Long-term acoustic outcomes, perceptual voice assessment and voice-related quality of life in transgender women undergoing Wendler glottoplasty: a single-center experience

<b>Introduction:</b> Since the voice is uniquely tied to gender identity, it constitutes a considerable factor in the transition process of transgender individuals. <br><br><b>Aim:</b> We aimed to analyze the long-term durability of Wendler glottoplasty (WG) acoustic outcomes in transgender women and juxtapose the objective results with voice-related quality of life (QoL) assessment and gender perception in telephone communication. <br><br><b>Methods:</b> We retrospectively reviewed the records of 7 transgender women who underwent WG, self-assessed their voice-related QoL, and participated in the telephone test. Long-term results were compared with data acquired preoperatively and at short-term follow-up, as well as with the age-matched control group of 7 cisgender males and 7 cisgender females. The speech samples of transfeminine individuals and cisgender controls were judged by 64 cisgender listeners. <br><br><b>Results:</b> After an average of 18.63 months, a persistent, significant increase in fundamental frequency, speaking fundamental frequency, and lower limit of the frequency range of spoken voice was observed, with the values being comparable to cisgender female controls. Despite a significant long-term improvement in the emotional domain of the Voice Handicap Index, the remaining voice-related QoL scores deteriorated compared to the short-term evaluation. The gender of transfeminine individuals was significantly more often incorrectly attributed compared to cisgender controls. The percentage of voice ratings as a female was not correlated with the acoustic measures, self-assessed vocal femininity, and satisfaction with WG results. <br><br><b>Conclusions:</b> Despite the long-term durability of acoustic changes after WG, the gradual reduction of the initially improved voice-related QoL suggests the need for multidisciplinary management. The acoustic measures cannot guarantee voice attribution as female by external evaluators, indicating the beneficial role of perceptual assessment in analyzing WG outcomes.