The association between subjective and objective masculine vocal quality in hormone-naïve trans-male individuals

Abstract

Objective: The aim of this study is to investigate the association between subjective and objective masculine vocal quality in hormone-naïve trans-male individuals.

Methods: Twenty-seven hormone-naïve trans-male individuals were recruited for the study. All the study participants had applied to undergo the gender transition process and been referred to the Voice Clinic. The Self-Perception of Voice Masculinity (SPVM) scale and the mean fundamental frequency (F0) were used to assess any association between subjective and objective vocal masculinity.

Results: The mean age of study participants was 25.3 years. The median F0 lay within the normal limits for cisgender females. However, in 12 out of 27 cases, F0 lay within the gender-ambiguous frequency range. SPVM scores were higher in this ambiguous group, a result with a strong tendency toward statistical significance (p=0.053). A moderate negative correlation between SPVM and F0 scores was observed (r=-0.484, p=0.027).  The smoking frequency was high, with 77.8% of individuals in the group as a whole being smokers. Not only were F0 values of smokers lower than those of non-smokers, but their SPVM scores were also higher.

Conclusion: The findings from this study indicate that diversity in objective and subjective voice parameters exists even within the hormone naïve period. There appear to be several factors which influence F0 to a significant extent. Accordingly, a more comprehensive approach is called for when assessing transgender voice at all stages of the gender-affirming medical treatment process. The high frequency of smoking amongst the trans-male population should also be noted as it constitutes a serious health hazard.

Keywords

• Transgenders,voice,masculinity,smoking behaviour,voice quality

Kaynakça

1. 1. Bouman WP, Schwend AS, Motmans J, et al. Language and trans health. Int J Transgend 2017;18:1-6.
2. 2. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Arlington: American Psychiatry Association; 2015.p.156-160.
3. 3. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgend 2012;13:165-232.
4. 4. Sirin S, Polat A, Alioğlu F. Voice-related gender dysphoria: quality of life in hormone naive trans male individuals. Anadolu Psikiyatri Derg 2019. doi: 10.5455/apd.41947.
5. 5. Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol 2017;5:301-311.
6. 6. Nygren U, Nordenskjöld A, Arver S, Södersten M. Effects on voice fundamental frequency and satisfaction with voice in trans men during testosterone treatment-a longitudinal study. J Voice 2016;30:766.e23-34.
7. 7. Deuster D, Matulat P, Knief A, et al. Voice deepening under testosterone treatment in female-to-male gender dysphoric individuals. Eur Arch Otorhinolaryngol 2016; 273:959-65.
8. 8. Azul D, Nygren U, Södersten M, Neuschaefer-Rube C. Transmasculine people's voice function: A review of the currently available evidence. J Voice 2017;31:261.e9-261.e23.

