Quantitative and Patient-Reported Outcomes Across Gender-Affirming Voice Therapy

Purpose: The purpose of this study was to determine when changes in fundamental frequency ( F 0) and improvements in Transgender Voice Questionnaire (TVQ) scores occur during the course of gender-affirming voice therapy (GAVT) for transgender women. Temporal and correlative relationships between improvements in TVQ scores and changes in quantitative voice measures were considered. Method: Thirteen transgender women ( M age = 32.8 years, SD = 10.1) pursuing GAVT were followed longitudinally from voice therapy initiation through discharge. F 0 on connected speech, percent accuracy in producing forward-focused resonance on connected speech, and the TVQ were collected at initial voice evaluations and at each subsequent therapy session. F 0 and resonance data were collected at the beginning and end of each session to determine at what point gains carried over between sessions. Results: On average, participants completed 6.58 ( SD = 2.6) sessions of GAVT. By Session 3, F 0 and resonance accuracy increased significantly from baseline levels ( p < .001). By Session 4, TVQ scores also improved significantly from baseline ( p < .001). Significant within-session (pre–post) increases in speaking F 0 were evident in Sessions 1–5, and significant within-session increases in resonance accuracy were observed in Sessions 2–7. This occurred because increases in F 0 and improved resonance accuracy were not maintained between time points until Sessions 5 and 7, respectively. Increases in F 0 and forward-focused resonance accuracy were only weakly correlated with changes in TVQ scores. Conclusions: GAVT-associated improvements in TVQ scores were evident by Session 4 for all patients. These improvements were likely driven by a combination of increased speaking F 0, increased accuracy in producing forward-focused resonance, and other factors. Future studies should examine other temporal aspects of GAVT and probe other drivers of TVQ scores before and following treatment.