Protocol for gender-affirming voice care: a systematic review
DOI:
https://doi.org/10.34631/sporl.3094Keywords:
Gender-affirming care, transgender, voice careAbstract
Objective: Development of a protocol for patients with gender dysphoria related to voice.
Study Design: Systematic review.
Materials and Methods: A literature review was conducted using the PubMed and Google Scholar databases, including publications in English, Portuguese, and Spanish that addressed the clinical evaluation and medical and/or surgical treatment of voice in transgender patients. The systematic review was performed in accordance with the PRISMA 2020 guidelines.
Results: Ten articles were included. The clinical evaluation of transgender patients should include an auditory-perceptual assessment (GRBAS and CAPE-V), an acoustic voice analysis (fundamental frequency, formant frequencies, vocal range, and maximum phonation time), laryngostroboscopy at low, medium, and high pitch, and the administration of questionnaires (Trans Woman Voice Questionnaire – TWVQ and 10-item Voice Handicap Index – VHI-10). In the initial phase of therapeutic management, transgender individuals should be referred to a qualified speech-language therapist. When speech therapy yields insufficient results, surgical options should be considered. As most transgender men are satisfied with the vocal changes achieved through hormone therapy, there are still few studies regarding surgical voice interventions in this subpopulation. For transgender women, Wendler glottoplasty is the preferred surgical procedure.
Conclusions: Given the significant growth of this field, there is a pressing need to establish a standardized approach protocol that synthesizes the best current practices for voice care.
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Alves Rodrigues C, Marguilho M, Ferreira B, Nascimento S, Nascimento M, Cardoso S. et al. Gender dysphoria: concepts, diagnosis and clinical management. Acta Med Port. 2024 May 2;37(5):379-385. doi: 10.20344/amp.21057.
Dornelas R, da Silva K, Pellicani AD. Proposal of the vocal attendance protocol and vocal redesignation program in the services of the transsexualizing process. Codas. 2021 Apr 12;33(1):e20190188. doi: 10.1590/2317-1782/20202019188.
Chang J, Yung K. Gender affirming voice care: a literature review. Int J Head Neck Surg. 2021;12(3):93–7. doi: 10.5005/jp-journals-10001-1448
Young VVN, Yousef A, Zhao NW, Schneider SL. Voice and stroboscopic characteristics in transgender patients seeking gender-affirming voice care. Laryngoscope. 2021 May;131(5):1071-1077. doi: 10.1002/lary.28932.
Dwyer CD, Schneider SL, Gutierrez D, Rosen CA. Gender-affirming voice surgery: considerations for surgical intervention. Semin Speech Lang. 2023 Mar;44(2):76-89. doi: 10.1055/s-0043-1761948.
Chaiet SR, Yoshikawa N, Sturm A, Flanary V, Ishman S, Streed CG. The otolaryngologist’s role in providing gender-affirming care: an opportunity for improved education and training. Otolaryngol Head Neck Surg. 2018 Jun;158(6):974-976. doi: 10.1177/0194599818758270.
McBrinn S, Antoni C, Al Yaghchi C. Current approaches to gender-affirming vocal care. Curr Opin Otolaryngol Head Neck Surg. 2024 Jun 1;32(3):143-150. doi: 10.1097/MOO.0000000000000967.
Adessa M, Weston Z, Ruthberg J, Bryson PC. Gender-affirming voice modification for transgender women: characteristics and outcomes. Transgend Health. 2023 Jul 28;8(4):352-362. doi: 10.1089/trgh.2021.0071.
Schwarz K, Cielo CA, Spritzer PM, Villas-Boas AP, Costa AB, Fontanari AMV. et al. A speech therapy for transgender women: an updated systematic review and meta-analysis. Syst Rev. 2023 Jul 23;12(1):128. doi: 10.1186/s13643-023-02267-5.
