Salud Mental

Relevance of the voice in the process of gender affirmation in transsexual women: A cross-sectional study

##plugins.themes.bootstrap3.article.main##

Rafael Jesús Salín Pascual
Mario Sergio Dávalos Fuentes

Abstract

Introduction. Voice is a gender marker and can therefore be a source of gender dysphoria. There is a relationship between symptoms of anxiety and depression and voice-related difficulties in trans women (TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to voice feminization procedures is limited while the population demanding transgender healthcare is increasing.

Objective. To describe the degree of voice-related dysphoria experienced by TW that seek a voice feminization treatment.

Method. A descriptive, cross-sectional study, 26 TW completed quality of life (QoL) questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was measured.

Results. 77% of the participants were legally recognized as women, 96% were under HRT, and 27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a feminine voice that allows gender conformity was the main reason for seeking treatment.

Discussion and conclusion. Voice non-conformity affects QoL. None of the participants perceived their voice as feminine while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization treatments, it is difficult to define how to measure success.
Keywords:
Voice, transsexual women, sex reassignment procedures, quality of life

Downloads

Download data is not yet available.

References

Aguirre-Sánchez-Beato, S. (2018). Trans Terminology and Definitions in Research on Transphobia: A conceptual review. Quaderns de Psicologia, 20(3), 295-305. doi: 10.5565/rev/qpsicologia.1453

American Psychological Association. (2011). Answers to your questions about transgender people, gender identity, and gender expression. [Fact sheet] Retrieved from http://www.apa.org/topics/ lgbt/transgender.aspx

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 7(9), 832-864. doi:10.1037/a0039906

Anderson, A. D., Irwin, J. A., Brown, A. M., & Grala, C. L. (2020). Your Picture Looks the Same as My Picture: An Examination of Passing in Transgender Communities. Gender Issues, 37(1), 44-60. doi: 10.1007/s12147-019-09239-x

Balzer, C., LaGata, C., & Berredo, L. (2016). TMM Annual Report 2016: 2,190 murders are only the tip of the iceberg – An introduction to the Trans Murder Monitoring project. Berlin, Germany: Carsten Balzer and Transgender Europe (TGEU).

Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Dolezal, C., Robinson, B. B. E., Rosser, B. R. S., & Coleman, E. (2020). The Transgender Identity Survey: A Measure of Internalized Transphobia. LGBT Health, 7(1), 15-27. doi: 1089/lgbt.2018.0265

Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., Millet, N., Fernandez-Aranda, F., & Arcelus, J. (2017). Transgender and anxiety: A comparative study between transgender people and the general population. International Journal of Transgenderism, 18(1), 16-26. doi: 10.1080/15532739.2016.1258352

Boza, C., & Perry, K. N. (2014) Gender-Related Victimization, Perceived Social Support, and Predictors of Depression Among Transgender Australians. International Journal of Transgenderism, 15(1), 35-52. doi: 10.1080/15532739.2014.890558

Carew, L., Dacakis, G., & Oates, J. (2007). The Effectiveness of Oral Resonance Therapy on the Perception of Femininity of Voice in Male-to-Female Transsexuals. Journal of Voice, 21(5), 591-603. doi: 10.1016/j.jvoice.2006.05.005

Casado, J. C., O’Connor, C., Angulo, M. S., & Adrián, J. A. (2016). Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: Resultados de la valoración pre- vs. poscirugía. Acta Otorrinolaringológica Española, 67(2), 83-92. doi: 10.1016/j.otorri.2015.02.003

Casado, J. C., Rodríguez-Parra, M. J., & Adrián, J. A. (2017). Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support. European Archives of Oto-Rhino-Laryngology, 274(4), 2049-2058. doi: 10.1007/s00405-016-4420-8

Contreras, F., Muñoz, C., Prieto, P., & Valdés, J. (2017). Instrumentos de Evaluación Fonoaudiológica. Una aproximación a las Metodologías de Evaluación. Serie Creación N° 15. Unidad Habla y Lenguaje Adultos, Carrera de Fonoaudiología. Santiago: Facultad de Ciencias de La Salud. Centro de Investigación en Educación Superior CIES - Universidad San Sebastián.

