Mapping the Characteristics of Voice and Communication Harmonization Programs for Transgender Women: A Scoping Review

To map the targets and treatment ingredients used by voice therapists in vocal and communicative harmonization programs for transgender women.

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology, registered in the Open Science Framework, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The search, with no language or date restrictions, included LILACS, MEDLINE, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials, as well as gray literature (ProQuest Dissertations and Theses, medRxiv, and Google Scholar), citation and reference mapping, and consultation with experts. Studies were included if they involved transgender women aged ≥18 years who underwent speech-language pathology interventions targeting voice and communication. Study selection and data extraction were performed independently and blindly by two reviewers. Data were extracted on study characteristics, sample characteristics, and features of the vocal and communicative harmonization programs, which were classified according to the voice rehabilitation treatment specification system. Data analysis was descriptive.

A total of 1908 records were identified, of which 35 studies met the eligibility criteria. Most studies were conducted in the United States (28.6%), published in 2024 (22.9%), and appeared in the Journal of Voice (37.1%). The mean sample size was 22.34 participants per study. Most studies included participants receiving gender-affirming hormone therapy (31.4%), without prior vocal feminization surgery (65.7%), and without previous vocal harmonization programs (60.0%). Interventions were predominantly traditional, in-person, and individual, delivered weekly, with a mean of 12.49 sessions, and lacked follow-up in 54.3% of studies. The most frequent targets were vocal function (94.3%), speech and communication function (88.6%), and pedagogy and counseling (80.0%). The most commonly reported ingredients were resonance-based methods (88.6%), guidance and counseling (80.0%), pitch and loudness modification techniques (77.1%), and articulatory exercises (71.4%).

Vocal and communicative harmonization programs for transgender women primarily prioritize voice- and communication-related targets; however, the treatment ingredients are largely concentrated on vocal adjustments, while components addressing broader communicative aspects remain less explored. These findings highlight the need to expand the scope of interventions to more comprehensively address global communication.