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Patient-Reported Outcome Measures of Transmasculine Voice: A Scoping Review
Alexandra B Beam1, Michelle Adessa2, Rachel Mulheren3
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Objectives/Hypotheses:
The aim of this paper is to review patient-reported outcome measures (PROMs) of voice-related quality of life (QOL), participation, and gender congruence among transmasculine individuals. Gender-affirming voice care contributes to self-perception, thus we hypothesized improvements in QOL and participation related to voice therapy.
Study Design:
Scoping review.
Methods:
Online databases were searched using terms related to voice, speech therapy, transmasculine clients, and QOL. Studies were included if they reported a) transmasculine participants, b) planned or ongoing engagement with voice therapy, and c) at least one PROM of QOL, participation, or gender congruence. All results were screened for inclusion by title and abstract, followed by full-text review.
Results:
Of the five included studies with transmasculine participants, outcome measures varied widely and included standardized and non-standardized questionnaires. Kennedy and Thibeault (2020) reported that Voice Handicap Index (VHI) scores for masculine participants were lower than for feminine participants but higher than for gender-neutral participants; masculine participants reported greater barriers to seeking help. Myers et al. (2024) reported that gender incongruence scores on the Utah Gender Presentation Scale for Communication (U-GPS) decreased after gender-affirming voice care for transgender men, but the sample size was too limited for statistical analysis. In their original forms, the Communicative Participation Item Bank (CPIB) and the Transsexual Voice Questionnaire Female to Male (TVQFtM) were reportedly not representative, and the validity of the VHI in the transmasculine population remains to be determined.
Conclusions:
PROMs for transmasculine voice have limited validity and sample sizes. Furthermore, barriers to seeking care may impact participation and QOL. Future investigations should prospectively determine the validity and reliability of existing instruments, consider methods of obtaining representative sample sizes, and develop more sensitive measures based on community input.
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