Dacakis, G., Davies, S., Oates, J. M., Douglas, J. M., & Johnston, J. R. (2013). Development and Preliminary Evaluation of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals. Journal of Voice, 27(3), 312-320. doi: 10.1016/j.jvoice.2012.11.005

Dacakis, G., Oates, J., & Douglas, J. (2017). Associations between the Transsexual Voice Questionnaire (TVQMtF) and self-report of voice femininity and acoustic voice measures. International Journal of Language & Communication Disorders, 52(6), 831-838. doi: 10.1111/1460-6984.12319

Davies, S., Papp, V. G., & Antoni C. (2015) Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside. International Journal of Transgenderism, 16(3), 117-159. doi: 10.1080/15532739.2015.1075931

de Vries, E., Kathard, H., & Müller, A. (2020). Debate: Why should gender-affirming health care be included in health science curricula? BMC Medical Education, 20(1), 1-10. doi: 10.1186/s12909-020-1963-6

Deutsch, M. B. & Center of Excellence for Transgender Health. (2016). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. San Francisco: University of California. Retrieved from https://transcare.ucsf.edu/guidelines

Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016) Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1), 44-57. doi: 10.3109/09540261.2015.1115753

Dias, C. K., da Rocha, L. R. L., Tateo, L., & Marsico, G. (2021). “Passing” and its effects on Brazilian transgender people’s sense of belonging to society: A theoretical study. Journal of Community & Applied Social Psychology, 31(6), 690-702. doi: 10.1002/casp.2535

Enriquez-Estrada, V. M. (2019). Health care human rights and citizenship: Issues faced by trans people in Mexico. Revista Mexicana de Psiquiatría y Salud Mental, 1(4), 117-125. doi: 10.13140/RG.2.2.23511.11688

Glynn, T. R., Gamarel, K. E., Kahler, C. W., Iwamoto, M., Operario, D., & Nemoto, T. (2016). The role of gender affirmation in psychological well-being among transgender women. Psychology of Sexual Orientation and Gender Diversity, 3(3), 336-344. doi: 10.1037/sgd0000171

Gyamerah, A. O., Baguso, G., Santiago-Rodriguez, E., Sa’id, A., Arayasirikul, S., Lin, J., …Wesson, P. (2021). Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across race. BMC Public Health, 21(1), 1-15. doi: 10.1186/s12889-021-11107-x

Hancock, A. & Helenius, L. (2012). Adolescent male-to-female transgender voice and communication therapy. Journal of Communication Disorders, 45(5), 313-324. doi: 10.1016/j.jcomdis.2012.06.008

Hancock, A. B., Krissinger, J., & Owen, K. (2011). Voice perceptions and quality of life of transgender people. Journal of Voice, 25(5), 553-558. doi: 10.1016/j.jvoice.2010.07.013

Hasan, S., Alviany, Y., Clarissa C., & Sudana, S. (2017) High perceived discrimination and no family support increase risk of poor quality of life in gender dysphoria. Universa Medicina, 36(3), 187-96. doi: 10.18051/UnivMed.2017.v36.187-196

Hoffman, B. (2014). An Overview of Depression among Transgender Women. Depression Research and Treatment. 2014(394283), 1-9. doi: 10.1155/2014/394283

Jacobson, B. H., Jonson, A., Grywalski, C., Silbergleit A., Jacobson G., Benninger M. S., … Newman, C. W. (1997). The Voice Handicap Index (VHI): Development and Validation. American Journal of Speech-Language Pathology, 6(3), 66-70. doi: 10.1044/1058-0360.0603.66

Lozano-Verduzco, I., & Melendez, R. (2019). Transgender individuals in Mexico: exploring characteristics and experiences of discrimination and violence. Psychology & Sexuality, 12(3), 235-247. doi: 10.1080/19419899.2019.1698449

Luhur, W., Lozano-Verduzco, I., & Shaw, A. (2020). Public opinion of transgender rights in Mexico. Los Angeles, CA: UCLA School of Law Williams Institute. Retrieved from https://williamsinstitute.law.ucla.edu/wp-content/uploads/Public-Opinion-Trans-Mexico-English-Dec-2020.pdf

Malta, M., Cardoso, R., Montenegro, L., Gomes de Jesus, J., Seixas, M., Benevides, B., ...Whetten, K. (2019). Sexual and gender minorities rights in Latin America and the Caribbean: a multi-country evaluation. BMC International Health and Human Rights, 19(1), 1-16. doi: 10.1186/s12914-019-0217-3

Manning, M. L., Baruth, L., & Lee, L. (2017). Multicultural Education of Children and Adolescents (6th ed.). Routledge.

