Communication and Psychosocial Outcomes of a Six-Month Group Intervention for Older Transgender Women

Speech and Language Therapy (SLT) plays a crucial role in gender-affirming care, supporting transgender individuals to achieve congruence between their communication and their gender identity. While the benefits of voice therapy are well-documented, research on its efficacy with older transgender women is limited. Additionally, psychosocial factors such as confidence, identity affirmation, and social connection are underexplored in this population.

This study evaluated the effectiveness of a structured, group-based intervention designed to enhance the communicative and psychosocial well-being of transgender women aged 50 and over.

A nonrandomized, single-group, pre-post intervention design was employed. Seven participants (median age 66, range 51-72) completed a six-month SLT group program incorporating voice training, reflective discussions, and home practice. Quantitative measures included fundamental frequency (F₀) during reading aloud, Voice Symptom Scale (VoiSS), Vocal Congruence Scale (VCS), and Group Cohesiveness Scale (GCS). Qualitative data were participants' self-goals, expectations, and perspectives on intervention, analyzed using Thematic Analysis.

F₀ significantly increased post-intervention (Mdn = 179 Hz vs 152 Hz, P = 0.018), with individual gains of +5 to +47 Hz. VCS scores also improved significantly (P = 0.028), indicating greater vocal congruence. VoiSS scores showed nonsignificant reductions in voice-related difficulties. Group cohesion remained high throughout, and qualitative findings highlighted increased communication confidence and social connection.

A structured, group-based approach to voice intervention is feasible and beneficial for older transgender women, improving voice outcomes, vocal congruence, and psychosocial well-being. Findings reinforce the need for holistic interventions that integrate voice training with peer support and identity-affirming discussions. Future studies should explore long-term generalization and application to other gender-diverse groups.