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Leyns C, Alighieri C, De Wilde J, Van Lierde K, T’Sjoen G, D’haeseleer E. Experiences of Transgender Women with Speech Feminization Training: A Qualitative Study. Healthcare (Basel) 2022; 10:2295. [PMID: 36421620 PMCID: PMC9690106 DOI: 10.3390/healthcare10112295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 10/18/2023] Open
Abstract
This study investigated the experiences of transgender women after following sessions for speech feminization using semi-structured face-to-face interviews. Transgender women who completed a clinical trial were invited for an interview and 12 accepted the invitation. Interviews were conducted using an interview guide and were recorded and transcribed verbatim. NVivo 12 was used for qualitative data analysis, applying an inductive thematic approach. Four main themes were identified: communication, therapy experiences, impact on mental health, and external factors associated with the outcomes. For most participants, fear of speaking in public decreased after the training and all participants mentioned improved vocal characteristics. Though, reactions ranged from needing more speech therapy to being satisfied with the results. Coping strategies during misgendering occasions differed a lot between participants. More emotive counseling during speech feminization sessions is necessary to help clients in managing possible negative emotions.
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Affiliation(s)
- Clara Leyns
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Cassandra Alighieri
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Jana De Wilde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Kristiane Van Lierde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, 9000 Ghent, Belgium
| | - Evelien D’haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
- Musical Department, School of Arts, Royal Conservatory Brussels, 1000 Brussels, Belgium
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Zhao NW, Mason JM, Blum AM, Kim EK, Young VN, Rosen CA, Schneider SL. Using Item-Response Theory to Improve Interpretation of the Trans Woman Voice Questionnaire. Laryngoscope 2022; 133:1197-1204. [PMID: 36054670 DOI: 10.1002/lary.30360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/09/2022] [Accepted: 08/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Trans Woman Voice Questionnaire (TWVQ) is commonly used to quantify self-perceptions of voice for trans women seeking gender-affirming voice care, but the interpretation of TWVQ scores remains challenging. The objective of this study was to use item-response theory (IRT) to evaluate the relationship between TWVQ items and persons on a common scale and identify improvements to increase the meaningfulness of TWVQ scores. METHODS A retrospective review of TWVQ scores from trans women patients between 2018-2020 was performed. Rasch-family models were used to generate item-person maps positioning respondent location and item difficulty estimates on a logit scale, which was then converted into a scaled score using linear transformations. RESULTS TWVQ responses from 86 patients were analyzed. Initial item-person maps demonstrated that the middle response categories ("sometimes" and "often") performed inconsistently across items (poor threshold banding); interpretability improved when these ratings were scored as one category. The models were rerun using revised scoring, which retained high reliability (0.93) and supported a unidimensional construct. Updated item-person maps revealed four scaled score zones (≤54, >54 to ≤101, >101 to ≤140, and >140) that each corresponded to an increasing pattern of item thresholds (probability of selecting one response category vs. others). These ranges can be interpreted as minimal, low, moderate, and high, respectively. CONCLUSIONS Empiric data from Rasch analysis supports new interval scoring for the TWVQ that advances the clinical and research utility of the instrument and lays the foundation for future improvements in clinical care and outcomes assessment. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - James M Mason
- Graduate School of Education, University of California, Berkeley, Berkeley, California, U.S.A
| | - Alexander M Blum
- Department of Special Education, San Francisco State University, San Francisco, California, U.S.A.,Graduate School of Education, Stanford University, Palo Alto, California, U.S.A.,Enrich Your Academics, Emeryville, California, U.S.A
| | - Eric K Kim
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - VyVy N Young
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Sarah L Schneider
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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Leyns C, Papeleu T, Tomassen P, T’Sjoen G, D’haeseleer E. Effects of speech therapy for transgender women: A systematic review. Int J Transgend Health 2021; 22:360-380. [PMID: 37808532 PMCID: PMC10553375 DOI: 10.1080/26895269.2021.1915224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background: For transgender women, communication and speech characteristics might not be congruent with their gender expressions. This can have a major influence on their psychosocial functioning. Higher quality of life scores were observed the more their voice was perceived as feminine. Speech language pathologists may play an important role in this, as the gender affirming hormone treatment for transgender women does not affect the voice. Aim: This systematic review aimed to provide speech and language pathologists with the current literature concerning the effects of speech therapy in transgender women in terms of acoustic and perceptual outcomes. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting this systematic review. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (using the PubMed interface) and Embase (using the embase.com interface) were used as electronic databases. All individual studies which measured the effects of speech therapy in transgender women were evaluated with a risk of bias assessment tool and levels of evidence. Relevant data were extracted from these studies and a narrative synthesis was performed. Results: 14 studies were identified through the databases and other sources. These studies show positive outcome results concerning pitch elevation, oral resonance, self-perception and listener perception. However, methodological issues contribute to problems with generalization and reproducibility of the studies. Conclusion: There is an urgent need for effectiveness studies using RCT designs, larger sample sizes, multidimensional voice assessments, well-described therapy programs, investigators blinded to study process, and longer-term follow-up data. Speech and language pathologists who work with transgender women may find these results essential for defining therapy goals.
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Affiliation(s)
- Clara Leyns
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Tine Papeleu
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Evelien D’haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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