Ulrika Nygren

Purpose: The Voice and Communication Situation Questionnaire developed with and for transgender and gender-diverse People Presumed Female At Birth (VCSQ ^PFAB ) is the first questionnaire developed with and for transgender and gender-diverse (TGD) people presumed female at birth (PFAB) that considers all possible gender identifications and intersections with other aspects of human diversity. It is informed by contemporary conceptual models of person-centered care, minority stress, and voice and gender as a dynamic, biocultural assemblage of agents, as well as reflections and feedback from intended users. Previous work confirmed content validity and developed guidance for implementation that would foster its use as a tool for person-centered care. This study aimed to psychometrically evaluate and finalize the VCSQ ^PFAB for use as a patient-reported outcome measure. Method: Seventy-three TGD people PFAB and 88 cisgender speakers completed the VCSQ ^PFAB . Thirty-one of the TGD people PFAB completed the VCSQ ^PFAB twice to evaluate test–retest reliability. We evaluated whether scores on the VCSQ ^PFAB were robustly different for the two groups (criterion validity) and calculated the test–retest reliability and the amount of measurement error. Results: The VCSQ ^PFAB had strong criterion validity (area under the receiver operating characteristic curve = .997). Reliability was excellent (intraclass correlation coefficient = 93%), and the degree of measurement error in the VCSQ ^PFAB was small (17% of the total range of the scale). Conclusion: The VCSQ ^PFAB is a reliable and valid tool that can be used to provide person-centered and culturally responsive professional voice and communication support for TGD people PFAB. Supplemental Material: https://doi.org/10.23641/asha.30615281

Purpose: Transgender and gender-diverse (TGD) people and their communication wishes are diverse and heterogeneous, so it is important to understand the situation and goals of each person individually when they arrive for professional interventions. This article describes the development and content validation of the Voice and Communication Situation Questionnaire developed with and for TGD people presumed female at birth (VCSQ ^PFAB ). Method: Phase 1 included a transdisciplinary literature review and an initial draft of a questionnaire designed to collect self-reports of sociocultural positioning, voice and communication function, and well-being of TGD people presumed female at birth (PFAB). Phase 2 involved collection of information and feedback on the draft questionnaire via focus groups of 31 members of the PFAB community in Germany, Sweden, and the United States. Results: Revisions were based on the feedback from all focus groups and consensus within the research team. Feedback highlighted the need to develop a clear approach to introducing the questionnaire to respondents and to provide support during its completion so that self-ratings and descriptions capture the client perspective regarding categories built into the questionnaire. Conclusions: The final draft of the VCSQ ^PFAB provides an adequate framework for a person-centered and culturally responsive approach to working with TGD people PFAB. The tool is now ready to be piloted in clinical settings and statistically analyzed for further psychometric properties.

Purpose: Although speech-language pathologists have provided gender-affirming voice training for trans women since the 1970s, evidence for this training's effectiveness remains weak. Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women.Method: Seventy-four trans women (19–54 years old) who wanted a more female-sounding voice were recruited through two health facilities and provided with an eight- to 12-session voice training program based on contemporary literature, usual clinical practice, and client-centered care principles. Self-reported outcomes and an audio-recorded reading sample were collected 3 months before, immediately before and after, and 3 months after training. Forty cisgender speakers were audio-recorded reading the same sample material as comparison voices. Seventy-nine naive listeners made gender-related voice ratings of an extract from these audio recordings. Training effectiveness was evaluated using group-level analyses (linear mixed-effects models) and individual-level analyses to establish what proportion of participants improved to a predetermined relevant degree.Results: Group-level analyses demonstrated positive training effects, maintained 3 months posttraining, for trans women's vocal satisfaction, perceptions of voice-related social participation, and self- and listener perceptions of their voices. Individual-level analyses also demonstrated positive effects. Two thirds of trans women increased vocal satisfaction to a relevant degree, one third who reported restricted social participation before training reduced this restriction to a relevant degree, and all were rated more female-sounding after training (although not all to a relevant degree).Conclusions: All trans women participants made progress toward their voice goals and maintained those gains at follow-up. These findings provide evidence that gender-affirming speech-language pathology services warrant prioritization. Further research is warranted to investigate factors predicting outcomes of voice training for trans women.

Purpose: Gender dysphoria is commonly conceptualized as a mental disorder in gender-diverse people who do not identify with the gender assigned to them at birth. Direct support for well-being tends to be delegated to the field of mental health (MH), whereas speech-language pathology (SLP) practice is charged with modifying gender-diverse people's voice and communication in the belief that well-being will improve as a byproduct. However, with the introduction of the minority stress model, gender dysphoria is now understood as the result of sociocultural processes of stigmatization, pathologization, coping, and resilience, and it is to be addressed by all professions providing transgender health services. The purposes of this tutorial are to examine practices in SLP in light of the current conceptualization of gender dysphoria and guide speech-language pathologists in their role in supporting the well-being of gender-diverse people. Method: We reviewed the SLP and MH literature in the topic area to compare the two disciplines' conceptualizations and approaches to professional support for gender-diverse people. Results: We propose a transdisciplinary, person-centered, and culturally responsive approach to SLP practice that directly attends to minority stress, microaggressions, coping skills, and resilience factors. Conclusions: It is not sufficient for speech-language pathologists to delegate support for well-being in gender-diverse people to MH practitioners. Rather, speech-language pathologists need to be proactive in taking responsibility for supporting their clients' well-being based on each individual clinician's knowledge, skills, and capacity to do so. We recommend addressing barriers and facilitators of gender-diverse people's well-being both within SLP as a professional culture and by adapting the clinician's own professional practice.

Objective: Changes of sex hormone levels in disorders of sex development (DSD) can affect the body, including the vocal folds, during and after foetal development. The voice is a gender characteristic that may also be affected. There is a lack of knowledge on voice alteration in DSD. To explore this in different forms of DSD, we describe the prevalence of voice alterations and investigate patient satisfaction with voice.Design: The study is part of dsd‐LIFE, a multicentre cross‐sectional clinical evaluation project assessing the long‐term outcomes of surgical, hormonal and psychological interventions in individuals with DSD.Patients: The study included 1040 individuals with different forms of DSD, that is Turner and Klinefelter syndromes, different degrees of gonadal dysgenesis and 46 XY DSD. Participants were recruited through patient advocacy groups and health care.Measurements: Satisfaction with voice, Adam's apple, if patient's self‐identified gender was mistaken on the phone leading to distress.Results: A vast majority of the participants with DSD (between 58.3% to 82% in various groups) were not satisfied with their voice, and approximately 15% (n = 147) were mistaken on the phone in accordance with self‐identified gender. For 102 participants, this caused distress.Conclusions: We have identified that voice problems are a cause of distress in all forms of DSD. This result needs to be confirmed and compared with controls. We recommend that evaluation of the voice should be included in future international guidelines for management of DSD.