Transgender Voice Research Articles

Perceptions, knowledge, and perceived competencies of South African speech-language pathologists to render transgender voice and communication training

Background Speech-language pathologists (SLPs) receive extensive education and training on voice and voice disorders. Therefore, they are integral in rendering transgender voice and communication training (TVCT), as part of their scope of practice. Research has, however, identified a lack of confidence in SLPs to render this service due to a perceived lack of education, knowledge, and clinical exposure. Aim To determine the perceptions, knowledge, and perceived competencies of South African SLPs regarding TVCT. Methods A cross-sectional open online survey design using non-probability purposive and convenience sampling was used. Fully qualified, practicing South African SLPs were asked to volunteer to participate on social media platforms. Fifty-two valid data sets were recorded. Results Most participants agreed that TVCT falls within their scope of practice (n = 42, 84%), viewing it as their ethical responsibility (n = 40, 80%) as well as a necessity (n = 34, 68%). However, most participants reported feeling inadequately prepared to provide TVCT (n = 34, 68%) due to insufficient education and training in this field, with 23 participants (45.1%) reporting that they had not received any education or training on the topic. Conclusions Participants generally held positive attitudes toward TVCT yet felt unprepared to render the service due to insufficient education, training, and exposure, revealing a crucial professional development need.

Inclusive Healthcare Settings: Promoting Post-operative Follow-up in Transgender Voice Care through Awareness and Education

Objectives: Gender-affirming laryngeal surgeries are becoming more common. Surgical outcomes for benign laryngeal disease are often affected by post-operative care. Documented barriers to medical care faced by transgender persons may affect their ability to participate in post-operative care visits and may affect their overall outcome. This study was initiated to compare the post-operative follow-up rates between patients who underwent gender-affirming laryngeal surgery and those who underwent voice surgery for non-neoplastic vocal fold lesions.

Introduction to the Perspectives Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Introduction to the <i>Perspectives</i> Forum on the Topic of Meta-Therapy in Speech-Language Pathology

Irish transgender voices on mental health and mental health care

PurposePeople who identify as transgender face stigma, isolation and harassment while often struggling to come to terms with their gender identity. They also disproportionately experience mental health difficulties. The purpose of this paper is to present the voices of transgender people in the Republic of Ireland (RoI) in regard to the issues they are facing, improvements they would like to see made to schools, workplaces, services and society in general and whether mental health supports fulfil their needs.Design/methodology/approachTen open questions were embedded within a quantitative online survey (LGBTIreland study) on factors impacting social inclusion, mental health and care. These open questions were re-analysed with exclusive focus on the transgender participants (n = 279) using content/thematic analysis.FindingsThe participants in this study reported significant signs of mental distress. The following themes emerged: impact of stigma, deficiencies in mental health services, need for education on transgender identity, importance of peer support, achieving self-acceptance and societal inclusion questioned.Research limitations/implicationsEfforts to recruit young participants have led to a possible over-representation in this study.Practical implicationsThe findings suggest the need for improvement in mental health support services, including further education in how to meet the needs of transgender individuals.Social implicationsTransgender people in Ireland experience social exclusion. The need for more inclusivity was emphasised most in secondary schools. Education on transgender identities in all contexts of society is recommended by the participants.Originality/valueThis study reports on the largest group of transgender participants to date in RoI. Their voices will affect perceptions on social inclusion and mental health care.

‘Everything about Us, for Us’: Avoiding ‘Perlocutionary Dominion’ in Catholic Writing about Trans People

This paper anticipates a peril involved in Catholic writing on trans issues, which I call perlocutionary dominion: the empowerment of cisgender voices, and disempowerment of transgender voices within our theological communities through perlocutionary acts. It finds an example of this peril in Helen Watt's paper, ‘Gender Transition: The Moral Meaning of Bodily and Social Presentation’, focusing specifically on the use of negative themes; as well as the less obvious, positive-affective feature of gestures of care. It then looks to Pope Francis's ‘four principles’ in Evangelii gaudium as the basis for a methodological principle that can help to avoid it. It argues that Francis's principles exhort us towards a project of community building that embraces alterity and invites critical engagement with our own convictions, while reflecting honestly on how our speech shapes that community in ways beyond their constative function. It concludes by suggesting the principle, ‘Everything About Us, For Us’, which encapsulates the kinds of behaviours required by this project.

