2022, Number 3
<< Back Next >>
Salud Mental 2022; 45 (3)
Relevance of the voice in the process of gender affirmation in transsexual women: A cross-sectional study
Ramírez-Arroyo G, Salín Pascual RJ, Dávalos Fuentes MS
Language: English
References: 57
Page: 115-123
PDF size: 221.72 Kb.
ABSTRACT
Introduction. Voice is a gender marker and can therefore be a source of gender dysphoria. There is a
relationship between symptoms of anxiety and depression and voice-related difficulties in trans women
(TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to
voice feminization procedures is limited while the population demanding transgender healthcare is increasing.
Objective. To describe the degree of voice-related dysphoria experienced by TW that seek a voice
feminization treatment. Method. A descriptive, cross-sectional study, 26 TW completed quality of life (QoL)
questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was
measured.
Results. 77% of the participants were legally recognized as women, 96% were under HRT, and
27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with
QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a
feminine voice that allows gender conformity was the main reason for seeking treatment.
Discussion and
conclusion. Voice non-conformity affects QoL. None of the participants perceived their voice as feminine
while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a
detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization
of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization
treatments, it is difficult to define how to measure success.
REFERENCES
Aguirre-Sánchez-Beato, S. (2018). Trans Terminology and Definitions in Researchon Transphobia: A conceptual review. Quaderns de Psicologia, 20(3), 295-305.doi: 10.5565/rev/qpsicologia.1453
American Psychological Association. (2011). Answers to your questions abouttransgender people, gender identity, and gender expression. [Fact sheet]Retrieved from http://www.apa.org/topics/ lgbt/transgender.aspx
American Psychological Association. (2015). Guidelines for psychological practicewith transgender and gender nonconforming people. American Psychologist,7(9), 832-864. doi:10.1037/a0039906
Anderson, A. D., Irwin, J. A., Brown, A. M., & Grala, C. L. (2020). Your PictureLooks the Same as My Picture: An Examination of Passing in TransgenderCommunities. Gender Issues, 37(1), 44-60. doi: 10.1007/s12147-019-09239-x
Balzer, C., LaGata, C., & Berredo, L. (2016). TMM Annual Report 2016: 2,190murders are only the tip of the iceberg – An introduction to the Trans MurderMonitoring project. Berlin, Germany: Carsten Balzer and Transgender Europe(TGEU).
Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Dolezal, C., Robinson, B.B. E., Rosser, B. R. S., & Coleman, E. (2020). The Transgender Identity Survey:A Measure of Internalized Transphobia. LGBT Health, 7(1), 15-27. doi: 1089/lgbt.2018.0265
Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., Millet, N., Fernandez-Aranda,F., & Arcelus, J. (2017). Transgender and anxiety: A comparative study betweentransgender people and the general population. International Journal ofTransgenderism, 18(1), 16-26. doi: 10.1080/15532739.2016.1258352
Boza, C., & Perry, K. N. (2014) Gender-Related Victimization, PerceivedSocial Support, and Predictors of Depression Among TransgenderAustralians. International Journal of Transgenderism, 15(1), 35-52. doi:10.1080/15532739.2014.890558
Carew, L., Dacakis, G., & Oates, J. (2007). The Effectiveness of OralResonance Therapy on the Perception of Femininity of Voice in Male-to-Female Transsexuals. Journal of Voice, 21(5), 591-603. doi: 10.1016/j.jvoice.2006.05.005
Casado, J. C., O’Connor, C., Angulo, M. S., & Adrián, J. A. (2016). Glotoplastia deWendler y tratamiento logopédico en la feminización de la voz en transexuales:Resultados de la valoración pre- vs. poscirugía. Acta OtorrinolaringológicaEspañola, 67(2), 83-92. doi: 10.1016/j.otorri.2015.02.003
Casado, J. C., Rodríguez-Parra, M. J., & Adrián, J. A. (2017). Voice feminizationin male-to-female transgendered clients after Wendler’s glottoplasty with vs.without voice therapy support. European Archives of Oto-Rhino-Laryngology,274(4), 2049-2058. doi: 10.1007/s00405-016-4420-8
Contreras, F., Muñoz, C., Prieto, P., & Valdés, J. (2017). Instrumentos de EvaluaciónFonoaudiológica. Una aproximación a las Metodologías de Evaluación. SerieCreación N° 15. Unidad Habla y Lenguaje Adultos, Carrera de Fonoaudiología.Santiago: Facultad de Ciencias de La Salud. Centro de Investigación enEducación Superior CIES - Universidad San Sebastián.