Ziegler A, Henke T, Wiedrick J, Helou LB. Effectiveness of testosterone therapy for masculinizing voice in transgender patients: a meta-analytic review. Int J Transgenderism 2018;19(1):25–45. doi: 10.1080/15532739.2017.1411857
Casado JC, ÓConnor C, Angulo MS, Adrián JA. Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: resultados de la valoración pre- vs.poscirugía. Acta Otorrinolaringol Esp. 2016 Mar-Apr;67(2):83-92. doi: 10.1016/j.otorri.2015.02.003.
Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS. et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol1997;6(3):66-9. doi: 10.1044/1058-0360.0603.66
Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004 Sep;114(9):1549-56. doi: 10.1097/00005537-200409000-00009.
Davies S, Goldberg JM. Trans Care Project. Trans Care Gender transition [Internet] Available from: https://www.rainbowhealthontario.ca/wp-content/uploads/2009/05/Changing-speech.pdf
Dacakis G, Davies S, Oates JM, Douglas JM, Johnston JR. Development and preliminary evaluation of the transsexual voice questionnaire for male-to-female transsexuals. J Voice. 2013 May;27(3):312-20. doi: 10.1016/j.jvoice.2012.11.005.
Bultynck C, Pas C, Defreyne J, Cosyns M, T’Sjoen G. Organizing the voice questionnaire for transgender persons. Int J Transgend Health. 2019 May 8;21(1):89-97. doi: 10.1080/15532739.2019.1605555.
Tavares AID. Avaliação Percetiva da Voz: GRBAS e CAPE-V. [dissertation on the Internet]. [Portugal] Universidade de Aveiro. 2014. 126 p. Available from: https://sweet.ua.pt/lmtj/lmtj/Tavares2014/Tavares2014.pdf
Mendes A, Moreira M, Costa A, Murtinheira A, Jorge A. Validade e sensibilidade do texto foneticamente equilibrado para o Português-Europeu “O Sol” Validity and sensitivity of the European-Portuguese phonetically balanced text “O Sol” (The Sun) La validez y la sensibilidade del texto fonéticamente equilibrado. Distúrb Comun [Internet]. 2014;26(2):277–86. Available from: https://comum.rcaap.pt/bitstream/10400.26/14519/1/2014 Rev Disturbios Comunicacao 17589-49960-2-PB.pdf
Azevedo SR, Santos M, Sousa F, Freitas S, Coutinho MB, Sousa CAE. et al. Validation of the Portuguese Version of the Voice Handicap Index-10. J Voice. 2023 Jan;37(1):140.e7-140.e11. doi: 10.1016/j.jvoice.2020.10.019.
Moreia K, Alves D, Correia P. Autoperceção vocal da pessoa transsexual - tradução e validação do instrumento “TWVQ - Trans Woman Voice Questionnaire” para português europeu. In: I Jornadas dos jovens investigadores em terapia da fala [Internet]. 2022. Available from: https://comum.rcaap.pt/entities/publication/e1a80f75-6775-48aa-802c-1a0593f959be
Akst L, Davis AC, Best S. Transgender and Gender-Diverse Voice Care. Johns Hopkins Medicine [Internet]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/transgender-and-gender-diverse-voice-care
Kravitz MB, Lee AH. Chondrolaryngoplasty: a review of its past, present, and future. Curr Otorhinolaryngol Rep 2025; 13. Doi: 10.1007/s40136-025-00516-w 2025;1–7.
Sirin S, Polat A, Alioglu F. Psychometric evaluation of adapted transsexual voice questionnaire for turkish trans male individuals. J Voice. 2021 Sep;35(5):805.e27-805.e32. doi: 10.1016/j.jvoice.2020.01.023.
Bultynck C, Cosyns M, T’Sjoen G, Van Borsel J, Bonte K. Thyroplasty Type III to lower the vocal pitch in trans men. Otolaryngol Head Neck Surg. 2021 Jan;164(1):157-159. doi: 10.1177/0194599820937675.
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