboscopy findings and acoustic characteristics.

Methods: Retrospective review of transgender patients presenting to tertiary-care laryngology center between February 2018-February 2019. Mean VHI-10, TVQ, and Singing VHI-10 (SVHI-10) scores; audio-perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI-10 and SVHI-10 vs TVQMtF were compared.

Results: Sixty-one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty-nine percent presented full-time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI-10), 19 ± 13 (SVHI-10), and 81 ± 22 (TVQMtF ). Correlation between VHI-10 and SVHI-10 versus TVQMtF was weak, R = 0.47 (P = .053) and R = 0.35 (P = .17), respectively. Mean audio-perceptual grade was 0.27 ± 0.15. Mean Cepstral Spectral Index of Dysphonia (CSID, sustained vowel) was 8.5 ± 21.9. Mean Cepstral Peak Prominence (CPP) Fo and CPP Fo SD in rainbow passage were 157.3 ± 16 and 59.4 ± 15.9, respectively.

Conclusion: Trans women report perceived voice handicap in speaking and singing, which appears separate from gender-related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI-10 or SVHI-10 and TVQMtF but requires further investigation. TVQMtF may provide information which more specifically reflects voice concerns of trans women as compared to VHI-10 and SVHI-10.

Level of evidence: 4 Laryngoscope, 131:1071-1077, 2021.

Keywords: Voice; acoustic; stroboscopy; transgender.

MeSH terms

  • Acoustics*
  • Adult
  • Disability Evaluation
  • Dysphonia / diagnosis*
  • Dysphonia / psychology
  • Dysphonia / therapy
  • Female
  • Gender Dysphoria / psychology
  • Gender Dysphoria / therapy*
  • Gender Identity
  • Humans
  • Male
  • Psychometrics / statistics & numerical data
  • Quality of Life
  • Retrospective Studies
  • Self Concept
  • Sex Factors
  • Sex Reassignment Procedures
  • Singing / physiology
  • Speech Acoustics
  • Stroboscopy / statistics & numerical data*
  • Surveys and Questionnaires / statistics & numerical data
  • Transgender Persons / psychology
  • Transgender Persons / statistics & numerical data*
  • Voice Quality / physiology
  • Young Adult