Gender-Affirming Voice Therapy Duration and Satisfaction: Experiences from a Single Institution

Chanticha Laohakittikul; Grant E Gochman; Sarah L Schneider; VyVy N Young

doi:10.1016/j.jvoice.2024.12.032

Gender-Affirming Voice Therapy Duration and Satisfaction: Experiences from a Single Institution

J Voice. 2025 Jan 6:S0892-1997(24)00467-3. doi: 10.1016/j.jvoice.2024.12.032. Online ahead of print.

Authors

Chanticha Laohakittikul¹, Grant E Gochman², Sarah L Schneider², VyVy N Young³

Affiliations

¹ UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California; Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
² UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California.
³ UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, California. Electronic address: vyvy.young@ucsf.edu.

PMID: 39765446
DOI: 10.1016/j.jvoice.2024.12.032

Abstract

Objective: Current literature involving gender-affirming voice therapy (GAVT) for transgender and nonbinary (TGNB) individuals is limited. This study describes treatment duration and satisfaction at a single institution.

Study design: Retrospective cohort.

Setting: Tertiary laryngology center.

Methods: TGNB patients receiving gender-affirming treatment were identified.

Data collected: age, sex assigned at birth, gender identity, race, ethnicity, number/frequency of GAVT, Voice Handicap Index-10 (VHI-10), Trans Women Voice Questionnaire (TWVQ) (as appropriate), Gender Congruence Scale (GCS), patient and speech language pathologist (SLP) assessment of treatment satisfaction, and surgical data. Descriptive statistics were reported.

Results: 82 TGNB patients [trans female (n=65), trans male (n=5), nonbinary (n=12)] sought gender-affirming voice care. Mean age was 33.6±10.7years. Majority were assigned male at birth (n=71). Mean presentation VHI-10 was 15.7±8. In the first year of treatment, patients had mean 5.7±3.1 (range 1-16, median 5) GAVT sessions, biweekly (n=36, 44%) or monthly (n=12, 15%). 62% (n=51) of patients were satisfied/very satisfied, 23% (n=19) fairly satisfied, and 10% (n=8) unsatisfied with GAVT outcomes. SLP impression of GAVT outcome was more variable: 15% (n=12) completely met voice goals and 11% (n=9) had excellent GAVT response. Most patients (39%, n=32) were making good progress, with further treatment recommended. SLP referred 11% (n=9) to the laryngologist for surgery consideration; 9% (n=6) underwent Wendler glottoplasty.

Conclusions: Voice therapy is integral to gender-affirming voice care and often requires more sessions (mean 5.7) than the literature-reported average (∼4) for other voice diagnoses. Appropriate expectations should be set for patients, treating clinicians, and third-party payors about the increased anticipated duration of GAVT.

Keywords: Disparities; Gender-affirming; Outcomes; Transgender; Voice surgery; Voice therapy.