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Clinician and Consumer Perspectives on Gender-Affirming Voice Services

      Summary

      Introduction

      A significant portion of the transgender, nonbinary, and gender-expansive community experiences gender-related voice issues. However, barriers exist to accessing gender-affirming voice care, and most existing voice research does not include the gender-nonbinary population. Our study aimed to examine transgender, nonbinary, and gender-expansive consumer/potential consumer (hereafter referred to as consumer) engagement and compare/contrast consumer and speech-language pathologist perspectives on gender-affirming voice services. A secondary aim was to assess possible voice impairments in transgender, nonbinary, and gender-expansive individuals.

      Methods

      Two surveys were distributed via listservs for SLPs and flyers and social media posts for consumers. Surveys included items regarding experience with and accessibility of gender-affirming voice services and clinician competence. Consumers and clinicians answered the same questions from their respective positions. Consumers additionally completed the Voice Handicap Index-10 (VHI-10).

      Results

      Forty-eight consumer and 54 clinician responses were collected. Twenty (41.7%) consumers were trans women, 15 (31.2%) were trans men, 12 (25%) were gender-nonbinary, and one (2.1%) was gender fluid. VHI-10 responses were in the abnormal range for 61.4% of consumers, and 68.8% indicated desire to receive gender-affirming voice services, including 58.3% of gender-nonbinary respondents. However, only 6.25% of consumers considered themselves as having a voice disorder and 29.2% reported that their voice impairs communication. In contrast, 24.1% of clinicians felt consumers seeking gender-affirming voice services have a voice disorder and 51.2% felt they have an impaired communication ability. Consumers indicated positive perceptions of voice services/providers but reported a variety of barriers to access. SLPs indicated mixed confidence in accessibility of services. Both groups perceived an affordability barrier.

      Conclusions

      This study demonstrates the desire and need for gender-affirming voice services and is the first to our knowledge to explicitly include gender-nonbinary individuals’ perspectives on them. Understanding how consumer and clinician perspectives differ can help focus provider efforts in improving experiences with, access to, and visibility of gender-affirming voice services.

