Physical Features Contributing to Gender Dysphoria: The Role of Voice.

Abstract

Objective: Features that cause gender incongruence (gender identity not aligning with assumptions based on sex assigned at birth) in transgender individuals often motivate them to seek out gender-affirming treatments. Voice has rarely been included as a major contributor to gender dysphoria. The primary objective of this study is to understand the significance of dysphoria related to voice compared to dysphoria secondary to other features.

Study design: Prospective population-based survey study.

Setting: Social media.

Methods: The survey requested a ranking of features that contribute to gender dysphoria, whether the features were bothersome due to external or internal perception, and self-reported ideal order for pursuing gender-affirming treatments. The categories of features that were ranked included upper body, lower body, face, neck, voice, and height.

Results: In total, 79% of respondents experience gender incongruence secondary to their voice. Voice was the second most important feature contributing to gender dysphoria, only after upper body. In transgender men (29.4%) and transgender women (25%), voice was both the second most important feature contributing to gender dysphoria and the second most important intervention to alleviate gender dysphoria. Specifically, vocal incongruence is largely due to perception by others, as opposed to lower body which contributes to incongruence due to perception by self.

Conclusion: Voice is the second most common contributor to gender dysphoria after upper body. Due to self-rated importance of voice to gender incongruence, health care providers must be aware that voice interventions are critical to improve gender dysphoria experienced by transgender individuals.