Mastronikolis, N. S., Remacle, M., Biagini, M., Kiagiadaki, D., & Lawson, G. (2013). Wendler glottoplasty: An effective pitch raising surgery in male-to-female transsexuals. Journal of Voice, 27(4), 516-522. doi: 10.1016/j.jvoice.2013.04.004

Meister, J., Kühn, H., Shehata-Dieler, W., Hagen, R., & Kleinsasser, N. (2017). Perceptual analysis of the male-to-female transgender voice after glottoplasty—the telephone test. Laryngoscope, 127(4), 875-881. doi: 10.1002/lary.26110

Millet, N., Longworth, J., & Arcelus, J. (2017). Prevalence of anxiety symptoms and disorders in the transgender population: A systematic review of the literature. International Journal of Transgenderism, 18(1), 27-38. doi: 10.1080/15532739.2016.1258353

Mora, E., Carrillo, A., Giribet, A., Becerra, A., Lucio, M. J., & Cobeta, I. (2018). Translation, Cultural Adaptation, and Preliminary Evaluation of the Spanish Version of the Transgender Voice Questionnaire for Male-to-Female Transsexuals (TVQMtF). Journal ofVoice, 32(4), 514.e1-514.e6. doi: 10.1016/j.jvoice.2017.05.012

Moreno-Pérez, O., Esteva De Antonio, I., & Grupo de Identidad y Diferenciación Sexual de la SEEN. (2012). Clinical practice guidelines for assessment and treatment of transsexualism. SEEN Identity and Sexual Differentiation Group (GIDSEEN). Endocrinología y Nutrición, 59(6), 367-382. doi: 10.1016/j.endoen.2012.07.004

Nešić, M., Čičević, S., Nešić, V., Kostić, J., & Ćirić, M. (2013). Gender Differences in Prosodic Characteristics of Speech in the Task of Serial Subtracting of Sevens. Acta Facultatis Medicae Naissensis, 30(1), 5-13. doi: 10.2478/v10283-012-0030-6

Nolan, I. T., Morrison, S. D., Arowojolu, O., Crowe, C. S., Massie, J. P., Adler, R. K., ... Francis, D. O. (2019). The role of voice therapy and phonosurgery in transgender vocal feminization. Journal of Craniofacial Surgery, 30(5), 1368-1375. doi: 10.1097/SCS.0000000000005132

Novais Valente Junior, C., & Mesquita de Medeiros, A. (2020). Voice And Gender Incongruence: Relationship Between Vocal Self-Perception And Mental Health Of Trans Women. Journal of Voice, (In Press). doi: 10.1016/j.jvoice.2020.10.002

Nuffield Council on Bioethics. (2017). Cosmetic procedures: ethical issues. Retrieved from http://nuffieldbioethics.org/wp-content/uploads/Cosmetic-procedures-full-report.pdf

Núñez-Batalla, F., Corte-Santos, P., Señaris-González, B., Llorente-Pendás, J. L., Górriz-Gil, C., … Suárez-Nieto, C. (2007). Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español. Acta Otorrinolaringológica Española, 58(9), 386-392. doi: 10.1016/S0001-6519(07)74954-3

Owen-Smith, A. A., Gerth, J., Sineath, R. C., Barzilay, J., Becerra-Culqui, T. A., Getahun, D., ... Goodman, M. (2018). Association Between Gender Confirmation Treatments and Perceived Gender Congruence, Body Image Satisfaction, and Mental Health in a Cohort of Transgender Individuals. The Journal of Sexual Medicine, 15(4), 591-600. doi: 10.1016/j.jsxm.2018.01.017

Ramírez-Rentería, C., López-Juárez, N., Cruz, J., Román, E., & Fong, M. (2018) El manejo integral de la salud en pacientes adultos transgénero y transexuales: un tema cada vez más frecuente en la práctica clínica en México. Rev Mex Endocrinol Metab Nutr, 5, 141-159.