Dacakis, G., Davies, S., Oates, J. M., Douglas, J. M., & Johnston, J. R. (2013).Development and Preliminary Evaluation of the Transsexual VoiceQuestionnaire for Male-to-Female Transsexuals. Journal of Voice, 27(3), 312-320. doi: 10.1016/j.jvoice.2012.11.005
Dacakis, G., Oates, J., & Douglas, J. (2017). Associations between the TranssexualVoice Questionnaire (TVQMtF) and self-report of voice femininity and acousticvoice measures. International Journal of Language & CommunicationDisorders, 52(6), 831-838. doi: 10.1111/1460-6984.12319
Davies, S., Papp, V. G., & Antoni C. (2015) Voice and Communication Changefor Gender Nonconforming Individuals: Giving Voice to the PersonInside. International Journal of Transgenderism, 16(3), 117-159. doi:10.1080/15532739.2015.1075931
de Vries, E., Kathard, H., & Müller, A. (2020). Debate: Why should gender-affirminghealth care be included in health science curricula? BMC Medical Education,20(1), 1-10. doi: 10.1186/s12909-020-1963-6
Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016) Mental health andgender dysphoria: A review of the literature. International Review of Psychiatry,28(1), 44-57. doi: 10.3109/09540261.2015.1115753
Dias, C. K., da Rocha, L. R. L., Tateo, L., & Marsico, G. (2021). “Passing” andits effects on Brazilian transgender people’s sense of belonging to society: Atheoretical study. Journal of Community & Applied Social Psychology, 31(6),690-702. doi: 10.1002/casp.2535
Deutsch, M. B. & Center of Excellence for Transgender Health. (2016). Guidelinesfor the Primary and Gender-Affirming Care of Transgender and GenderNonbinary People. San Francisco: University of California. Retrieved fromhttps://transcare.ucsf.edu/guidelines
Enriquez-Estrada, V. M. (2019). Health care human rights and citizenship: Issuesfaced by trans people in Mexico. Revista Mexicana de Psiquiatría y SaludMental, 1(4), 117-125. doi: 10.13140/RG.2.2.23511.11688
Glynn, T. R., Gamarel, K. E., Kahler, C. W., Iwamoto, M., Operario, D., & Nemoto,T. (2016). The role of gender affirmation in psychological well-being amongtransgender women. Psychology of Sexual Orientation and Gender Diversity,3(3), 336-344. doi: 10.1037/sgd0000171
Gyamerah, A. O., Baguso, G., Santiago-Rodriguez, E., Sa’id, A., Arayasirikul, S., Lin,J., …Wesson, P. (2021). Experiences and factors associated with transphobic hatecrimes among transgender women in the San Francisco Bay Area: comparisonsacross race. BMC Public Health, 21(1), 1-15. doi: 10.1186/s12889-021-11107-x
Hancock, A. B., Krissinger, J., & Owen, K. (2011). Voice perceptions and qualityof life of transgender people. Journal of Voice, 25(5), 553-558. doi: 10.1016/j.jvoice.2010.07.013
Hancock, A. & Helenius, L. (2012). Adolescent male-to-female transgender voiceand communication therapy. Journal of Communication Disorders, 45(5), 313-324. doi: 10.1016/j.jcomdis.2012.06.008
Hasan, S., Alviany, Y., Clarissa C., & Sudana, S. (2017) High perceived discriminationand no family support increase risk of poor quality of life in gender dysphoria.Universa Medicina, 36(3), 187-96. doi: 10.18051/UnivMed.2017.v36.187-196
Hoffman, B. (2014). An Overview of Depression among TransgenderWomen. Depression Research and Treatment. 2014(394283), 1-9. doi:10.1155/2014/39428326. Jacobson, B. H., Jonson, A., Grywalski, C., Silbergleit A., Jacobson G., Benninger M.S., … Newman, C. W. (1997). The Voice Handicap Index (VHI): Developmentand Validation. American Journal of Speech-Language Pathology, 6(3), 66-70.doi: 10.1044/1058-0360.0603.66
Lozano-Verduzco, I., & Melendez, R. (2019). Transgender individuals in Mexico:exploring characteristics and experiences of discrimination and violence.Psychology & Sexuality, 12(3), 235-247. doi: 10.1080/19419899.2019.1698449
Luhur, W., Lozano-Verduzco, I., & Shaw, A. (2020). Public opinion of transgenderrights in Mexico. Los Angeles, CA: UCLA School of Law Williams Institute.Retrieved from https://williamsinstitute.law.ucla.edu/wp-content/uploads/Public-Opinion-Trans-Mexico-English-Dec-2020.pdf
Malta, M., Cardoso, R., Montenegro, L., Gomes de Jesus, J., Seixas, M., Benevides,B., ...Whetten, K. (2019). Sexual and gender minorities rights in Latin Americaand the Caribbean: a multi-country evaluation. BMC International Health andHuman Rights, 19(1), 1-16. doi: 10.1186/s12914-019-0217-3
Manning, M. L., Baruth, L., & Lee, L. (2017). Multicultural Education of Childrenand Adolescents (6th ed.). Routledge.