Female to Male Transgender Voice Therapy at Gender Voice Centre

Female to Male Transgender Voice Therapy at Gender Voice Centre

Review: Women’s Voices in Digital Media: The Sonic Screen from Film to Memes, by Jennifer O’Meara

Review: <i>Women’s Voices in Digital Media: The Sonic Screen from Film to Memes</i>, by Jennifer O’Meara

J. K. Rowling and the Echo Chamber of Secrets

Abstract This autoethnographic article attempts to capture the distress of a trans woman in Scotland at the transphobia in the legacy media's coverage of the J. K. Rowling furore in June 2020. Through the use of a frame narrative, the article analyses some of the transphobic elements of Rowling's essay published on June 10, 2020, originally titled “TERF Wars,” which prompted an online backlash and a subsequent cycle of negative legacy media coverage against trans people. The article deconstructs two opinion pieces in the Scotsman and the National that depict Rowling as a victim and trans women as abusive and/or delusional, with an accompanying association of trans women with virtual spaces, set against cis women inhabiting real-world spaces. The newspapers' subsequent, respective refusal to publish counter articles criticizing the opinion pieces is then described, with reference to the legacy media's more general cancel-culture narrative, described by Sara Ahmed as a “mechanism of power.” Concluding on the experience of having no personal voice or access to the kind of influence enjoyed by a transphobic legacy media, the article refers to Andrew Anastasia's conception of three modes of transgender voice to identify how only collective action can allow trans voices to be heard and effect change.

Innovation in speech-language pathology research and writing: Transdisciplinary theoretical and ethical perspectives on cultural responsiveness

In this paper, we offer three paths for the development of innovation in speech-language pathology (SLP), which enhance the discipline’s capacity to address issues of diversity, inclusion and cultural responsiveness: transdisciplinary theoretical research, researcher reflexivity, and changes in ethical standards. First, we engage in a reflective conversation to identify facilitators and barriers to innovation we have encountered as academics who speak and write from personal and professional positionings that move between the privileged and the marginalised. Second, we present the results of a critical discourse analysis of the 2020 revisions to Speech Pathology Australia’s Code of Ethics and characterise recent changes in the field’s expanding understanding of ethical research and clinical practices. Third, we discuss how speech-language pathologists might reconsider their modes of engagement with clients and research populations in our shared area of specialisation—transgender voice. Together, these insights can support speech-language pathologists in further developing a contemporary, self-reflective, culturally humble and responsive professional culture.

Readability Analysis and Accessibility of Online Materials About Transgender Voice Care.

To determine readability, understandability, and actionability of online health information related to transgender voice care. Review of online materials. Academic medical center. A Google search of "transgender voice care" was performed with the first 50 websites meeting inclusion criteria included. Readability was assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and the Simple Measure of Gobbledygook (SMOG). Understandability and actionability were measured by 2 independent reviewers using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). Unpaired t tests were used to compare clinician- and patient-oriented sites, surgical and nonsurgical sites, and sites that discuss nonbinary indications for voice care. Analysis of variance was used to compare sites that discuss voice feminization, masculinization, both, or neither. Average scores across the cohort for FRES, FKGL, and SMOG were 43.77 ± 13.52, 12.14 ± 2.66, and 11.30 ± 1.93, respectively, indicating materials were above a 12th-grade reading level. PEMAT-P scores for understandability and actionability were 64.95% ± 15.78% and 40.55% ± 23.86%, respectively. Patient-oriented sites were significantly more understandable and actionable than clinician-oriented sites (P < .02). Websites that discussed only voice feminization were significantly more readable according to objective metrics (FKGL, SMOG) than websites that discussed both feminization and masculinization or those that did not differentiate care types (P < .05). Online information written about transgender voice care is written at a level above what is recommended for patient education materials. Providers may improve accessibility of transgender voice care by enhancing readability of online materials.

Transgender Care Experiences, Barriers, and Recommendations for Improvement in a Large Integrated Health Care System in the United States.

