Gender-Affirming Voice Therapy Duration and Satisfaction: Experiences from a Single Institution

Current literature involving gender-affirming voice therapy (GAVT) for transgender and nonbinary (TGNB) individuals is limited. This study describes treatment duration and satisfaction at a single institution.

Retrospective cohort.

Tertiary laryngology center.

TGNB patients receiving gender-affirming treatment were identified.

age, sex assigned at birth, gender identity, race, ethnicity, number/frequency of GAVT, Voice Handicap Index-10 (VHI-10), Trans Women Voice Questionnaire (TWVQ) (as appropriate), Gender Congruence Scale (GCS), patient and speech language pathologist (SLP) assessment of treatment satisfaction, and surgical data. Descriptive statistics were reported.

82 TGNB patients [trans female (n=65), trans male (n=5), nonbinary (n=12)] sought gender-affirming voice care. Mean age was 33.6±10.7years. Majority were assigned male at birth (n=71). Mean presentation VHI-10 was 15.7±8. In the first year of treatment, patients had mean 5.7±3.1 (range 1-16, median 5) GAVT sessions, biweekly (n=36, 44%) or monthly (n=12, 15%). 62% (n=51) of patients were satisfied/very satisfied, 23% (n=19) fairly satisfied, and 10% (n=8) unsatisfied with GAVT outcomes. SLP impression of GAVT outcome was more variable: 15% (n=12) completely met voice goals and 11% (n=9) had excellent GAVT response. Most patients (39%, n=32) were making good progress, with further treatment recommended. SLP referred 11% (n=9) to the laryngologist for surgery consideration; 9% (n=6) underwent Wendler glottoplasty.

Voice therapy is integral to gender-affirming voice care and often requires more sessions (mean 5.7) than the literature-reported average (∼4) for other voice diagnoses. Appropriate expectations should be set for patients, treating clinicians, and third-party payors about the increased anticipated duration of GAVT.