Mastronikolis, N. S., Remacle, M., Biagini, M., Kiagiadaki, D., & Lawson, G.(2013). Wendler glottoplasty: An effective pitch raising surgery in maleto-female transsexuals. Journal of Voice, 27(4), 516-522. doi: 10.1016/j.jvoice.2013.04.004
Meister, J., Kühn, H., Shehata-Dieler, W., Hagen, R., & Kleinsasser, N. (2017).Perceptual analysis of the male-to-female transgender voice after glottoplasty—the telephone test. Laryngoscope, 127(4), 875-881. doi: 10.1002/lary.26110
Millet, N., Longworth, J., & Arcelus, J. (2017). Prevalence of anxiety symptomsand disorders in the transgender population: A systematic review of theliterature. International Journal of Transgenderism, 18(1), 27-38. doi:10.1080/15532739.2016.1258353
Mora, E., Carrillo, A., Giribet, A., Becerra, A., Lucio, M. J., & Cobeta, I. (2018).Translation, Cultural Adaptation, and Preliminary Evaluation of the SpanishVersion of the Transgender Voice Questionnaire for Male-to-FemaleTranssexuals (TVQMtF). Journal of Voice, 32(4), 514.e1-514.e6. doi: 10.1016/j.jvoice.2017.05.012
Moreno-Pérez, O., Esteva De Antonio, I., & Grupo de Identidad y DiferenciaciónSexual de la SEEN. (2012). Clinical practice guidelines for assessment andtreatment of transsexualism. SEEN Identity and Sexual Differentiation Group(GIDSEEN). Endocrinología y Nutrición, 59(6), 367-382. doi: 10.1016/j.endoen.2012.07.004
Nešić, M., Čičević, S., Nešić, V., Kostić, J., & Ćirić, M. (2013). Gender Differences inProsodic Characteristics of Speech in the Task of Serial Subtracting of Sevens.Acta Facultatis Medicae Naissensis, 30(1), 5-13. doi: 10.2478/v10283-012-0030-6
Nolan, I. T., Morrison, S. D., Arowojolu, O., Crowe, C. S., Massie, J. P., Adler, R.K., ... Francis, D. O. (2019). The role of voice therapy and phonosurgery intransgender vocal feminization. Journal of Craniofacial Surgery, 30(5), 1368-1375. doi: 10.1097/SCS.0000000000005132
Novais Valente Junior, C., & Mesquita de Medeiros, A. (2020). Voice And GenderIncongruence: Relationship Between Vocal Self-Perception And Mental HealthOf Trans Women. Journal of Voice, (In Press). doi: 10.1016/j.jvoice.2020.10.002
Nuffield Council on Bioethics. (2017). Cosmetic procedures: ethical issues. Retrievedfrom http://nuffieldbioethics.org/wp-content/uploads/Cosmetic-proceduresfull-report.pdf
Núñez-Batalla, F., Corte-Santos, P., Señaris-González, B., Llorente-Pendás, J. L.,Górriz-Gil, C., … Suárez-Nieto, C. (2007). Adaptación y validación del índicede incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español.Acta Otorrinolaringológica Española, 58(9), 386-392. doi: 10.1016/S0001-6519(07)74954-3
Owen-Smith, A. A., Gerth, J., Sineath, R. C., Barzilay, J., Becerra-Culqui, T.A., Getahun, D., ... Goodman, M. (2018). Association Between GenderConfirmation Treatments and Perceived Gender Congruence, Body ImageSatisfaction, and Mental Health in a Cohort of Transgender Individuals. TheJournal of Sexual Medicine, 15(4), 591-600. doi: 10.1016/j.jsxm.2018.01.017
Ramírez-Rentería, C., López-Juárez, N., Cruz, J., Román, E., & Fong, M. (2018)El manejo integral de la salud en pacientes adultos transgénero y transexuales:un tema cada vez más frecuente en la práctica clínica en México. Rev MexEndocrinol Metab Nutr, 5, 141-159.
