Karine Schwarz

The Brazilian Journal of Psychiatry is the official publication of Brazilian Psychiatric Association (Associação Brasileira de Psiquiatria - ABP)

Objectives: The aim of this study was to adapt and apply the Portuguese version of the Transgender Man Voice Questionnaire in a sample of Brazilian transgender men and to investigate the relationship between voice satisfaction and hormone therapy duration. In addition, we suggest reducing and reformulating the questionnaire for screening.Methods: We conducted a cross-sectional study of 31 transgender men aged 18–50 years undergoing hormone therapy who answered a questionnaire adapted from the Transgender Woman Voice Questionnaire, validated in Portuguese. Sociodemographic and clinical data were collected from the individuals’ electronic medical records: age, smoking status, and type and duration of hormone therapy. The questionnaire, consisting of 30 questions rated on a Likert scale, was answered individually during a psychotherapy session. In each question, the gender-specific words were modified. Furthermore, we added a question: 31 (After GAHT, my voice became completely male), with the response options yes or no. In questions 32 and 33, asking participants to provide an overall rating of their voice. Total score ranged from 0 to 120, with higher scores indicating greater dissatisfaction with voice.Results: Mean patient age was 30.13 ± 7.6 years, and 19.4% were smokers. The mean duration of hormone therapy was 29.7 ± 24.9 months, and 95% received intramuscular testosterone cypionate, maintaining serum testosterone levels within the male reference range. The questionnaire mean total score was 51 ± 17.72. There was a significant negative correlation between the questionnaire total score and duration of hormone therapy (r = −0.484, p = 0.006). The questionnaire had a high level of internal consistency/reliability, with a Cronbach’s alpha coefficient of 0.95 for all items and a split-half Spearman-Brown coefficient of 0.96. For the elaboration of a screening tool, it is suggested to remove questions 8, 10, 12, 13, 14, 17, 19, 23, 27, and 29 and modify question 1.Conclusion: Longer hormone therapy favors voice deepening and satisfaction with voice. The psychometric properties of the Transgender Man Voice Questionnaire are reliable, supporting its use as a screening tool in clinical practice and as an adjunct to the planning of vocal and communication support for transgender individuals.

Objective: The objective of the study was to investigate dropout rates and discern potential factors contributing to the discontinuation of treatment provided to transgender individuals by the Transdisciplinary Gender Identity Program at the Hospital de Clínicas de Porto Alegre (PROTIG).Methodology: This study employs a descriptive, cross-sectional, retrospective design to analyze socio-demographic and clinical data obtained from medical records of patients treated at PROTIG between 2000 and 2018. A structured form, devised by PROTIG’s professional team, was utilized to extract and evaluate several variables including: age, gender, education level, diagnosis of F64 according to the International Classification of Diseases (ICD-10: Version: 2010), clinical comorbidities (coded by ICD-10), laboratory diagnosis of sexually transmitted infections, distance between patients’ residence and the hospital, and year of entry into PROTIG. The patient cohort was stratified into two categories based on their duration of attendance: dropout (defined as attendance for up to 365 days) and non-dropout (attendance exceeding 365 days). Categorical variables between dropout and non-dropout groups were compared using Pearson’s chi-square test. Additionally, Poisson regression analysis was utilized, employing a 95% confidence interval (CI) and setting the significance level at 0.05.Results: The study included a total of 888 patients accessing PROTIG, with 275 (31%) classified in the dropout group. Of the patient population, 65.5% (n = 582) self-identified as transgender women, while 34.5% (n = 306) identified as transgender men. Significant differences were noted between the dropout and non-dropout groups. Specifically, differences were noted among transgender women (p < 0.001), individuals with lower levels of education (p < 0.001), those with fewer diagnoses classified under ICD-10 as F64 (p < 0.001), individuals exhibiting fewer clinical comorbidities recorded in ICD-10 (p < 0.001), and those who commenced inclusion in PROTIG after 2010 (p < 0.001).Conclusion: There exists a notable rate of treatment discontinuation among individuals receiving care at PROTIG, with statistically significant variances observed between groups. We posit potential rationales for this discontinuation, informed by care experiences and feedback from group attendees: Increased accessibility to outpatient services in our jurisdiction for Transgender Care, along with heightened societal awareness of gender identity fostering diverse gender expression avenues devoid of reliance on gender-affirming surgical interventions.

From a case report of a person with pedophilic disorder, this paper focuses on the issue of pedophilia, child sexual abuse, and the need for specific prevention and treatment strategies in Brazil. It seems inevitable to increase awareness for this topic within the mental health care system to protect children and reduce the risk for sexual offense in individuals at-risk. This is a case report of an individual, known by medical-psychiatric and forensic facilities for a past history of patricide, who revealed his pedophilic fantasies and behavior belatedly. To assess a pedophilic disorder and screen for other paraphilic contents, a screening questionnaire and clinical interview were used during the patient hospitalization in 2020 for a proper evaluation of sexual history and past offending behaviors. A review of the literature on pedophilia prevention programs was also carried out. WW is a middle-aged man admitted to a psychiatric unit for a severe episode of major depressive disorder and at risk of suicide. During recovery, he reported pedophilic fantasies and behaviors in his life. Sexual fantasies involving children and actual sexual offenses have remained unknown to mental health professionals and unreported to legal authorities. WW’s case alarmingly emphasizes the need for the training of health care professionals and for preventive strategies in Brazil for those who are at risk of engaging in offending sexual behaviors in a combined and intensive effort to protect children from sexual offense.