Transgender individuals who pursue gender affirmation medical procedures often need to navigate a complex health system and interact with multiple health care providers in primary and specialty care. We sought to better understand patient, provider, and system level barriers to transgender care in a large integrated health care system in California. Three 90-min focus groups were conducted with 13 transgender individuals who received specialty care between April and August 2018 in Kaiser Permanente Southern California. Participants cited common adversities such as misgendering and system-wide insensitivity during health care encounters and low levels of understanding of their transgender experience among primary care providers. Provider-patient relationship improvements were recommended for pre- and postsurgical care and service-provider sensitivity training. Suggestions include better care coordination, reducing redundancy in clearance for specialty care services, and enhancing patient support for navigation of gender affirmation services. Participants requested careful consideration when implementing systemwide routine processes such as using pronouns and names when calling patients in for visits or describing procedures on service invoices. Education and training programs for improving transgender care competency and enhancing care coordination between primary care and specialty care for transgender patients are warranted. Including transgender voices with lived-experience as active stakeholders in ongoing efforts such as community advisory boards to identify care gaps may facilitate patient-centered and culturally sensitive transgender care and increased patient satisfaction. There is a need for systematic training for transgender care competent providers and enhancement of care coordination between primary care and specialty care.

‘This app can help you change your voice’: Authenticity and authority in mobile applications for transgender voice training

Mobile applications for transgender voice training seek to help trans people alter their speaking voices, often with the goal of alignment with one or another pole of binary gender expression (i.e., voice ‘feminization’ or ‘masculinization’). These apps offer instruction, audio tools and feedback mechanisms that allow users to record, evaluate and track their progress relative to a desired – and gendered – goal. As with digital technologies generally, however, these apps draw on and reproduce particular ideas of both the needs and capacities of imagined users and broader social and political phenomena – in this case, voice, gender expression and gender transition. In the following paper, we undertake a critical discourse analysis of five mobile voice training apps for transgender people. We find that rather than offering expansive or open-ended conceptions of gender, these apps reproduce ideals of gender as not only binary but also white, affluent and able-bodied. We also offer a critique of the apps’ characterization of transition as reifying the normative authority of clinical and technoscientific knowledge and conditioning ‘authenticity’ on an ability to conform to (racialized, classed and ableist) binary gender norms.

Transgenders in Ancient Tamil Literature

There is no transgender voice or pro-transgender voice in the ancient Tamil literature. Transgender explanations need to be compiled from what is reported as information in grammatical commentary and literary works. Transgender people have been living in Tamil Nadu since ancient times can be found in Sangam literary works. Records about transgenders have appeared in Tolkappiyam and Nigandus. Tamil epics narrates that it is possible to know the status of transgender people living in harmony with palace life. Devotional literary works refer to gender’s past status as Lord being male, female, and transgender. In Tamil Nadu, transgender people are completely ignored as the emphasis of male chauvinism. In general values about transgender have been recorded in the ancient literary works.

Out of Place in Time: Queer Discontents and Sigisangjo

AbstractThis article discusses queer and transgender voices that took part in the South Korean Candlelight Protests of 2016–17 but became sidelined during the special election that followed Park Geun-hye's impeachment. Drawing from theories of queer temporality and feminist critiques of homogenous time, the article argues that idioms of postponement (najunge) and prematurity (sigisangjo) have significantly shaped liberal political discourses regarding the timing and timeliness of social change and minority politics in South Korea. These normative idioms of temporality articulate the stakes of being out of place in time.

Perceived Gender and Client Satisfaction in Transgender Voice Work: Comparing Self and Listener Rating Scales across a Training Program

Background/Aim: Scales used to collect perceptual ratings related to a speaker’s gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps. Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors “very feminine/very masculine” and “very female/very male.” Trans participants also rated their satisfaction with their current voice on a VAS with anchors “very satisfied/very unsatisfied.” Correlation coefficients were calculated to investigate the relationship between collected ratings. Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training. Discussion/Conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice.

Thud-Tempters and Mockingbirds: A Cognitive–Linguistic Approach to Acoustic Assumptions