Remacle, M., Matar, N., Morsomme, D., Veduyckt, I., & Lawson, G. (2011). Glottoplasty for Male-to-Female Transsexualism: Voice Results. Journal of Voice, 25(1), 120-123. doi: 10.1016/j.jvoice.2009.07.004

Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to Health Care for Transgender Individuals. Curr Opin Endocrinol Diabetes Obes, 23(2), 168-171. doi: 10.1097/MED.0000000000000227

Schmidt, J. G., Goulart, B. N. G., Dorfman, M. E. K. Y., Kuhl, G., & Paniagua, L. M. (2018). Voice challenge in transgender women: trans women self-perception of voice handicap as compared to gender perception of naïve listeners. Revista CEFAC, 20(1), 79-86. doi: 10.1590/1982-021620182011217

Schwarz, K., Fontanari, A. M. V., Schneider, M. A., Borba Soll, B. M., da Silva, D. C., Spritzer, P. M., ... Lobato, M. I. R. (2017). Laryngeal surgical treatment in transgender women: A systematic review and meta-analysis. Laryngoscope, 127(11), 2596-2603. doi: 10.1002/lary.26692

Sevelius, J. M. (2013). Gender Affirmation: A Framework for Conceptualizing Risk Behavior Among Transgender Women of Color. Sex Roles, 68(11-12), 675-689. doi: 10.1007/s11199-012-0216-5

Song, T. E., & Jiang, N. (2017). Transgender Phonosurgery: A Systematic Review and Meta-analysis. Otolaryngology-Head and Neck Surgery, 156(5), 803-808. doi: 10.1177/0194599817697050

Thomas, J. P., & MacMillan, C. (2013). Feminization laryngoplasty: Assessment of surgical pitch elevation. European Archives of Oto-Rhino-Laryngology, 270(10), 2695-2700. doi: 10.1007/s00405-013-2511-3

T’Sjoen, G., Arcelus, J., Gooren, L., Klink, D.T., & Tangpricha, V. (2019). Endocrinology of Transgender Medicine. Endocrine Reviews, 40(1), 97 -117. doi: 10.1210/er.2018-00011

Unger, C. A. (2016). Hormone therapy for transgender patients. Translational Andrology and Urology, 5(6), 877-884. doi: 10.21037/tau.2016.09.04

Van Borsel, J., Janssens, J., & De Bodt, M. (2009). Breathiness as a Feminine Voice Characteristic: A Perceptual Approach. Journal of Voice, 23(3), 291-294. doi: 10.1016/j.jvoice.2007.08.002

Van Damme, S., Cosyns, M., Deman, S., Van den Eede, Z., & Van Borsel, J. (2017). The Effectiveness of Pitch-raising Surgery in Male-to-Female Transsexuals: A Systematic Review. Journal of Voice, 31(2), 244.e1-244.e5. doi: 10.1016/j.jvoice.2016.04.002

Wiepjes, C. M., Nota, N. M., de Blok, C. J. M., Klaver, M., de Vries, A. L. C., Wensing-Kruger, S. A., …den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine, 15(4), 582-590. doi: 10.1016/j.jsxm.2018.01.016

Williams, E. A., Patete, C. L., & Thaller, S. R. (2019). Gender affirmation surgery from a public health perspective: Advances, challenges, and areas of opportunity. Journal of Craniofacial Surgery, 30(5), 1349-1351. doi: 10.1097/SCS.0000000000005367

Witcomb, G. L., Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., & Arcelus, J. (2018). Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Journal of Affective Disorders, 235, 308-315. doi: 10.1016/j.jad.2018.02.051

World Professional Association for Transgender Health [WPATH]. (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (7th Version). Retrieved from https://www.wpath.org/publications/soc