Pitch Change In Male‐To‐Female Transsexuals: Has Phonosurgery A Role To Play?

Abstract

Male-to-female transsexuals, who have undergone gender reassignment surgery, may continue to have low pitched voices. Voice therapy may assist them to use their voice in a manner more likely to be perceived as female but, if this approach is unsuccessful, a laryngeal framework operation may be necessary to raise vocal pitch. This study assessed the effects of crico-thyroid approximation surgery in 14 transsexuals. Modal pitch was significantly increased by surgery but with substantial variation across speakers. Modal pitch was significantly correlated with judgements of gender by speech and language therapists who listened to tapes of the subjects. The results suggest that crico-thyroid approximation may be used to raise the pitch of voices of male-to-female transsexuals. Further research is needed to clarify the reasons for the variability in outcome, to monitor the longer-term changes in voice and the impact for clients of their modified voice in real life situations.

Meta-Analysis of Validated Quality of Life Outcomes Following Voice Feminization in Transwomen

“…However, our meta-analysis found that increased F 0 did not correlate with improvements in QoL scores. Thus, although F 0 is a valuable indicator of technical success and has been shown to be the most important factor in perception of the femininity of one’s voice, 16,17 it is unlikely to be sufficient in determining overall success, namely, the efficacy of voice feminization for the improvement of patients’ QoL.…”

“…6 However, our meta-analysis found that increased F 0 did not correlate with improvements in QoL scores. Thus, although F 0 is a valuable indicator of technical success and has been shown to be the most important factor in perception of the femininity of one's voice, 16,17 it is unlikely to be sufficient in determining overall success, namely, the efficacy of voice feminization for the improvement of patients' QoL. This is likely because there exist many additional objective acoustic parameters, including resonance, intensity, average vowel formants, and sound pressure level, which may interplay with F 0 to impact the perceived femininity of one's voice.…”

“…13,14 The fundamental frequency (F 0 ) of vocal pitch is a functional outcome widely utilized to assess the efficacy of voice feminization. [15][16][17] Previous studies have suggested that voices with F 0 below 155 to 160 Hz are generally perceived as male, whereas those above are more likely perceived as gender-neutral or female. [15][16][17] Consequently, F 0 has become an attractive target for surgeons and researchers.…”

“…[15][16][17] Previous studies have suggested that voices with F 0 below 155 to 160 Hz are generally perceived as male, whereas those above are more likely perceived as gender-neutral or female. [15][16][17] Consequently, F 0 has become an attractive target for surgeons and researchers. However, it has been demonstrated that F 0 is not the sole determinant of voice femininity, with other vocal parameters such as resonance and sound pressure level playing important roles as well.…”

<p>Vocal Feminization for Transgender Women: Current Strategies and Patient Perspectives</p>

“…However, evidence of the efficacy of such procedure is limited and peer-reviewed publications are mostly limited to a few case reports. [3][4][5] Two studies that did systematically examine separate cohorts of 14 male to female (MTF) transsexuals who underwent surgery for androphonia were those reported by Brown et al regarding CTA 6 and Wagner et al who assessed ACA, CTA, or both. 7 Alteration of vocal fold mass can be accomplished by scarification of vocal folds, 3 steroid injection of vocal folds, 3 or reduction of vocal fold mass by CO 2 laser vaporization.…”