Georgia Dacakis

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.

Background: The Transsexual Voice Questionnaire (TVQ^MtF) was designed to capture the voice‐related perceptions of individuals whose gender identity as female is the opposite of their birth‐assigned gender (MtF women). Evaluation of the psychometric properties of the TVQ^MtF is ongoing.Aims: To investigate associations between TVQ^MtF scores and (1) self‐perceptions of voice femininity and (2) acoustic parameters of voice pitch and voice quality in order to evaluate further the validity of the TVQ^MtF. A strong correlation between TVQ^MtF scores and self‐ratings of voice femininity was predicted, but no association between TVQ^MtF scores and acoustic measures of voice pitch and quality was proposed.Methods & Procedures: Participants were 148 MtF women (mean age 48.14 years) recruited from the La Trobe Communication Clinic and the clinics of three doctors specializing in transgender health. All participants completed the TVQ^MtF and 34 of these participants also provided a voice sample for acoustic analysis. Pearson product‐moment correlation analysis was conducted to examine the associations between TVQ^MtF scores and (1) self‐perceptions of voice femininity and (2) acoustic measures of F0, jitter (%), shimmer (dB) and harmonic‐to‐noise ratio (HNR).Outcomes & Results: Strong negative correlations between the participants’ perceptions of their voice femininity and the TVQ^MtF scores demonstrated that for this group of MtF women a low self‐rating of voice femininity was associated with more frequent negative voice‐related experiences. This association was strongest with the vocal‐functioning component of the TVQ^MtF. These strong correlations and high levels of shared variance between the TVQ^MtF and a measure of a related construct provides evidence for the convergent validity of the TVQ^MtF. The absence of significant correlations between the TVQ^MtF and the acoustic data is consistent with the equivocal findings of earlier research. This finding indicates that these two measures assess different aspects of the voice‐related experience.Conclusions & Implications: Evidence supporting the validity of the TVQ^MtF is strong and indicates that it is a sound measure for capturing the MtF woman's self‐perceptions of her vocal functioning and how her voice impacts on her everyday life.

The recently developed Transsexual Voice Questionnaire (TVQ^MtF) is a self-report tool that assesses the perceptions of male-to-female transsexual women (MtF women) regarding their voices and the impact of voice on their everyday lives. Initial psychometric evaluation has demonstrated strong reliability of the TVQ^MtF, however, there has been relatively little investigation of its validity. There is evidence in the literature to support the notion that MtF women who have undergone gender reassignment surgery (GRS) have different perceptions of their voice than MtF women who have not undergone GRS. This information was used to examine the validity of the TVQ^MtF using a known-groups analysis. Method: The TVQ^MtF scores of 26 MtF women who had undergone GRS were compared with the scores of 27 MtF women who had not undergone GRS. A one-way analysis of variance (ANOVA) was used to compare the total TVQ^MtF scores. Mann Whitney U tests were used for comparison across individual items. Results: Individuals who had undergone GRS perceived that they experienced fewer voice-related difficulties and impacts on their lives than individuals who had not undergone GRS. This difference was significant (F(1, 51) = 8.87, p = .004). MtF women who had undergone GRS reported less impact of voice on their gender identity, however, perceived impact of vocal-functioning and voice-related activity and participation limitations did not differ between groups. The study findings support the construct validity of the TVQ^MtF.

This review covers recent research findings that demonstrate the effectiveness of speech pathology intervention in enabling male-to-female transsexual individuals to portray their gender identity through speech. Research reports that extend our understanding of communication characteristics that contribute to perceptions of sex in male-to-female transsexuals are identified. Current issues related to the measurement of therapy effectiveness are also presented. Earlier studies confirmed that an increase in voice pitch is achievable for many transsexuals. However, it is now accepted that pitch is not the sole contributor to perceptions of gender. Recently, modification of vocal resonance has been shown to increase perceptions of a speaker as female. There is evidence that encouraging precise articulation results in increased perceptions of the speaker as female. Evidence for the contribution of voice quality and loudness to perceptions of gender is inconclusive. Speech rate does not appear to contribute significantly to gender perceptions. Ecologically valid measures of the individual's vocal functioning and its impact on everyday life in clinical assessment of male-to-female transsexuals are needed to provide meaningful measures of therapy outcome. There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender. It is essential to include the perspective of the individual when evaluating therapy outcome.

The aim of this qualitative study was to gain an understanding of the way male-to-female transsexuals perceived their communication and their satisfaction with it in different aspects of their lives. Three focus groups were conducted for the purposes of this study, each consisting of four participants. The transcribed dialogues of the groups were analysed using a grounded theory approach to find the common underlying themes. These then formed the basis of the five major categories that identified key themes relating to transsexuals’ communicative satisfaction: communicative situations, emotions, groups of people, other contributing factors, and features of communication. The results revealed that although participants commented on the situations and contexts in which they experienced decreased communicative satisfaction, it was not always important to them to maintain their female communicative patterns in situations in which they felt comfortable. These five categories guided the development of a two-part pilot Functional Communicative Satisfaction Questionnaire (FCSQ). The FCSQ explores a variety of situations that the participants identified as impacting on their communicative satisfaction. Further development of the FCSQ is likely to enable speech pathologists to have a more informed approach to the management of this population.