Transgender voice and communication treatment: a retrospective chart review of 25 cases

People transitioning from male to female (MTF) gender seek speech-language pathology services when they feel their voice is betraying their genuine self or perhaps is the last obstacle to representing their authentic gender. Speaking fundamental frequency (pitch) and resonance are most often targets in treatment because the combination of these two voice characteristics can account for the majority of how listeners perceive a speaker's gender. Intonation, voice quality, pragmatics and non-verbal communication contribute to a lesser extent but are usually recommended in treatment guidelines. There are few examples of effective treatment with male-to-female transgender individuals in the literature. Due to a small number of reports, it remains unclear how closely clinical practice follows recommended approaches and the extent to which gains may be expected.

The purpose of this study was to examine retrospectively 5 years' worth of cases of voice feminization treatment at a university clinic in order to describe a unique clinical population and report treatment techniques and outcomes.

Demographic information and treatment outcome data (e.g. acoustic measures) were available for collection from 25 of the 32 cases discharged from a university clinic between 2006 and 2010. Behavioural targets of treatment goals also were examined.

Clients were in various stages of male-to-female gender transitions during treatment; at discharge, 80% of them presented as female 100% of the time. A majority (88%) had a history of feminizing hormone treatment and 28% presented with a voice disorder separate from gender presentation concerns. Treatment goals included the following (listed in order of percentage of cases that addressed the topic): forward resonance, increased fundamental frequency or pitch, physical and mental relaxation, intonation, phonotraumatic behaviours, breath control, non-verbal communication, pragmatics, and vocal hygiene. After treatment, clients had increased speaking fundamental frequency in sustained vowel, reading, and monologue tasks by five to six semitones, which is statistically significant. Gains in fundamental frequency correlated significantly with total number of sessions, but no other correlations were significant.

Treatment goals for clients included in this study were consistent with those goals most often recommended in the research literature regarding voice and communication treatment for transgender clients. Voice and communication treatment resulted in gains in areas important to listeners' perception of gender. Further research is warranted to determine efficacy of specific treatment protocols and potentially influential factors such as initial voice and communication status.