Symptomatic voice therapy enhances vocal exercise response in transgender patients

By Piriya Mahendra, medwireNews Reporter

Vocal function exercises do not significantly improve the voice feminization of male-to-female (MTF) transgender patients, but researchers say that symptomatic voice therapy and the experience of full-time living as a woman may help.

Marylou Gelfer (University of Wisconsin-Milwaukee, USA) and Bethany Van Dong (Wausau School District, Wisconsin, USA) studied the effect of individual voice therapy incorporating Stemple's vocal function exercises on three MTF transgender patients, and found that they appeared more similar to female control speakers after undergoing therapy than they did beforehand.

Although listeners continued to identify the voices of the MTF transgender patients as being male before they underwent the intervention, they rated the voices as significantly less masculine and more feminine than they did before the therapy intervention.

Indeed, just 7.4% of the listeners rated the voices they heard after the intervention as female, and 92.6% as male, compared with 100% rating the voices as male before the intervention. However, on a scale of 1.0 to 7.0 where 1.0 was equal to "very masculine," and 7.0 to "not very masculine at all," listeners rated the voices a mean of 5.55 after the voice intervention compared with 2.94 before it.

The speech samples of the three MTF transgender patients were played to listeners before and after their intervention, which consisted of two 1-hour symptomatic voice therapy sessions per week and two sessions of Stemple's vocal function exercises each day for 6 weeks. Three women and three men served as controls.

After an initial target for speaking fundamental frequency was chosen for each patient according to their age, vocal range, and initial speaking fundamental frequency measurements, each patient began their symptomatic voice therapy session by chanting syllables beginning with the letters "m," "n," and "l."

As part of the Stemple's exercises, each patient was instructed to hold the vowel "i" on the musical note middle C, then glide from their lowest to highest possible note on the prompt "knoll," glide from their highest to lowest possible note on the same prompt, and hold the vowel "o" on each note beginning with the musical note G below middle C.

The MTF transgender patients felt that the vocal function exercises were a positive part of their therapy experience, but they emphasized that the exercises alone would not have resulted in the same level of voice feminization as the combination of the symptomatic therapy and voice exercises, the authors note in the Journal of Voice.

"Results of this study suggest that symptomatic voice treatment plays the most important role in voice feminization, although physiological approaches may be used in a complementary way," say Gelfer and Van Dong.

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