| Abstract | Background: Transgender and gender-diverse (TGD) patients often seek voice therapy from a speech-language pathologist to improve vocal congruence. To date, quality of life (QOL) measures following gender-affirming voice therapy have primarily focused on voice-related QOL, but evaluation of additional QOL measures (i.e., stress, instances of misgendering) are necessary to fully understand the impact of voice services on daily living. Here, we investigated several previously understudied QOL outcome measures in a group of patients seeking gender-affirming voice therapy.
Method: TGD patients completed QOL questions over the course of their gender-affirming vocal therapy. Self-reported measures included: vocal incongruence (measured via visual-analog scale in mm); ratings of cognitive and physical effort to produce their desired voice (mm); the Transgender Self-Evaluation Questionnaire (TSEQ); the Perceived Stress Scale (PSS); the Quality of Life Scale; instances of misgendering based on physical appearance and voice (Likert scales); and overall voice satisfaction (mm). The relationships between the number of therapy sessions attended and QOL measures were assessed using individual mixed linear regression models. A backward stepwise regression model was calculated to determine the strongest combination of QOL measures related to therapy attendance.
Results: Currently, 10 patients have participated (6 trans women, 1 trans man, 3 non-binary individuals; Aged 19–44 years, M=29.5 +/- 6.9). On average, patients attended 8.4 therapy sessions and data were collected 3.3 times per patient. Preliminary results show moderate-to-strong significant relationships (R2=.41–.77) between the number of therapy sessions and vocal congruence as well as TSEQ, voice satisfaction, and PSS when analyzed in individual models. The backward stepwise mixed linear model revealed a combination of TSEQ (p=.006), misgendering based on physical appearance (p=.039), misgendering based on voice (p=.071), and voice satisfaction (p=.005) as the strongest model (R2=.87; R2adj=.78).
Conclusion: Recruitment for this study is ongoing. Preliminary results indicate that QOL measures other than vocal congruence are related to the number of therapy sessions attended. We recommend that gender-affirming voice specialists incorporate and consider these outcomes when documenting the success and medical necessity of voice therapy.
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