Toward a Protocol for Transmasculine Voice: A Service Evaluation of the Voice and Communication Therapy Group Program, Including Long-Term Follow-Up for Trans Men at the London Gender Identity Clinic

Abstract

Purpose: A service evaluation was undertaken with 10 participants identifying as trans men who received voice and communication group therapy and 12-month follow-up at the London Gender Identity Clinic between February 2017 and March 2018, to investigate levels of satisfaction, how helpful they found the program in facilitating vocal change and skill development, and whether they would recommend it to others. Methods: Participant evaluations of overall and ideal rating of masculinity of voice, and level of feeling comfortable with voice, evaluations of voice skills and changes in speaking and reading fundamental frequency were retrospectively reviewed and analyzed. Results: Six participants reported being very satisfied with the service; four were satisfied . Eight participants found the program very helpful in achieving voice and communication change; two found it helpful . Eight strongly agreed and two agreed with recommending the service. Participants' overall and comfort ratings of voice significantly increased ( p <0.01), while there was no significant change in ideal ratings ( p =0.063), and a significant decrease in the difference between overall and ideal ratings ( p <0.01). Participants achieved a significant decrease in fundamental frequency for reading and speaking ( p <0.01), a significant decrease in voice fatigue ( p =0.039) and restriction in voice adaptability ( p <0.01), a significant increase in confidence in public speaking ( p <0.01), but no significant change in vocal projection ( p =0.07). Conclusion: Ten trans men reported high levels of satisfaction with the voice group program and long-term follow-up, making significant positive shifts in voice skills and vocal self-perception. These findings apply locally but suggest appropriate interventions toward a transmasculine voice modification protocol.

The Importance of Orofacial Motricity in the Work of Confirmation of Transgender Voice: An Integrative Review

“…In this sense, one of the studies with an experiment conducted with transgender women points out that a therapy focused on oral resonance could improve the perception of listeners regarding the femininity of the voice [19]. In agreement with this point, another clinical experiment conducted with transgender men achieved fullbodied voice resulting from the combination of several exercises for resonance modification [15]. The authors of this article discuss and demonstrate that the reduction of fundamental frequency alone does not satisfy a complete gender identity, and interventions are also needed in vocal dynamics (pitch, resonance, loudness, intonation and vocal quality) and in social communication skills in order to achieve good results [15].…”

“…Of the nine texts analyzed, all addressed voice as a gender marker, anatomical differences between men and women [2,4,[13][14][15][16][17][18][19]. One of these studies13 confirmed that vocal and facial information is processed together to identify the person and gender as a whole, which reinforces the need for the transgender person to adapt the voice with the visually manifested gender to improve communication and the perception of gender authenticity.…”

“…Regarding prosody, two texts pointed it as a differential in voice confirmation [15,18]. Following the therapy model explained in one of the articles, prosody is one of several dimensions that should be addressed in the vocal confirmation of transgender.…”

“…All texts state that the voice plays an important role in social life, as it brings physical and sound congruence [2,4,[13][14][15][16][17][18][19]. According to one of the texts, this physical and sound symmetry produces well-being for transgender people and empirically demonstrated that well-being occurs in multiple dimensions and goes beyond simple satisfaction with the voice [14].…”

“…A study evaluating patients soon after therapy and, again, over a year later pointed out good results obtained with eight-week therapy and demonstrated that the effects were long-term, but vary from one individual to another [19]. All texts emphasize that resonance is the determinant for the patient's good performance and that transgender people need therapy so that they can confirm vocal identity [2,4,[13][14][15][16][17][18][19]. In this sense, one of the studies with an experiment conducted with transgender women points out that a therapy focused on oral resonance could improve the perception of listeners regarding the femininity of the voice [19].…”