Perception of Gender and Personal Attributes After Gender-Affirming Voice and Communication Therapy in a Military Population

Objective: Since transgender persons have been allowed to serve openly in the U.S. military (June 2016), the Speech Pathology Clinic at Walter Reed National Military Medical Center has provided gender-affirming voice and communication therapy. This project addresses the efficacy of such management in this unique population by examining unfamiliar listeners’ perceptual ratings of speech before and after therapy.

Method: Twenty transwomen received gender-affirming voice and communication therapy. Extemporaneous speech, cued for topic unrelated to voice or gender, was recorded during evaluation and discharge. Eight ciswomen were controls. One group of listeners (12 normal-hearing adults), blinded to the project’s purpose, assigned demographic information (sex, age, rank) to 54 randomly ordered samples (20 pre, 20 post, 8 control, 6 repeated). With a digital slider, they then rated the samples on visual analog scales (VASs) for naturalness, expressiveness, assertiveness, pleasantness, and competence. Another group (10 listeners) rated the same samples on VASs from masculine male to feminine female with feminine male and masculine female in the middle (Hancock et al., 2014). Data analysis used generalized linear mixed effects models.

Results: Post-therapy samples were more likely than pre-therapy samples to be identified as female (β=2.07, z=5.83, p<0.001), but less likely than cisgender females (β=-7.08, z=-6.26, p<0.001). Compared to pre-therapy, post-therapy samples were less natural (β=-7.16, t=-3.67, p<0.001), less pleasant (β=-3.33, t=-2.09, p=0.04), less assertive (β = -5.50, t = -2.00, p = 0.01), and less competent (β=-4.22, t=-2.45, p=0.01) than they were prior to therapy. Ratings of femininity increased (β=17.67, t=11.64, p<0.001) following therapy and were highest for cisgender controls (β=-44.83, t=-9.66, p<0.001). Response distribution was trimodal, indicating male, female, and ambiguous.

Discussion/Conclusion: Gender-affirming voice and communication therapy was effective in a military setting for increasing the number of listeners who perceived the samples as being spoken by a woman. When provided with a continuous scale, listeners indicated uncertainty about speakers’ gender after therapy. Personal attributes were negatively affected post-therapy and were not affected systematically by gender perception, suggesting that other factors influenced attribute ratings. Further investigation should examine whether attribute perception has meaningful consequences among peers or superiors in military settings.

Disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy of the Department of Defense or U.S. Government.