Remacle, M., Matar, N., Morsomme, D., Veduyckt, I., & Lawson, G. (2011).Glottoplasty for Male-to-Female Transsexualism: Voice Results. Journal ofVoice, 25(1), 120-123. doi: 10.1016/j.jvoice.2009.07.004
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., &Sevelius, J. (2016). Barriers to Health Care for Transgender Individuals.Curr Opin Endocrinol Diabetes Obes, 23(2), 168-171. doi: 10.1097/MED.0000000000000227
Schmidt, J. G., Goulart, B. N. G., Dorfman, M. E. K. Y., Kuhl, G., & Paniagua, L.M. (2018). Voice challenge in transgender women: trans women self-perceptionof voice handicap as compared to gender perception of naïve listeners. RevistaCEFAC, 20(1), 79-86. doi: 10.1590/1982-021620182011217
Schwarz, K., Fontanari, A. M. V., Schneider, M. A., Borba Soll, B. M., da Silva, D.C., Spritzer, P. M., ... Lobato, M. I. R. (2017). Laryngeal surgical treatmentin transgender women: A systematic review and meta-analysis. Laryngoscope,127(11), 2596-2603. doi: 10.1002/lary.26692
Sevelius, J. M. (2013). Gender Affirmation: A Framework for Conceptualizing RiskBehavior Among Transgender Women of Color. Sex Roles, 68(11-12), 675-689.doi: 10.1007/s11199-012-0216-5
Song, T. E., & Jiang, N. (2017). Transgender Phonosurgery: A Systematic Reviewand Meta-analysis. Otolaryngology-Head and Neck Surgery, 156(5), 803-808.doi: 10.1177/0194599817697050
Thomas, J. P., & MacMillan, C. (2013). Feminization laryngoplasty: Assessmentof surgical pitch elevation. European Archives of Oto-Rhino-Laryngology,270(10), 2695-2700. doi: 10.1007/s00405-013-2511-3
T’Sjoen, G., Arcelus, J., Gooren, L., Klink, D.T., & Tangpricha, V. (2019).Endocrinology of Transgender Medicine. Endocrine Reviews, 40(1), 97 -117.doi: 10.1210/er.2018-00011
Unger, C. A. (2016). Hormone therapy for transgender patients. TranslationalAndrology and Urology, 5(6), 877-884. doi: 10.21037/tau.2016.09.04
Van Borsel, J., Janssens, J., & De Bodt, M. (2009). Breathiness as a Feminine VoiceCharacteristic: A Perceptual Approach. Journal of Voice, 23(3), 291-294. doi:10.1016/j.jvoice.2007.08.002
Van Damme, S., Cosyns, M., Deman, S., Van den Eede, Z., & Van Borsel, J. (2017).The Effectiveness of Pitch-raising Surgery in Male-to-Female Transsexuals:A Systematic Review. Journal of Voice, 31(2), 244.e1-244.e5. doi: 10.1016/j.jvoice.2016.04.002
Wiepjes, C. M., Nota, N. M., de Blok, C. J. M., Klaver, M., de Vries, A. L. C.,Wensing-Kruger, S. A., …den Heijer, M. (2018). The Amsterdam Cohortof Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment,and Regrets. Journal of Sexual Medicine, 15(4), 582-590. doi: 10.1016/j.jsxm.2018.01.016
Williams, E. A., Patete, C. L., & Thaller, S. R. (2019). Gender affirmation surgeryfrom a public health perspective: Advances, challenges, and areas ofopportunity. Journal of Craniofacial Surgery, 30(5), 1349-1351. doi: 10.1097/SCS.0000000000005367
Witcomb, G. L., Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., & Arcelus,J. (2018). Levels of depression in transgender people and its predictors:Results of a large matched control study with transgender people accessingclinical services. Journal of Affective Disorders, 235, 308-315. doi: 10.1016/j.jad.2018.02.051
World Professional Association for Transgender Health [WPATH]. (2012). Standardsof Care for the Health of Transsexual, Transgender, and Gender NonconformingPeople (7th Version). Retrieved from https://www.wpath.org/publications/soc