9. 9. Ziegler A, Henke T, Wiedrick J, Helou LB. Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review. Int J Transgender 2018;19:25-45.
10. 10. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009;94:3132-54.
11. 11. Dekker MJ, Wierckx K, Van Caenegem E, et al. A European Network for the Investigation of Gender Incongruence: Endocrine Part. J Sex Med 2016;13:994-9.
12. 12. Scheidt D, Kob M, Willmes K, Neuschaefer-Rube C. Do we need voice therapy for female-to-male transgenders? In: Murdoch BE, Gooze J, Whelan B-M, et al., eds. 2004 IALP-Congress-Proceedings. Brisbane: Speech Pathology Australia: 2004.
13. 13. Polat A, Alioğlu F. Gender dysphoria: Kocaeli University Hospital experience. [Article in Turkish] Anadolu Psikiyatri Derg 2019;20:101-109.
14. 14. Dacakis G, Oates J, Douglas J. Associations between the Transsexual Voice Questionnaire (TVQMtF) and self-report of voice femininity and acoustic voice measures. Int J Lang Commun Disord 2017;52:831-838.
15. 15. Watt SO, Tskhay KO, Rule NO. Masculine voices predict well-being in female-to-male transgender individuals. Arch Sex Behav 2018;47:963-72.
16. 16. Hillenbrand JM, Clark MJ. The role of f (0) and formant frequencies in distinguishing the voices of men and women. Atten Percept Psychophys 2009;71:1150-66.
17. 17. Hardy TL, Boliek CA, Wells K, Dearden C, Zalmanowitz C, Rieger JM. Pretreatment acoustic predictors of gender, femininity, and naturalness ratings in individuals with male-to-female gender identity. Am J Speech Lang Pathol 2016;25:125-37.
18. 18. Azul D. Transmasculine people’s vocal situations: a critical review of gender-related discourses and empirical data. Int J Lang Commun Disord 2015;50:31–47.
19. 19. Gelfer MP, Mordaunt M. Pitch and intonation. In Adler RK, Hirsch S, Mordaunt M, editors. Voice and Communication Therapy for The Transgender/Transsexual Client: A Comprehensive Clinical Guide. San Diego, CA: Plural Publishing; 2012. p. 187-224.
20. 20. Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez- Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry 2015;30:807-815.
21. 21. Åhs JW, Dhejne C, Magnusson C, et al. Proportion of adults in the general population of Stockholm County who want gender-affirming medical treatment. PloS One 2018;13: e0204606.
22. 22. Belin P, Bestelmeyer PE, Latinus M, Watson R. Understanding voice perception. Br J Psychol 2011;102:711-25.
23. 23. Belin P, Fecteau S, Bedard C. Thinking the voice: neural correlates of voice perception. Trends in Cogn Sci 2004;8:129-135.
24. 24. Nobili A, Glazebrook C, Arcelus J. Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Rev Endocr Metab Disord 2018;19:199-220.
25. 25. Sandmann K, Am Zehnhoff-Dinnesen A, Schmidt CM, et al. Differences between self-assessment and external rating of voice with regard to sex characteristics, age, and attractiveness. J Voice 2014;28:128.e11-128.e18.
26. 26. Berg M, Fuchs M, Wirkner K, et al. The speaking voice in the general population: normative data and associations to sociodemographic and lifestyle factors. J Voice 2017;31:257.e13-257.e24.
27. 27. Bultynck C, Pas C, Defreyne J, Cosyns M, den Heijer M, T’Sjoen G. Self-perception of voice in transgender persons during cross-sex hormone therapy. Laryngoscope 2017; 127:2796-2804.
28. 28. Van Borsel J, De Cuypere G, Rubens R, Destaerke B. Voice problems in female-to-male transsexuals. Int J Lang Commun Disord 2000;35:427-442.
29. 29. Damrose EJ. Quantifying the impact of androgen therapy on the female larynx. Auris Nasus Larynx 2009;36:110-112.
30. 30. Deuster D, Di Vincenzo K, Szukaj M, Am Zehnhoff-Dinnesen A, Dobel C. Change of speech fundamental frequency explains the satisfaction with voice in response to testosterone therapy in female-to-male gender dysphoric individuals. Eur Arch Otorhinolaryngol 2016;273:2127-2131.
31. 31. Irwig MS, Childs K, Hancock AB. Effects of testosterone on the transgender male voice. Andrology 2017;5:107-112.
32. 32. Pegoraro Krook MI. Speaking fundamental frequency characteristics of normal Swedish subjects obtained by glottal frequency analysis. Folia Phoniatr (Basel) 1988;40:82-90.
33. 33. Tatar EC, Sahin M, Demiral D, Bayir O, Saylam G, Ozdek A. Normative values of voice analysis parameters with respect to menstrual cycle in healthy adult Turkish women. J Voice 2016;30:322-8.
34. 34. Vincent I, Gilbert HR. The effects of cigarette smoking on the female voice. Logoped Phoniatr Vocol 2012;37:22-32.
35. 35. Davies S, Papp VG, Antoni C. Voice and communication change for gender nonconforming individuals: Giving voice to the person inside. Int J Transgender 2015;16:117-159.
36. 36. Cosyns M, Van Borsel J, Wierckx K, et al. Voice in female-to-male transsexual persons after long-term androgen therapy. Laryngoscope 2014;124:1409-14.
37. 37. T’Sjoen G, Moerman M, Van Borsel J, et al. Impact of Voice in Transsexuals. Int J Transgender 2006;9:1-7.
38. 38. Klatt DH, Klatt LC. Analysis, synthesis, and perception of voice quality variations among female and male talkers. J Acoust Soc Am 1990;87:820-857.
39. 39. Sanchez K, Oates J, Dacakis G, et al. Speech and voice range profiles of adults with untrained normal voices: methodological implications. Logoped Phoniatr Vocol 2014;39:62-71.