Preliminary Analysis of Candidate Items for an Abbreviated 11-Item Trans Woman Voice Questionnaire

Clinicians evaluating gender-affirming voice patients often use voice quality-of-life questionnaires. The Trans Woman Voice Questionnaire (TWVQ), formerly the Transsexual Voice Questionnaire Male to Female, evaluates vocal functioning and social participation. Our goal was to find which questions had the most impact, defined by higher distress/symptom burden and greater frequency of severe responses, for the patient. Our secondary, more exploratory goal was to identify items to inform, potentially formulate, and validate a preliminary 11-question version of the same questionnaire.

TWVQ responses from transgender women presenting for initial evaluation were retrospectively analyzed. Each of the 30 items was scored on a four-point Likert scale. Statements were ranked by the frequency of severe endorsement ("usually or always"). Item-total correlations were calculated using Pearson correlation to evaluate association with the overall questionnaire burden. Internal consistency for the full questionnaire and the proposed exploratory abbreviated version was evaluated using Cronbach's alpha as a preliminary estimate of internal consistency.

Twenty-six participants completed the 30-item TWVQ. Twelve items were endorsed as severe by at least 40% of respondents, with the highest frequencies observed among statements related to vocal identity. Item-total correlations ranged from r = 0.21 to r = 0.81, with multiple items demonstrating moderate to strong associations with overall questionnaire burden. Items with low correlations were excluded, even if they had moderate endorsement frequency. The full questionnaire demonstrated excellent internal consistency (Cronbach's α = 0.95). The proposed preliminary 11-item abbreviated version maintained good internal consistency (α = 0.89) while retaining representation across vocal identity, anxiety and avoidance, and vocal function domains.

This exploratory analysis identified candidate items that may inform the future development of an abbreviated version of the TWVQ. The proposed preliminary short form demonstrates good internal consistency and retains items most indicative of patient-reported voice-related burden. Further validation in larger independent cohorts is required before clinical implementation, and a more detailed analysis of a larger patient cohort may yield a different short-form questionnaire. A future short-form instrument may serve as a practical tool for screening and monitoring in time-limited clinical settings, while the full TWVQ remains suitable for comprehensive assessment.