The effect of hormonal treatment on the voice perception in transgender people

The first two authors contributed equally to this work.As voice is a salient factor in perception of gender by society and has a significant psychosocial impact on transgender persons, it is important to measure a client’s... [ view full abstract ]

The first two authors contributed equally to this work.

As voice is a salient factor in perception of gender by society and has a significant psychosocial impact on transgender persons, it is important to measure a client’s perception of voice and its impact on everyday life during clinical follow-up. It has been shown that repeated exposure to androgen concentrations higher than 200 ng/dL results in irreversible virilising changes of the voice. By broadening the vocal cords and strengthening the vocal muscles, the pitch lowers. However, currently, there is no published research about the evolution of voice perception during CSHT in transgender persons.

The first aim was to examine if voice perception changes occur during cross-sex hormone therapy (CSHT) and if so, when these changes happen. The second aim was to study if a change of testosterone levels (as a result of the... [ view full abstract ]

The first aim was to examine if voice perception changes occur during cross-sex hormone therapy (CSHT) and if so, when these changes happen. The second aim was to study if a change of testosterone levels (as a result of the CSHT) predicts a change of voice perception and if so, when during follow-up this prediction can be made.

In this longitudinal prospective study the corresponding Transsexual Voice Questionnaire (TVQc) was used to evaluate transgender persons’ voice perception. This is a questionnaire based on the validated 30 item Transsexual... [ view full abstract ]

In this longitudinal prospective study the corresponding Transsexual Voice Questionnaire (TVQ^c) was used to evaluate transgender persons’ voice perception. This is a questionnaire based on the validated 30 item Transsexual Voice Questionnaire for Male to Female (TVQ^MtF). The TVQ^c can be divided into 3 factors: ‘anxiety and avoidance’, ‘gender identity’ and ‘voice quality’. Transgender persons completed the TVQ^c at baseline, after 3 months and after 12 months of CSHT. Testosterone levels were checked at baseline (80 trans men and 103 trans women), after 3 months (57 trans men and 74 trans women) and after 12 months of CSHT (52 trans men and 70 trans women). Trans men were treated with 1000 mg testosterone undecanoate injected intramuscularly every 12 weeks. Trans women were treated with 50 mg cyproterone acetate and 4 mg estradiol valerate, orally on a daily basis. Trans women aged 45 years and older were given a transdermal patch E2 (100 µg/24h) instead of the orally estradiol valerate. A student’s t-test and simple linear regression analysis were performed using the Statistical Package for Social Sciences (SPSS) software, version 22. All transgender persons who got speech therapy or underwent voice surgery, were excluded from this analysis. 

Trans menBetween 0 and 3 months of CSHT an improvement of factor ‘anxiety and avoidance’ (Mean=-3, p=0.001) and factor ‘gender identity’ (Mean=-5, p=0.000) was seen. Similar results were described between 0 and 12... [ view full abstract ]

Trans men

Between 0 and 3 months of CSHT an improvement of factor ‘anxiety and avoidance’ (Mean=-3, p=0.001) and factor ‘gender identity’ (Mean=-5, p=0.000) was seen. Similar results were described between 0 and 12 months of CSHT, with improvement of factor ‘anxiety and avoidance’ (Mean=-5, p=0.000) and factor ‘gender identity’ (Mean=-10, P=0.000). Between 3 and 12 months of CSHT there was improvement of factors ‘anxiety and avoidance’ (Mean=-4 p=0.002), ‘gender identity’ (Mean=-6, p=0.000) and ‘voice quality’ (Mean=-2, p=0.050). During the first 3 months of CSHT the increase of the testosterone level (as a result of the androgen therapy) was a predictor for the improvement of factors ‘anxiety and avoidance’ (B=-0.008, p=0.031) and ‘gender identity’ (B=-0.009, p=0.009).

Trans women

In trans women, there was an improvement of factor ‘gender identity’ (Mean=-2, P=0.003) during the first 3 months of CSHT. Between 0 and 12 months of CSHT an improvement of factors ‘anxiety and avoidance’ (Mean=-2, P=0.003), ‘gender identity’ (Mean=-5, P=0.000) and ‘voice quality’ (Mean=-2, P=0.032) was reported.

Trans menBetween 0 and 3 months of CSHT an improvement of factor ‘anxiety and avoidance’ (Mean=-3, p=0.001) and factor ‘gender identity’ (Mean=-5, p=0.000) was seen. Similar results were described between 0 and 12... [ view full abstract ]

Trans men

Between 0 and 3 months of CSHT an improvement of factor ‘anxiety and avoidance’ (Mean=-3, p=0.001) and factor ‘gender identity’ (Mean=-5, p=0.000) was seen. Similar results were described between 0 and 12 months of CSHT, with improvement of factor ‘anxiety and avoidance’ (Mean=-5, p=0.000) and factor ‘gender identity’ (Mean=-10, P=0.000). Between 3 and 12 months of CSHT there was improvement of factors ‘anxiety and avoidance’ (Mean=-4 p=0.002), ‘gender identity’ (Mean=-6, p=0.000) and ‘voice quality’ (Mean=-2, p=0.050). During the first 3 months of CSHT the increase of the testosterone level (as a result of the androgen therapy) was a predictor for the improvement of factors ‘anxiety and avoidance’ (B=-0.008, p=0.031) and ‘gender identity’ (B=-0.009, p=0.009).

Trans women

In trans women, there was an improvement of factor ‘gender identity’ (Mean=-2, P=0.003) during the first 3 months of CSHT. Between 0 and 12 months of CSHT an improvement of factors ‘anxiety and avoidance’ (Mean=-2, P=0.003), ‘gender identity’ (Mean=-5, P=0.000) and ‘voice quality’ (Mean=-2, P=0.032) was reported.

In this prospective study we show that voice perception is improving during CSHT in trans men and in trans women. Even more, in trans men there is a directly predictive linear correlation between the increasing testosterone... [ view full abstract ]

In this prospective study we show that voice perception is improving during CSHT in trans men and in trans women. Even more, in trans men there is a directly predictive linear correlation between the increasing testosterone level and the improving scores of factors ‘anxiety and avoidance’ and ‘gender identity’ during the first 3 months of CSHT. In trans women this directly predictive link does not exist. In conclusion, for trans men this study supports that the change of voice perception on the basis of the hormone therapy already occurs during the first 3 months of therapy. For trans women this study supports first that testosterone has already acted irreversibly virilising to the voice during puberty and second that the effect of estrogen and progesterone therapy on the the voice is not directly noticeable