Current approaches to gender-affirming vocal care.

Abstract

This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasises the importance of a multidisciplinary approach involving therapeutic and surgical interventions. Recent literature on gender-affirming vocal care emphasises key themes such as assessment, voice feminisation therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinised complications associated with surgical interventions. Most publications in the last 18 months advocate for the integration of voice therapy and surgery for optimal outcomes. Utilising a combined approach is significantly more effective in terms of fundamental frequency gain compared to therapy alone. Modified Wendler's Glottoplasty remains the preferred and most reliable surgical intervention. However, surgery is not without its complications and vocal trade-offs, in particular, its impact on vocal projection and the risk of long-term dysphonia. Post-surgery rehabilitation improves long-term outcomes. Recent publications on alternative surgical approaches, namely laser reduction glottoplasty and feminisation laryngoplasty, show promise but the results are more difficult to generalise. Prospective multicentre studies with standardised protocols are needed to establish best evidence-based practices.