Relevance of the voice in the process of gender affirmation in transsexual women: A cross-sectional study

Introduction. Voice is a gender marker and can therefore be a source of gender dysphoria. There is a relationship between symptoms of anxiety and depression and voice-related difficulties in trans women (TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to voice feminization procedures is limited while the population demanding transgender healthcare is increasing. Objective. To describe the degree of voice-related dysphoria experienced by TW that seek a voice feminization treatment. Method. A descriptive, cross-sectional study, 26 TW completed quality of life (QoL) questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was measured. Results. 77% of the participants were legally recognized as women, 96% were under HRT, and 27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a feminine voice that allows gender conformity was the main reason for seeking treatment. Discussion and conclusion. Voice non-conformity affects QoL. None of the participants perceived their voice as feminine while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization treatments, it is difficult to define how to measure success.