The Clinical and Surgical Landscape of Gender Affirming Vocal Care: A Scoping Review

To comprehensively map the surgical and nonsurgical gender affirming voice literature, synthesize our understanding of the current data, and guide future research.

A literature search was performed using PubMed, Embase, CINAHL, and Web of Science Core Collection databases. Following PRISMA-ScR guidelines, independent reviewers screened databases from inception, extracting data regarding methodological design, levels of evidence, patient demographics, outcome measures, and surgical techniques.

Of 3231 articles screened, 290 met inclusion criteria. Primary publication rates increased from an average of 2.7 articles/year (2000-2009) to 31.3 articles/year (2022-2024). Most studies were cross-sectional (n = 106) or retrospective (n = 70), nonrandomized (n = 181), and lacked a comparison group (n = 92). Primary research examined mostly transgender women (n = 119), followed by combined cohorts (n = 71), transgender men (n = 32), and nonbinary/gender diverse individuals (n = 4). Median sample sizes were 20 and 18 for all primary literature and surgical primary literature, respectively. Most primary studies addressed nonsurgical interventions (n = 180), fewer examined surgical (n = 74) or combined approaches (n = 36). Among surgical papers focused on trans women (n = 57), anterior web glottoplasty (n = 46) and cricothyroid approximation (n = 21) predominated. Surgical outcomes largely emphasized acoustic measures (75.3%) or quality of life metrics (56.8%), with limited information on functional impairment.

Current literature is characterized by small size, lack of randomization, and no comparison groups, features consistent with lower levels of evidence. Future research may address gaps in the literature including underrepresented populations, such as trans men and nonbinary/gender diverse individuals, and investigating the impact of vocal gender dysphoria on function.