Voice and Stroboscopic Characteristics in Transgender Patients Seeking Gender‐Affirming Voice Care

Objective Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment‐seeking trans women by comparing two validated questionnaires—Voice Handicap Index‐10 (VHI‐10) and Transsexual Voice Questionnaire (TVQMtF)—and reports incidence of abnormal stroboscopy findings and acoustic characteristics. Methods Retrospective review of transgender patients presenting to tertiary‐care laryngology center between February 2018–February 2019. Mean VHI‐10, TVQ, and Singing VHI‐10 (SVHI‐10) scores; audio‐perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI‐10 and SVHI‐10 vs TVQMtF were compared. Results Sixty‐one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty‐nine percent presented full‐time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI‐10), 19 ± 13 (SVHI‐10), and 81 ± 22 (TVQMtF). Correlation between VHI‐10 and SVHI‐10 versus TVQMtF was weak, R = 0.47 (P = .053) and R = 0.35 (P = .17), respectively. Mean audio‐perceptual grade was 0.27 ± 0.15. Mean Cepstral Spectral Index of Dysphonia (CSID, sustained vowel) was 8.5 ± 21.9. Mean Cepstral Peak Prominence (CPP) Fo and CPP Fo SD in rainbow passage were 157.3 ± 16 and 59.4 ± 15.9, respectively. Conclusion Trans women report perceived voice handicap in speaking and singing, which appears separate from gender‐related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI‐10 or SVHI‐10 and TVQMtF but requires further investigation. TVQMtF may provide information which more specifically reflects voice concerns of trans women as compared to VHI‐10 and SVHI‐10. Level of Evidence 4 Laryngoscope, 131:1071–1077, 2021