Abstract
Purpose: A service evaluation was undertaken with 10 participants identifying as trans men who received voice and communication group therapy and 12-month follow-up at the London Gender Identity Clinic between February 2017 and March 2018, to investigate levels of satisfaction, how helpful they found the program in facilitating vocal change and skill development, and whether they would recommend it to others.Methods: Participant evaluations of overall and ideal rating of masculinity of voice, and level of feeling comfortable with voice, evaluations of voice skills and changes in speaking and reading fundamental frequency were retrospectively reviewed and analyzed.Results: Six participants reported being very satisfied with the service; four were satisfied. Eight participants found the program very helpful in achieving voice and communication change; two found it helpful. Eight strongly agreed and two agreed with recommending the service. Participants' overall and comfort ratings of voice significantly increased (p<0.01), while there was no significant change in ideal ratings (p=0.063), and a significant decrease in the difference between overall and ideal ratings (p<0.01). Participants achieved a significant decrease in fundamental frequency for reading and speaking (p<0.01), a significant decrease in voice fatigue (p=0.039) and restriction in voice adaptability (p<0.01), a significant increase in confidence in public speaking (p<0.01), but no significant change in vocal projection (p=0.07).Conclusion: Ten trans men reported high levels of satisfaction with the voice group program and long-term follow-up, making significant positive shifts in voice skills and vocal self-perception. These findings apply locally but suggest appropriate interventions toward a transmasculine voice modification protocol.
Highlights
Transmasculine people form a diverse group,[1] and studies addressing the invisibility of this population, the psychosocial impact of voice, self-perception of vocal masculinity, and experience of voice and communication therapy services are starting to emerge.2,3 ‘‘Transmasculine’’ is an overarching term used in this article to refer to individuals assigned female at birth who have a more masculine, sometimes nonbinary, identity; signaling birth assignation, though, requires sensitive handling as it may be experienced as shaming.[4,5]
The analyses showed a significant decrease in ratings of vocal fatigue [t(9) = 2.41, p = 0.039, d = 0.76] and restriction on the adaptability of voice [t(9) = 6, p < 0.01, d = 1.9], and a significant increase in confidence in public speaking [t(9) = 5.02, p < 0.01, d = 1.59]
Qualitative data from client narratives at the 12-month follow-up, together with the decrease in the difference between participants’ overall and ideal ratings for their voice, suggest that positive achievements were linked to increasing confidence, for example: ‘‘I have been able to raise the bar higher as I developed my voice more.’’ Self-evaluations confirmed that group therapy can address broader aspects of vocal function such as vocal stamina and flexibility, and more confident presentation of self, such as in public speaking
Summary
Transmasculine people form a diverse group,[1] and studies addressing the invisibility of this population, the psychosocial impact of voice, self-perception of vocal masculinity, and experience of voice and communication therapy services are starting to emerge.2,3 ‘‘Transmasculine’’ is an overarching term used in this article to refer to individuals assigned female at birth who have a more masculine, sometimes nonbinary, identity; signaling birth assignation, though, requires sensitive handling as it may be experienced as shaming.[4,5] Vocal researchers tend to report lowering of the speaking fundamental frequency (F0) as a result of the action of exogenous androgen therapy in thickening vocal fold mass to gender-confirming and satisfactorily masculine-sounding levels.[2,3,6,7,8] This has led to claims that transmasculine people experience fewer barriers to achieving their desired vocal identity thanLondon Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom. Transmasculine people form a diverse group,[1] and studies addressing the invisibility of this population, the psychosocial impact of voice, self-perception of vocal masculinity, and experience of voice and communication therapy services are starting to emerge.2,3 ‘‘Transmasculine’’ is an overarching term used in this article to refer to individuals assigned female at birth who have a more masculine, sometimes nonbinary, identity; signaling birth assignation, though, requires sensitive handling as it may be experienced as shaming.[4,5] Vocal researchers tend to report lowering of the speaking fundamental frequency (F0) as a result of the action of exogenous androgen therapy in thickening vocal fold mass to gender-confirming and satisfactorily masculine-sounding levels.[2,3,6,7,8] This has led to claims that transmasculine people experience fewer barriers to achieving their desired vocal identity than. There is growing evidence that transmasculine people have particular needs beyond the testosterone-induced effect on pitch in terms of developing voice and communication skills in dynamic psychosocial contexts.[14,17] Azul[1] considers the ‘‘vocal situation’’ of transmasculine speakers to be potentially challenging as a result of the interplay between complex factors: presentational (the anatomy and physiology of the speaker/singer’s voice and their vocalcommunicative behaviors), attributional
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