Voice-Related Quality of Life and Psychological Well-Being in Transgender and Gender-Diverse Adults

Introduction: Voice often plays a significant role in one’s gender experiences, which can include contributing to being a source of dysphoria for transgender and gender-diverse (TGD) people. This study examined the associations of gender-affirming care on voice-related quality of life and psychological wellbeing.

Methods: TGD adults with voice concerns completed (via Prolific) the Trans Woman Voice Questionnaire (TWVQ), Trans Man Voice Questionnaire (TMVQ), and/or Voice related Experiences of Nonbinary Individuals (VENI). Psychological wellbeing was assessed via Flourishing Scale and the Scale of Positive and Negative Experience. Interventions included mental health therapy, gender-affirming counseling, speech therapy, hormone therapy, and surgery. Descriptive statistics and comparative analysis were performed.

Results: Among 313 participants (M 25.6 years, SD 5.8), 40% were nonbinary, 28% trans women, 23% trans men, 14% genderfluid, 13% genderqueer. Mean voice scores: TWVQ (M 81.1, SD 19.8), TMVQ (M 72.1, SD 21.4), and VENI (M 40, SD 10.2). Common interventions were mental health therapy (n=197), hormone therapy (n=118), and counseling (n=87). Phonosurgery was rare (n=1). VENI scores were better in those who began gender-affirming counseling, hormone therapy and/or speech therapy compared to those still deciding (all p’s < 0.02). Unexpectedly, TWVQ and TMVQ scores were better in those still deciding, compared to those who began gender-affirming counseling, hormone therapy and/or speech therapy (all p’s < 0.01). Positive Experience scores were higher in those planning phonosurgery compared to those still deciding (p =0.012).

Conclusions: While gender-affirming counseling, hormone and/or speech therapy was associated with overall better voice-related quality of life in nonbinary adults, specific TMVQ and TWVQ findings warrant further attention in gender-affirming care. Planning for phonosurgery was associated with greater wellbeing.