Efficacy and Patient Satisfaction in Voice Feminization Procedures: A Systematic Review and Meta-Analysis

To evaluate the efficacy and quality of life impact of voice feminization interventions in transgender women.

We searched PubMed, EMBASE, Scopus, and Web of Science for RCTs and retrospective studies published between 2008 and 2023 that quantitatively evaluated any voice feminization procedure.

Studies in English reporting quantitative measures of efficacy were included. Studies using qualitative methodology were excluded. Risk of bias was assessed using Cochran tools and a random-effects model was applied using inverse-variance pooling. Primary outcomes were fundamental frequency [F0]/speaking fundamental frequency [SF0] and patient-reported outcomes (PROs) (PROSPERO: CRD42023476192).

Twenty-four studies involving 893 participants showed significant SF0 improvements for voice therapy (VT, g = 0.86, [0.46, 1.26], P < .0001), Wendler glottoplasty (WG, g = 1.21, [0.65, 1.77], P < .0001), feminization laryngoplasty (FL, g = 3.05, [2.24, 3.86], P < .0001), and laser reduction glottoplasty (LRG, g = 12.28, [8.19, 15.64], P < .0001). PROs indicated enhanced quality of life for VT (g = 1.32, [0.68, 1.96], P < .0001), WG (g = 1.82, [1.07, 2.57], P < .0001), and LRG (g = 1.90, [0.72, 3.07], P = .0015), with a strong correlation between pitch alteration and QoL (r² = 0.83, P = .0001).

Our results indicate that both VT and surgical procedures enhance vocal pitch and strongly correlate with improved QoL. Our findings validate the role of voice feminization in gender-affirming care, though methodological limitations prevent evaluation of newer interventions.