Trans Erkeklerde Uzun Dönem Androjen Tedavisinin Sesle İlişkili Sonuçları

Öz

Amaç: Bu çalışmanın amacı trans erkek bireylerde uzun süreli androjen tedavisinin sesle ilişkili sonuçlarını değerlendirmektir.

Yöntem: En az bir yıldır hormon tedavisi gören trans erkek bireyler değerlendirmeye alındı. Sesin Erkeksiliğini Algısal Değerlendirme (SPVM) ölçeği, trans erkekler için uyarlanmış Transseksüel Ses Anketi (a-TVQ^FtM), Sesle ilişkili Yaşam Kalitesi (V-RQOL) ve fundamental frekans (f0) ses sonuç ölçütleri kullanıldı.

Bulgular: Çalışmaya dahil edilen 13 trans erkek bireyin yaş ortalaması 26.15 idi. Medyan SPVM skoru 4 olup biraz erkeksi algılandığı gözlendi. Medyan f0 skoru 119 Hertz idi ve Türk erkek normatif verilerinden farklı değildi. Medyan a-TVQ^FtM skorlarındaki azalma eğilimi ve medyan V-RQOL ölçek skorlarında artış eğilimi, medyan f0 skorlarının düşüşü ile uyumlu idi. İki bireyin f0’ı cinsiyet belirsiz ses aralığındaydı ve % 15,4'lük bir başarısızlık gözlendi. Cinsiyeti belirsiz ses aralığında olan bu iki bireyden biri sesini nötral algılarken diğeri sesini çok erkeksi algıladı.

Sonuç: Karşı cins hormon tedavisi, tedavi isteyen trans erkek bireyler için erkeksi ses elde etmede etkilidir. Ses perdesini düşürücü etkisi, trans bireylerin sesle ilgili yaşam kalitesinde, özellikle de ses kimliği ile ilişkili anlamlı iyileşme sağlamaktadır. Bazı olgularda, erkek ses aralığı elde edilemeyebilir. Böyle bir durumda, tedavi sonuçları ve ek müdahalelerin gerekliliği dikkatle değerlendirilmelidir.

Anahtar Kelimeler

• Ses, Hormon tedavisi, transseksüel,testosteron,yaşam kalitesi,öz algı

Voice-related Outcomes after Long-Term Androgen Treatment in Trans Males

Öz

Objective: The aim of this study was to evaluate voice-related outcomes of long-term androgen treatment in trans male individuals.

Methods: Trans male individuals who were under hormone treatment for at least one year were evaluated. Self-Perception of Voice Masculinity (SPVM) scale, adapted Transsexual Voice Questionnaire for trans males (a-TVQ^FtM), Voice-related Quality of Life (V-RQOL), and the mean fundamental frequency (f0) were used to assess voice outcomes.

Results: Of the thirteen trans male individuals in this study, the mean age was 26.15 years. The median SPVM was 4, which equated to “somewhat male”. The median f0 was 119 Hz and did not differ from Turkish cisgender male normative data. The median a-TVQ^FtM scores showed a decreasing trend and the median V-RQOL scale scores showed an increasing trend in accordance with the decrease of median f0 scores. Two individuals were within a gender ambiguous f0 range and a failure rate of 15.4% was observed. Of these two individuals who were still within a gender ambiguous f0 range, one perceived his voice as gender neutral, while the other one perceived his voice as very male.

Conclusion: Cross-sex hormone treatment was largely effective in voice masculinization for trans male individuals seeking treatment. Its pitch lowering effect is associated with a significant improvement in the voice-related quality of life of trans individuals, especially in vocal identity. In some cases, a cisgender male frequency may not be achieved. This situation should be evaluated with caution when discussing treatment outcomes and the necessity of additional interventions. 

Anahtar Kelimeler

• Voice,hormone therapy,transgender,testosterone,quality of life,self-perception

Kaynakça

1. Bouman WP, Schwend AS, Motmans J, et al. Language and trans health. Int J Transgend. 2017;18(1):1-6.
2. 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(4):165-232.
3. 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(2):125-37.
4. Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5(4):301-311.
5. 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; 2012:187-224.
6. 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(2):261.e9-261.e23.
7. Dacakis G, Davies S, Oates JM, Douglas JM, Johnston JR. Development and preliminary evaluation of the transsexual voice questionnaire for male-to-female transsexuals. J Voice. 2013;27(3):312-320.
8. 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(6):994-9.

9. 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(12):2796-2804.
10. Watt SO, Tskhay KO, Rule NO. Masculine voices predict well-being in female-to-male transgender individuals. Arch Sex Behav. 2018;47(4):963-72.
11. Bultynck C, Pas C, Defreyne J, Cosyns M, T’Sjoen G. Organizing the voice questionnaire for transgender persons. Int J Transgend. 2019;1-9. doi: 10.1080/15532739.2019.1605555.
12. Taskin A, Aydınlı FE, Başar K, Yılmaz T, Özcebe E. Investigating the validity and reliability of the Turkish version of the transsexual voice questionnaire (TVQMtF). Paper presented at: 3rd Biennal of EPATH Conference Inside Matters. On Law, Ethics and Religion; April 11-13, 2019; Rome. Completed Text book, 2019, pp. 80-81, Rome, Italy.
13. Sirin S, Polat A. Psychometric evaluation of adapted transsexual voice questionnaire for Turkish trans males. Paper presented at: VoiceIstanbul. International Conference on Voice in All Aspects; September 16-19, 2019; Istanbul. Abstract book, 2019, pp.27, Istanbul, Turkey.
14. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999;13(4):557- 69.
15. Tezcaner ZC, Aksoy S. Reliability and Validity of the Turkish version of the voice-related quality of life measure. J Voice. 2017;31(2):262.e7-262.e11.
16. Demirhan E, Unsal ME, Yilmaz C, Ertan E. Acoustic voice analysis of young Turkish speakers. J Voice. 2016;30(3):378.e21-5.
17. Ziegler A, Henke T, Wiedrick J, Helou LB. Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review. Int J Transgend. 2018;19(1):25-45.
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(1):31-47.
19. Cosyns M, Van Borsel J, Wierckx K, et al. Voice in female-to-male transsexual persons after long-term androgen therapy. Laryngoscope. 2014;124(6):1409-14.
20. Van Borsel J, De Cuypere G, Rubens R, Destaerke B. Voice problems in female-to-male transsexuals. Int J Lang Commun Disord. 2000;35(3):427-42.
21. 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(6):766.e23-766.e34.
22. 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(4):959-65.
23. 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., editors. 2004 IALP-Congress-Proceedings. Brisbane: Speech Pathology Australia; 2004:1-6.
24. Hancock AB, Childs KD, Irwig MS. Trans male voice in the first year of testosterone therapy: make no assumptions. J Speech Lang Hear Res. 2017;60(9):2472-2482.
25. Van Borsel J, de Pot K, De Cuypere G. Voice and physical appearance in female-to-male transsexuals. J Voice. 2009;23(4):494-7.
26. Damrose JE. Quantifying the impact of androgen therapy on the female larynx. Auris Nasus Larynx. 2009;36(1):110-2.
27. Pegoraro Krook MI. Speaking fundamental frequency characteristics of normal Swedish subjects obtained by glottal frequency analysis. Folia Phoniatr (Basel). 1988;40(2):82-90.
28. Klatt DH, Klatt LC. Analysis, synthesis, and perception of voice quality variations among female and male talkers. J Acoust Soc Am. 1990;87(2):820-857.
29. 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.