Beyond Pitch: Exploring Acoustic and Psychosocial Factors Shaping Voice Perception in Transmasculine Individuals

Purpose: Self-perception of voice is a critical outcome for individuals seeking gender-affirming care; however, the variables associated with vocal self-perception remain unclear. While masculinizing gender-affirming hormone therapy (GAHT) contributes to voice masculinization and overall well-being, its relationship with multidimensional factors warrants further investigation. This study aimed to (a) evaluate longitudinal changes in acoustic parameters, body image, and psychosocial status during the first 6 months of GAHT and (b) identify the extent to which these factors predict the variance in self-perception of voice and its daily living impact. Method: Twenty-six transmasculine individuals beginning hormone therapy were followed for 6 months and assessed at three time points. At each point, serum testosterone level, self-perception of voice and its daily living impact, body image, and psychosocial status were measured. Participants' voice recordings were collected for acoustic analysis. Results: Significant changes were found in fundamental frequency ( F 0), voice quality, and resonance, as well as in perceived social support following the initiation of GAHT. Statistical modeling revealed that body image, state anxiety, and F 0 served as significant predictors, accounting for the variation in self-perception of voice and its daily living impact. Conclusions: Beyond the acoustic parameters commonly used in gender-affirming voice therapy, body image and anxiety levels are significantly associated with patient self-perception and voice-related quality of life. This suggests that voice-related outcomes are linked to a multidimensional array of psychosocial variables, necessitating a holistic approach by voice specialists during gender-affirming voice care. Considering both domains may improve assessment and intervention in gender-affirming voice care, and future research should explore these dynamic associations over longer follow-up periods.