Purpose This study analyzed information shared through journal reflections of a client and a student clinician participating in The College of Saint Rose Transgender Voice and Communication Program related to the application and implications of Acoustic Assumptions. This research note was generated by a client, a student clinician, and certified speech-language pathologists. Method This single-case study focused on an eclectic approach to gender-affirmative voice services that addressed factors related to resonance commonly explored with transgender clients. A first-person account of reactions to therapy served as the foundation for journal reflections made by the client and the student clinician. Therefore, first-person language appears in the journal entries to detail our perspectives of this clinical experience. Results Providing gender-affirmative voice services in a holistic manner helped the client align her communication with her gender identity. Creating a client-specific conceptual framework that prioritized elements of cognitive–linguistic therapy, education, and counseling supported the client as the resonance challenges frequently experienced by transgender and gender-nonconforming individuals outlined in Acoustic Assumptions were explored. Limitations regarding the clinical application of this highly individualized approach to resonance are acknowledged. The findings from this study may not generalize to entire clinical populations, given the format of the research design. Conclusions We found this therapeutic approach helped the client develop a personalized understanding of the resonance challenges she was experiencing (see below for a more detailed discussion of those challenges). And she was able to deepen her ability to produce voice with forward resonance, an acoustic parameter that researchers have found many listeners to associate with “femininity” and that, in this case, aligned with the client's perception of femininity. Techniques used and observations on them may be useful for future work in gender-affirmative voice services.

Voice-related Experiences of Nonbinary Individuals (VENI) Development and Content Validity

Transgender individuals may seek a variety of gender-affirming health and educational services, including voice modification from speech-language pathologists. Measuring the client's self-perception of their communication experiences is crucial for providing client-centered services and measuring outcomes. However, there is currently no validated assessment tool for the nonbinary population, a part of the transgender population. This study explores the voice-related concerns and experiences among the nonbinary population to create a valid measure of their self-perception of voice. Ten nonbinary individuals were surveyed about their voice-related concerns and experiences. A thematic analysis of the responses led to the development of the questionnaire, titled the Voice-related Experiences of Nonbinary Individuals. The questionnaire was systematically evaluated for its content validity by a panel of speech-language pathologist experts in transgender voice services. Outcomes of this analysis supported the measure's content validity and motivated further revisions. This is the first assessment tool that measures self-perception of voice and voice-related experiences for nonbinary individuals. Initial psychometric testing supported its content validity and further research is needed for large-scale testing of validity and reliability.

Online Community-based Design of Free and Open Source Software for Transgender Voice Training

This paper describes Project Spectra, a collective of open source developers that aims to build free and open source voice training technology for transgender people. We demonstrate how a design prioritizing the agency of trans users was made possible through sustained community collaboration. Using an autoethnographic approach, we discuss our community-based design process, which was documented with memos, online meetings and text conversations, sketches, and other data sources. We illustrate how we articulated our values as a group: deciding our programming framework (including a Statement of Principles), elaborating our "Experience Goals" (the feelings we wanted our design to elicit), and determining the features we wanted to implement in our app. We conclude with a reflection on the benefits and challenges of conducting community-based design research through an open-source organizational model.

The Importance of Orofacial Motricity in the Work of Confirmation of Transgender Voice: An Integrative Review

The voice is a manifestation of the muscular process, but with psychological basis, thus being an important aspect in performance and gender recognition. The transgender person finds him/herself in biological bodies not recognized by him/her. Many of them undergo hormone treatments and surgeries to suit their gender identity and value interventions in their body and voice. Objective: To explain the importance of the relationship between orofacial motricity and voice in the phonotherapeutic work to confirm the transgender voice. Methods: A literature search was conducted covering the period from 2010 to 2020, including articles with experimental validation, which discussed therapy techniques or evaluation instruments. Results: The search resulted in 1512 publications. After applying the inclusion and exclusion criteria, 31 articles were selected. After detailed analysis of the selected abstracts and prioritization of the discussion of orofacial motricity elements, nine articles were chosen for critical analysis. All selected articles contributed to clarify the research question. Conclusion: Orofacial motricity plays a fundamental role in the confirmation of the transgender voice.

Constructivism over Determinism

The literal voice is a principal contributor to identity construction. Consequently, it is a common source of gender dysphoria for transgender females undergoing voice feminisation. Much of the research in this field has primarily viewed this phenomenon from a determinist perspective, equating physiology with vocal identity. Although many approaches to voice feminisation rely on this predominately physiological point of view, objective measures defining voice femininity are not always correlated with transgender client satisfaction (Dacakis et al., 2017: 835–37). This evidence demonstrates the need to look at the voice more constructively—or as a conglomeration of many social, physical and cultural factors—in therapeutic voice interventions. Previously reported clinical outcomes and empirical research concerning the links between the voice and gender identity give credence to this constructivist perspective, which must be more heavily emphasised in transgender voice feminisation approaches moving forward.