Dysphonia Risk, Presence of Vocal Changes, and Vocal Self-Perception in Brazilian Transgender Women

Objective: Once scientific literature states that general behaviors, dysphonia risk and vocal behaviors are key to vocal quality and global vocal performance, our aim is to evaluate and correlate the risk of dysphonia, the presence of vocal changes and their associated factors, and vocal self-perception of Brazilian transgender women.

Methods: Cross-sectional Observational study. Sociodemographic and lifestyle aspects data were collected of all participants. After that, their voices were recorded (CAPE-V) and vocal quality was classified based on a perceptual-auditory and acoustic analysis by a voice specialist with high experience and high intra-rater correlation (p < 0.001). All participants answered the General Dysphonia Risk Screening Protocol (DRSP-G) and the Voice Questionnaire for Male-to-Female Transsexuals – TVQ (MtF), both protocols are tested and validated to Brazilian Portuguese. The sample was divided into two groups based on the grade of hoarseness (CAPE-V) – Vocal Deviation Group (VDG) and Normal Vocal Quality Group (NVG) – to verify the association between the presence of vocal changes and other variables. The correlation between the grade of hoarseness, DRSP and TVQ(MtF) scores was also verified.

Results: The sample included 32 transgender women with a mean age of 30.1 years old and 11.52 years of trans female gender performance. Over a half declared themselves Black, and a third of the sample did not have a defined profession. The use of female hormones was reported by 71.9% of the participants, most of them, without a medical prescription. The participants had a high dysphonia risk (mean 43.47), and a moderate impact on voice-related quality of life (TVQ [MtF] mean 59.46). The DRSP-G and TVQ(MtF) scores had a moderate positive correlation (Coef.: 0.565; p< 0.001). Nasal and pharyngeal resonance was observed in 59.4%, of the participants and the mean fundamental frequency (f0) was 156.14 Hz. VDG had a shorter experience in gender performance than NVG (p= 0.032). On their own opinion, the participants idealized more feminine voices than they currently had (p< 0.001).

Conclusions: The study sample had characteristics compatible with high degree of social and health vulnerability. There was a moderate impact of voice on their quality of life, and a high dysphonia risk. There was a correlation between the DRSP-G and TVQ(MtF) scores. Even though the participants have a low occurrence of vocal changes, it interferes on their vocal gender performance. These findings grouping different aspects of vocal evaluation are key to understand how general behaviors, self-perception and vocal quality comprise gender global vocal performance and have to be considered on a vocal gender performance training or therapy.