Jennifer Oates

Many trans and gender diverse people feel that they cannot express their authentic selves through the sound of their voice and they may also experience distress about how others react to their voic...

Purpose: This randomized clinical trial investigated the short- and longer-term effects of intonation training on acoustic parameters, listener perceptions, and self-reported outcomes in transgender and gender diverse (TGD) individuals. Method: Twenty-three TGD individuals presumed female at birth (17 nonbinary and six transmasculine) aiming for a more masculine-sounding voice were randomized into two groups. Group 1 completed 4 weeks of intonation training for developing more masculine intonation patterns. Group 2 received 4 weeks of intonation training after 4 weeks of sham training. Recordings were made pretraining, after sham training (only Group 2), after intonation training (Groups 1 and 2), and at follow-up (after 4 weeks of no intervention). Acoustic and perceptual intonation parameters, self-perception of voice, and perception of masculinity/femininity by others were examined. The outcomes were analyzed using linear mixed models. Results: Significant and desired decreases were observed in all acoustic and perceptual intonation parameters (i.e., general and final intonation shifts, general fundamental frequency [ f _o ] range, and f _o variation index) across sentence types (i.e., yes/no questions, question word questions, and declarative sentences). Naive listeners perceived participants' voices as significantly more masculine after intonation training. In addition, the participants reported their voice as significantly more masculine and more aligned with their gender identity. They observed significantly more downward intonation shifts at the end of utterances, significantly less pitch variation, and significantly slower pitch changes. Conclusion: Findings support including intonation in voice and communication training for TGD individuals seeking a more masculine-sounding voice, offering an effective intervention for gender-affirming voice modification. Supplemental Material: https://doi.org/10.23641/asha.31079494

To explore how speech-language pathologists perceive their professional identity and practices in gender affirming care and to explore how these perceptions are related to supporting gender diverse clients' psychological wellbeing and their experience of identity. In this exploratory, qualitative study, we facilitated three focus group discussions. Reflexive thematic analysis was used to construct themes in a data-driven, iterative manner. Fourteen speech-language pathologists shared their perspectives on their professional identity and practices in gender affirming care. We constructed five themes: Identifying as a voice modification expert, the client's confidante, an equal collaborator, a self-compassionate clinician, and a unique clinician. Speech-language pathologists felt most comfortable assisting clients with their voice but were somewhat uncertain about supporting client psychological wellbeing directly and systematically. They experienced gender affirming care as rewarding, demanding, and appreciably different to other areas of speech-language pathology. Speech-language pathologists who provide gender affirming care need support to expand their professional identity to feel comfortable and responsible addressing clients' various needs, including client psychological wellbeing and their experience of identity. Speech-language pathologists need further support to manage the demanding aspects of their work, maintain their own psychological wellbeing, and provide continuous care for gender diverse people.

Purpose: The aim of this randomized clinical trial was to investigate the effect of intonation training in transgender and gender diverse (TGD) persons aiming for a more feminine-sounding voice on acoustic (intonation) parameters, listener perceptions, and self-reported outcome measures. Method: Thirty TGD individuals presumed male at birth with an aim of developing a more feminine-sounding voice were included and were randomly allocated to two groups. Group 1 received 4 weeks of intonation training. Group 2 received 4 weeks of intonation training after 4 weeks of sham training. Participants were recorded three or four times: baseline (before sham training; only Group 2), pre (before intonation training), Post 1 (after intonation training), and Post 2 (after 4 weeks of no intervention). Both acoustic and perceptual outcome measures were examined and analyzed using linear mixed models. Results: Statistically significant increases were found for all acoustic intonation parameters. In addition, significant increases were found for the fundamental frequency values (median, percentile [pc] 25, and pc 75). The listening experiments showed a significant increase in femininity ratings and increases in all perceptual intonation parameters. Participants perceived that their voice was more in line with their gender identity, but they still needed voice and communication training (VCT). Conclusion: Positive acoustic and perceptual effects were found after intonation training in TGD people aiming for a more feminine-sounding voice, which adds to the evidence that intonation can be a beneficial aspect of VCT for TGD individuals. Supplemental Material: https://doi.org/10.23641/asha.28611542

Autistic trans and gender diverse (TGD) individuals face unique voice and communication challenges compounded by minority stressors, impacting wellbeing and access to care. Speech pathologists are crucial in providing gender-affirming and neurodiversity-affirming support; however, guidance for working with this intersectional population remains limited. This scoping review mapped current knowledge on voice and communication challenges, identifies available supports, and demonstrates the limitations of existing guidance for speech pathologists. This review draws on 40 sources, including 29 peer-reviewed articles, 8 clinical guidelines, 2 books, and 1 position statement, identified through comprehensive searches of databases such as CINAHL, ERIC, Medline, APA PsycINFO, and grey literature in May 2024. Findings indicated that 96.8% of identified challenges pertained to communication, while fewer (3.2%) focused on voice-specific issues. Similarly, supports primarily addressed communication (91.3%), with 8.7% targeting voice needs. Communication challenges included barriers faced by autistic TGD individuals and those interacting with them, including healthcare professionals, peers, and family. Supports were identified as strategies and resources to enhance service delivery and client wellbeing, such as using visual aids or offering multiple communication options. However, significant gaps remain in addressing the unique voice and communication needs of this population, particularly regarding voice dysphoria, camouflaging versus identity disclosure, and communication within healthcare settings. Autistic TGD individuals represent a unique population whose needs are not sufficiently addressed by current guidance. This review highlights significant gaps in research and clinical practice and calls for improved clinical guidelines and specialized training for speech pathologists to enhance care.