Vocal Fold Thinning in Transgender Patients

Area of Science:

• Laryngology
• Speech-Language Pathology
• Endocrinology

Background:

• Transgender individuals often seek voice modification to align with their gender identity.
• Videostroboscopy in transgender patients sometimes reveals an increased glottal gap without a clear cause.
• Hormone replacement therapy (HRT) may affect laryngeal tissues, potentially influencing vocal fold closure.

Purpose of the Study:

• To quantify the glottal gap in transgender individuals using videostroboscopy.
• To investigate the relationship between hormone replacement therapy, voice therapy, and laryngeal changes.
• To compare the glottal gap in transgender individuals with cisgender male and female controls.

Main Methods:

• Retrospective analysis of videostroboscopy exams from transgender patients and controls.
• Measurement of open quotient (OQ) using vocal fold cycle frame counts.
• Quantification of glottal gap during maximal adduction of arytenoids.

Main Results:

• Transgender patients exhibited a significantly different open quotient compared to both male and female controls (P <0.001 and P = 0.037, respectively).
• The duration of hormone therapy did not correlate with glottal area or open quotient.
• Increased duration of voice therapy showed a correlation with a larger glottal area (Kendall's Tau = 0.03).

Conclusions:

• A quantifiable difference in the glottal gap, measured by open quotient, exists between transgender individuals and cisgender controls.
• The findings suggest that voice therapy duration, rather than hormone therapy, may be associated with increased glottal gap in transgender patients.