Background: We systematically reviewed the literature and performed a meta-analysis on the effects of speech therapy and phonosurgery, for transgender women, in relation to the fundamental frequency gain of the voice, regarding the type of vocal sample collected, and we compared the effectiveness of the treatments. In addition, the study design, year, country, types of techniques used, total therapy time, and vocal assessment protocols were analyzed. Methods: We searched the PubMed, Lilacs, and SciELO databases for observational studies and clinical trials, published in English, Portuguese, or Spanish, between January 2010 and January 2023. The selection of studies was carried out according to Prisma 2020. The quality of selected studies was assessed using the Newcastle–Ottawa scale. Results: Of 493 studies, 31 were deemed potentially eligible and retrieved for full-text review and 16 were included in the systematic review and meta-analysis. Six studies performed speech therapy and ten studies phonosurgery. The speech therapy time did not influence the post-treatment gain in voice fundamental frequency (p = 0.6254). The type of sample collected significantly influenced the post-treatment voice frequency gain (p < 0.01). When the vocal sample was collected through vowel (p < 0.01) and reading (p < 0.01), the gain was significantly more heterogeneous between the different types of treatment. Phonosurgery is significantly more effective in terms of fundamental frequency gain compared to speech therapy alone, regardless of the type of sample collected (p < 0.01). The average gain of fundamental frequency after speech therapy, in the /a/ vowel sample, was 27 Hz, 39.05 Hz in reading, and 25.42 Hz in spontaneous speech. In phonosurgery, there was a gain of 71.68 Hz for the vowel /a/, 41.07 Hz in reading, and 39.09 Hz in spontaneous speech. The study with the highest gain (110 Hz) collected vowels, and the study with the lowest gain (15 Hz), spontaneous speech. The major of the included studies received a score between 4 and 8 on the Newcastle–Ottawa Scale. Conclusion: The type of vocal sample collected influences the gain result of the fundamental frequency after treatment. Speech therapy and phonosurgery increased the fundamental frequency and improved female voice perception and vocal satisfaction. However, phonosurgery yielded a greater fundamental frequency gain in the different samples collected. The study protocol was registered at Prospero (CRD42017078446).

Corrigendum: The impact of the COVID-19 pandemic on the lives of people with Gender Dysphoria

This cross-sectional and descriptive study aimed to evaluate the sexual function, urinary function, and quality of life of 26 Brazilian trans women who have undergone gender-affirming surgery (GAS) using the gold standard technique (penile inversion vaginoplasty) in the Gender Identity Transdisciplinary Program at Hospital de Clínicas de Porto Alegre, Brazil, between March 2016 and July 2017. The Female Sexual Function Index, the SF-36 Health Survey, and the International Consultation on Incontinence Questionnaire-Short Form were used. Regarding their surgical results, 84.6% of the women said they were satisfied, 73.1% were sexually functional, and 15.4% reported urinary incontinence not associated with surgery. Participants also reported a good quality of life, despite low scores of pain and physical vitality. Transgender women in our sample reported a good quality of life and sexual function after GAS. Further studies are required to improve the psychosexual wellbeing of this specific population.

Objective: To analyze the impact on the psychological and social aspects caused by the COVID-19 pandemic in individuals diagnosed with Gender Dysphoria (GD).Methods: Google Forms inventory was sent via WhatsApp, including qualitative and quantitative questions evaluating three life dimensions denominated as Sociodemographic, Economic, and COVID-19 pandemic. It was applied in two periods: At the beginning of the pandemic (June-2020) (P1) and one year later (June-2021) (P2). The inventory also included questions about economic dimensions before the pandemic for individual comparison purposes (P0). 48 individuals (28 transsexual women, 20 transsexual men) participated in both periods.Results: 77.1% (n = 37) lived in Rio Grande do Sul, 50.0% (n = 24) refereed incomplete high school; Monthly Income increased significantly between the periods (P0) and (P1). Emergence aid approval was significantly higher in (P2), 56.3% (n = 27), compared to (P1), 39.6% (n = 19). A statistically significant difference was detected in the feeling of depression in the (P2) among the cases that requested Emergency Aid.Conclusion: The studied population presented deterioration regarding their condition of social vulnerability in relation to formal employment, access to health services, and mental health.

Objetivo: abordar aspectos relacionados à disforia de gênero e à terapia fonoaudiológica, organizando e fornecendo informações sobre os princípios terapêuticos. Métodos: trata-se de uma revisão de literatura por meio de pesquisa em artigos científicos nas bases de dados Pubmed e Science Direct sobre o tema disforia de gênero e voz, nos últimos 20 anos. A pesquisa foi realizada, pelos autores do estudo, de janeiro de 2018 a setembro de 2021, com as palavras-chave: (Pessoas trans) OR (Transexualismo) OR (Transexual) OR (Identidade de Gênero)) AND ((treinamento vocal) OR (voz) OR (qualidade de voz)). Resultados: 31 artigos científicos foram incluídos no estudo. Conclusão: há necessidade de acompanhamento multiprofissional e ratifica-se a importância da fonoterapia, uma vez que o tratamento hormonal e as cirurgias laríngeas não contemplam todas as alterações desejadas na voz e na fala em mulheres transgênero. Dessa forma, o fonoaudiólogo, além de buscar a elevação da f0, deve estimular os maneirismos femininos, minúcias da voz e delicadezas da fala. Verificou-se a importância da realização de cirurgia laríngea associada à fonoterapia para modificação vocal de mulheres transgênero.

Introduction The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied.