Translation, Cultural Adaptation, and Preliminary Evaluation of the Spanish Version of the Transgender Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF)



      This study aimed to perform translation, cross-cultural adaptation, and validation of the Spanish version of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (TVQ MtF).

      Study Design

      This is a prospective study.


      The study was conducted by the Gender Identity Unit and the Voice Unit of a tertiary hospital referral center for surgical feminization of the voice.

      Subjects and Methods

      The study had two parts: translation and adaptation of the TVQ MtF with the following actions: translation (with authorization and consensus of the authors of the original questionnaire), back-translation, pretesting, and final version; and preliminary study of the psychometric properties (feasibility, internal consistency, test-retest reliability, construct validity, discriminant validity, and ceiling and floor effects). Thirty male-to-female transsexual women filled out the questionnaire, and 18 of the 30 filled out the questionnaire approximately 2 weeks after filling it out for the first time.


      Feasibility was 100%. Cronbach α was 0.976. The intraclass correlation coefficient was 0.885. The Spearman correlation coefficient between TVQ MtF and the physical component of SF-12 v2 was 0.102 (P value = 0.592) and between TVQ MtF and the mental component was −0.263 (P value = 0.161). A ceiling effect was not found. A floor effect was found in two questionnaires (6.7%).


      Feasibility, internal consistency, and reliability outcomes in our study support the validity of the authorized Spanish version of the TVQ MtF.

      Key Words

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        • Fisk N.
        Gender dysphoria syndrome.
        in: Laub D.R. Gandy P. 2nd Interdisciplinary Symposium of Gender Dysphoria Syndrome. Stanford University Press, Palo Alto, CA and Redwood City, CA1973: 7-14
        • Coleman E.
        • Bockting W.
        • Botzer M.
        • et al.
        Standards of care for the health of transsexual, transgender and gender-nonconforming people, version 7.
        Int J Transgend. 2012; 13: 165-232
        • Becerra A.
        • Rodríguez-Molina J.M.
        • Asenjo N.
        • et al.
        Prevalence, incidence and sex ratio of transsexualism in the province of Madrid (Spain) according to health care demand.
        Arch Sex Behav. 2016; (in press)
        • Van Damme S.
        • Cosyns M.
        • Deman S.
        • et al.
        The effectiveness of pitch-raising surgery in male-to-female transsexuals: a systematic review.
        J Voice. 2017; 31 (e1-e5): 244
        • Hancock A.
        • Krissinger J.
        • Owen K.
        Voice perceptions and quality of life of transgender people.
        J Voice. 2011; 25: 553-558
        • Asscheman H.
        • Gooren L.J.
        Hormone treatment in transsexuals.
        in: Bocking W.O. Coleman E. Gender Dysphonia: Interdisciplinary Approaches in Clinical Management. Haworth Press, New York, NY1992: 39-54
        • McNeill E.J.
        • Wilson J.A.
        • Clark S.
        • et al.
        Perception of voice in the transgender client.
        J Voice. 2008; 22: 727-733
        • Wolfradt U.
        • Neumann K.
        Depersonalization, self-esteem and body image in male-to-female transsexuals compared to male and female controls.
        Arch Sex Behav. 2001; 30: 301-310
        • Hancock A.
        • Colton L.
        • Douglas F.
        Intonation and gender perception: applications for transgender speakers.
        J Voice. 2014; 28: 203-209
        • Dejonckere P.H.
        • Bradley P.
        • Clemente P.
        • et al.
        A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS).
        Eur Arch Otorhinolaryngol. 2001; 258: 77-82
        • Rosen C.A.
        • Lee A.S.
        • Osborne J.
        • et al.
        Development and validation of the Voice Handicap Index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • T'Sjoen G.
        • Moerman M.
        • Van Borsel J.
        • et al.
        Impact of voice in transsexuals.
        Int J Transgend. 2009; 9: 1-7
        • Dacakis G.
        • Davies S.
        • Oates J.M.
        • et al.
        Development and preliminary evaluation of the transsexual voice questionnaire for male–to–female transsexuals.
        J Voice. 2013; 27: 312-320
        • Santos H.H.
        • Aguiar A.G.
        • Baeck H.E.
        • et al.
        Translation and preliminary evaluation of the Brazilian Portuguese version of the Transgender Voice Questionnaire for male-to-female transsexuals.
        Codas. 2015; 27: 89-96
        • Lewis M.P.
        • Simons G.F.
        • Fennig C.D.
        Ethnologue: Languages of the World.
        (19th ed. Dallas, TX: SIL International; Available at:) (Acceded January 25, 2017)
        • Alonso J.
        • Regidor E.
        • Barrio G.
        • et al.
        Valores poblacionales de referencia de la versión española del Cuestionario de salud SF-36.
        Med Clin (Barc). 1998; 111: 410-416
        • Guillemin F.
        • Bombardier C.
        • Beaton D.
        Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.
        J Clin Epidemiol. 1993; 46: 1417-1432
        • Terwee C.B.
        • Bot S.D.
        • de Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Medina M.M.
        • Carrillo A.
        • Polo R.
        • et al.
        Validation of the Penn Acoustic Neuroma Quality-of-life Scale (PANQOL) for Spanish-speaking patients.
        Otolaryngol Head Neck Surg. 2017; 156: 728-734
        • Sanz L.
        • Bau P.
        • Arribas I.
        • et al.
        Development and validation of a short version of the Spanish pediatric voice handicap index (P-VHI-10).
        Int J Pediatr Otorhinolaryngol. 2016; 88: 113-116
        • Ghirardi A.C.
        • Ferreira L.P.
        • Giannini S.P.
        • et al.
        Screening index for voice disorder (SIVD): development and validation.
        J Voice. 2013; 27: 195-200
        • Kaplan R.M.
        • Bush J.W.
        • Berry C.C.
        Health status: types of validity and the index of wellbeing.
        Health Serv Res. 1976; 11: 478-507
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Prieto L.
        • Lamarca R.
        • Casado A.
        Assessment of the reliability of clinical findings: the intraclass correlation coefficient.
        Med Clin (Barc). 1998; 110: 142-145
        • Vaz S.
        • Falkmer T.
        • Passmore A.E.
        • et al.
        The case for using the repeatability coefficient when calculating test-retest reliability.
        PLoS ONE. 2013; 8: e73990
        • Van Borsel J.
        • De Cuypere G.
        • Van den Berghe H.
        Physical appearance and voice in male–to–female transsexuals.
        J Voice. 2001; 15: 570-575
        • Hancock A.
        • Owen K.
        • Siegfriedt L.
        • et al.
        Relationship between self-perception, listener perception, and acoustic measures of femininity in transgender voice assessment.
        (Presented at; WPATH 2009 XXI Biennial Symposium; Oslo, Norway; June)2009