Quantitative and Patient-Reported Outcomes Across Gender-Affirming Voice Therapy

The purpose of this study was to determine when changes in fundamental frequency (F0) and improvements in Transgender Voice Questionnaire (TVQ) scores occur during the course of gender-affirming voice therapy (GAVT) for transgender women. Temporal and correlative relationships between improvements in TVQ scores and changes in quantitative voice measures were considered.

Thirteen transgender women (M_age = 32.8 years, SD = 10.1) pursuing GAVT were followed longitudinally from voice therapy initiation through discharge. F0 on connected speech, percent accuracy in producing forward-focused resonance on connected speech, and the TVQ were collected at initial voice evaluations and at each subsequent therapy session. F0 and resonance data were collected at the beginning and end of each session to determine at what point gains carried over between sessions.

On average, participants completed 6.58 (SD = 2.6) sessions of GAVT. By Session 3, F0 and resonance accuracy increased significantly from baseline levels (p < .001). By Session 4, TVQ scores also improved significantly from baseline (p < .001). Significant within-session (pre-post) increases in speaking F0 were evident in Sessions 1-5, and significant within-session increases in resonance accuracy were observed in Sessions 2-7. This occurred because increases in F0 and improved resonance accuracy were not maintained between time points until Sessions 5 and 7, respectively. Increases in F0 and forward-focused resonance accuracy were only weakly correlated with changes in TVQ scores.

GAVT-associated improvements in TVQ scores were evident by Session 4 for all patients. These improvements were likely driven by a combination of increased speaking F0, increased accuracy in producing forward-focused resonance, and other factors. Future studies should examine other temporal aspects of GAVT and probe other drivers of TVQ scores before and following treatment.