Patient Satisfaction and Acoustic Changes in Trans Women after Gender Affirming Voice Training

Abstract

ObjectivesGains in pitch from gender affirming voice training (GVT) alone in trans women have historically been shown to decline after 1 year. Currently no standard exists for length and type of GVT that yields meaningful behavioral change and patient satisfaction with voice outcomes in trans women. This study aims to determine whether GVT alone leads to sustained pitch elevation and patient satisfaction in trans women.MethodsRetrospective review from 2016 to 2020 of trans women patients who underwent GVT alone for voice change. Charts were reviewed for acoustic analysis of pitch including sustained vowel fundamental frequency, speaking fundamental frequency, and quality of life data from the Trans Woman Voice Questionnaire at pre‐therapy, immediate post‐therapy, and extended post‐therapy time intervals.ResultsA total of 157 patients presented to our Voice Center, of which 34 participated in the full course of GVT. Patients underwent an average of six sessions of GVT (range 5–7) over an average of 13.14 weeks (range 6–16). Average time between completing GVT and presenting for extended follow‐up was 11.37 months (range 6–31). Compared to initial presentation prior to therapy, at extended follow‐up after completing GVT average change in F0/a/, SF0, and TWVQ were 64.6 Hz, 31.3 Hz, and 32.45. No significant change was noted between immediate post‐therapy and extended post‐therapy acoustic measures. TWVQ demonstrated continued improvement between immediate post‐therapy and extended post‐therapy.ConclusionsIn self‐selected patients who present for extended follow‐up, GVT alone can result in sustained pitch elevation and voice‐related quality life in trans women.Level of Evidence4 Laryngoscope, 133:2340–2345, 2023

Factors Associated With Loss of Follow‐Up in Transgender Patients Receiving Vocal Therapy

“…Optimal vocal care, therefore, hinges upon consistent patient follow‐up, which may be difficult for patient populations that experience significant barriers to accessing health care. Indeed, in our study, 47.9% of transgender patients were lost to follow‐up, which is similar to the 63.9% vocal treatment attrition rate previously reported in transgender women patients 13 . Specific factors that lead to lower rates of follow‐up in transgender patients seeking vocal care have never before been investigated.…”

“…The efficacy of vocal therapy, however, is achieved gradually and usually necessitates at least six sessions to achieve the desired vocal outcomes. [10][11][12][13] Even for patients who undergo vocal surgery, following a week of vocal rest, several sessions of vocal therapy too are usually indicated, which also prolongs the overall treatment course. Optimal vocal care, therefore, hinges upon consistent patient follow-up, which may be difficult for patient populations that experience significant barriers to accessing health care.…”

“…Indeed, in our study, 47.9% of transgender patients were lost to follow-up, which is similar to the 63.9% vocal treatment attrition rate previously reported in transgender women patients. 13 Specific factors that lead to lower rates of follow-up in transgender patients seeking vocal care have never before been investigated.…”

“…Vocal therapy may be an effective form of treatment for both transgender men and women. The efficacy of vocal therapy, however, is achieved gradually and usually necessitates at least six sessions to achieve the desired vocal outcomes 10–13 . Even for patients who undergo vocal surgery, following a week of vocal rest, several sessions of vocal therapy too are usually indicated, which also prolongs the overall treatment course.…”

“…Vocal care may be provided by an otolaryngologist and/or speech‐language pathologist and may comprise vocal therapy and/or vocal surgery. The efficacy of vocal therapy is achieved gradually over time and usually necessitates at least six sessions before the desired vocal outcomes are attained 10–13 . For patients who opt for vocal surgery, although the changes in vocal quality may be more apparent and more quickly realized, post‐operative vocal therapy is still recommended for optimal outcomes.…”