Mutism as a Symptom of Gender Dysphoria: A Case Report

Transgender individuals may perceive voice as a meaningful component of their gender identity. We present a 33-year-old transgender woman with a history of major depressive disorder and social anxiety disorder who avoided communication through speech due to discomfort with the sound of her voice. While the patient had a history of social anxiety disorder, her symptoms related to speech production appeared rooted in her gender identity. Selective mutism and social anxiety disorder may be present in transgender individuals and affect communication; however, there may be a subset of patients whose mutism is driven by gender dysphoria. Clinicians should be aware that gender dysphoria may influence mutism, as gender-affirming interventions may improve both the psychological and vocal aspects of communication in transgender patients.