Effects of Voice Related Gender Dysphoria on the Autonomic Nervous System in Trans Women

Objective:. It is well documented that gender dysphoria and lack of gender affirming healthcare decreases the quality of life (QoL), increases suicidal ideation and attempts, and increases stress in trans women. Regarding voice related gender dysphoria, reduced access to communication is a compounding factor. There is little research on the effects of voice related gender dysphoria on stress responses that are regulated by the autonomic nervous system (ANS). Considering the amount of stress that gender dysphoria causes and the central role of ANS activity in stress responses, it is essential to examine the impact of voice related gender dysphoria on the ANS in trans women. More specifically, we aim to 1) examine parasympathetic nervous system activity (PNS) and sympathetic nervous system (SNS) responses to voice related gender dysphoria, and 2) investigate the implications of these findings on the QoL. We hypothesize that there will be decreased PNS activity and increased SNS activity, indicating increased stress levels that can negatively impact QoL in trans women.

Method: A mixed methods, cross sectional study design across 8 trans women with self reported low levels of voice related gender dysphoria, 8 trans women with self reported high levels of voice related gender dysphoria, and 8 cisgender women will be used. The study will be conducted in three phases: Phase 1- baseline voice (speaking fundamental frequency, standard deviation of fundamental frequency, smoothed cepstral peak prominence and standard deviation of smoothed cepstral peak prominence, and physiological measures (heart rate variability, respiratory sinus arrhythmia, cardiac output, stroke volume). Phase 2- Revised Trans Women Voice Questionnaire and semi-structured interview inviting participants to recount their experiences and feelings, and Phase 3- post voice and physiological measures.

Results/Conclusion: Recruitment, data collection, and analyses are ongoing. Based on our review of the available literature, we hypothesize that voice related gender dysphoria will increase the average fundamental frequency, increase sympathetic activation, and reduce parasympathetic control in trans women.