      Key Words

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      References

        • Kennedy E.
        • Thibeault S.L.
        Voice-gender incongruence and voice health information-seeking behaviors in the transgender community.
        Am. J. Speech Lang. Pathol. 2020; 29: 1563-1573https://doi.org/10.1044/2020_AJSLP-19-00188
        • Azul D.
        • Nygren U.
        • Södersten M.
        • et al.
        Transmasculine people's voice function: a review of the currently available evidence.
        J. Voice. 2017; 31: 261.e9-261.e23https://doi.org/10.1016/j.jvoice.2016.05.005
        • Azul D.
        • Arnold A.
        • Neuschaefer-Rube C.
        Do transmasculine speakers present with gender-related voice problems? Insights from a participant-centered mixed-methods study.
        J. Speech Lang. Hear Res. 2018; 61: 25-39https://doi.org/10.1044/2017_JSLHR-S-16-0410
        • Young V.N.
        • Yousef A.
        • Zhao N.W.
        • et al.
        Voice and stroboscopic characteristics in transgender patients seeking gender-affirming voice care.
        Laryngoscope. 2020; https://doi.org/10.1002/lary.28932
        • Watt S.O.
        • Tskhay K.O.
        • Rule N.O.
        Masculine voices predict well-being in female-to-male transgender individuals.
        Arch. Sex. Behav. 2018; 47: 963-972https://doi.org/10.1007/s10508-017-1095-1
        • Hancock A.B.
        • Krissinger J.
        • Owen K.
        Voice perceptions and quality of life of transgender people.
        J. Voice. 2011; 25: 553-558https://doi.org/10.1016/j.jvoice.2010.07.013
        • Kim H.T.
        Vocal feminization for transgender women: current strategies and patient perspectives.
        Int. J. Gen. Med. 2020; 13: 43-52https://doi.org/10.2147/IJGM.S205102
        • Mills M.
        • Stoneham G.
        • Davies S.
        Toward a protocol for transmasculine voice: a service evaluation of the voice and communication therapy group program, including long-term follow-up for trans men at the London Gender Identity Clinic.
        Transgend. Health. 2019; 4: 143-151https://doi.org/10.1089/trgh.2019.0011
        • Buckley D.P.
        • Dahl K.L.
        • Cler G.J.
        • et al.
        Transmasculine voice modification: a case study.
        J. Voice. 2020; 34: 903-910https://doi.org/10.1016/j.jvoice.2019.05.003
        • DeVore E.K.
        • Gadkaree S.K.
        • Richburg K.
        • et al.
        Coverage for gender-affirming voice surgery and therapy for transgender individuals.
        Laryngoscope. 2020; https://doi.org/10.1002/lary.28986
        • Levesque J.F.
        • Harris M.F.
        • Russell G.
        Patient-centred access to health care: conceptualising access at the interface of health systems and populations.
        Int. J. Equity Health. 2013; 12: 18https://doi.org/10.1186/1475-9276-12-18
        • Sawyer J.
        • Perry J.L.
        • Dobbins-Scaramelli A.
        A survey of the awareness of speech services among transgender and transsexual individuals and speech-language pathologists.
        Int. J. Transgenderism. 2015; 15: 146-163https://doi.org/10.1080/15532739.2014. 995260
        • Hancock A.
        • Haskin G.
        Speech-language pathologists' knowledge and attitudes regarding lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations.
        Am. J. Speech Lang. Pathol. 2015; 24: 206-212https://doi.org/10.1044/2015_AJSLP-14-0095
        • James S.E.
        • Herman J.L.
        • Rankin S.
        • et al.
        The Report of the 2015 U.S. Transgender Survey.
        National Center for Transgender Equality, Washington, DC2016
        • Pasternak K.
        • Francis D.O.
        An update on treatment of voice-gender incongruence by otolaryngologists and speech-language pathologists.
        Curr. Opin. Otolaryngol. Head Neck Surg. 2019; 27: 475-481https://doi.org/10.1097/MOO.0000000000000582
        • The 2019 American Housing Survey
        United States Census Bureau.
        2020
        • Campos I.
        • Skiados M.
        • Flynn P.
        The unicorn: the rarity of males in speech-language pathology.
        Perspect. ASHA Special Interest Gr. 2018; 3: 29-37https://doi.org/10.1044/persp3.SIG17.29
        • Ryan C
        Computer and internet usage in the United States: 2016.
        United States Census Bureau. 2018
        • Hancock A.B.
        • Garabedian L.M.
        Transgender voice and communication treatment: a retrospective chart review of 25 cases.
        Int. J. Lang. Commun. Disord. 2013; 48: 54-65https://doi.org/10.1111/j.1460-6984.2012.00185.x

      Glossary of Terms (in order of appearance, adapted from the PFLAG National Glossary of Terms)

      Transgender
      Often shortened to trans, from the Latin prefix for “on a different side as.” A term describing a person's gender identity that does not necessarily match their assigned sex at birth. Trans is often considered more inclusive than transgender because it includes transgender, transsexual, transmasc, transfem, and those who simply use the word trans.
      Nonbinary
      Refers to people who do not subscribe to the gender binary. They might exist between or beyond the man-woman binary. Some use the term exclusively, while others may use it interchangeably with terms like genderqueer, genderfluid, gender nonconforming, gender diverse, or gender expansive.
      Gender-expansive
      An umbrella term sometimes used to describe people who expand notions of gender expression and identity beyond perceived or expected societal gender norms.
      Gender-fluid
      Describes a person who does not consistently adhere to one fixed gender and who may move among genders.
      Gender-nonconforming
      A term for those who do not follow gender stereotypes. Often an umbrella for nonbinary genders. Though fairly uncommon, some people view the term as derogatory, so they may use other terms including gender expansive, differently gendered, gender creative, gender variant, genderqueer, nonbinary, agender, genderfluid, gender neutral, bigender, androgynous, or gender diverse.
      Gender binary
      The disproven concept that there are only two genders, male and female, and that everyone must be one or the other. Also often misused to assert that gender is biologically determined.