TGD adults who completed hormone therapy, counseling, and speech therapy had better voice-related quality of life than those still deciding or planning, while those planning phonosurgery had worse scores, suggesting motivation for surgery.
Key Findings
Results
Transgender and gender diverse adults who received gender care counseling had better voice-related quality of life scores than those planning to receive it.
Those with gender care counseling had lower TVQFtM scores (P = 0.03) than those planning it
Lower scores on the TVQFtM indicate better voice-related quality of life
Counseling was one of the common interventions, with n = 87 participants having received it
The study used multiple linear regression/ANOVA analyses to assess these associations
Results
Hormone therapy was associated with better voice-related quality of life for both trans women and trans men compared to those planning hormone therapy.
Those on hormone therapy had lower TWVQ scores than those planning it (P = 0.03)
Those on hormone therapy had lower TVQFtM scores than those planning it (P = 0.0002)
Hormone therapy was received by n = 118 participants, making it one of the more common interventions
The TWVQ (Trans Woman Voice Questionnaire) was used for trans women and the adapted TVQ Female to Male (TVQFtM) was used for trans men
Results
Engagement with speech therapy was associated with better voice-related quality of life scores compared to those who planned to pursue speech therapy.
Engagement with speech therapy was associated with lower TWVQ and TVQFtM scores than those who planned to do so
Lower scores on these instruments indicate better voice-related quality of life
No specific p-values for speech therapy associations were reported in the abstract
Speech therapy was assessed alongside mental health therapy, counseling, hormone therapy, and surgery as forms of gender-affirming care
Results
Transgender and gender diverse individuals interested in phonosurgery had worse voice-related quality of life scores than those not interested in phonosurgery.
Those interested in phonosurgery had higher TWVQ scores than those not interested (P = 0.02)
Those interested in phonosurgery had higher TVQFtM scores than those not interested (P = 0.0004)
Phonosurgery itself was rare in the sample, with only n = 1 participant having undergone it
The authors interpreted this finding as suggesting motivation for surgery among those with worse voice-related quality of life
Methods
The study sample of 313 TGD adults with voice concerns was predominantly young, nonbinary, and commonly utilized mental health therapy as a form of gender-affirming care.
Mean age of participants was 26 years
40% were nonbinary, 28% were trans women, and 23% were trans men
The most common intervention was mental health therapy (n = 197), followed by hormone therapy (n = 118) and counseling (n = 87)
Participants were recruited via an online platform (Prolific) and had to have voice concerns to be included
Voice-related quality of life was measured using the TWVQ, adapted TVQFtM, and/or the Voice-related Experiences of Nonbinary Individuals (VENI)
Methods
Psychological well-being was assessed alongside voice-related quality of life in TGD adults with voice concerns using validated scales.
Psychological well-being was measured with the Scale of Positive and Negative Experience and the Flourishing Scale
The study design was cross-sectional, limiting causal inference
Both voice-related QOL and psychological well-being were examined in relation to gender-affirming care interventions
The study highlights the importance of voice-related goals in the care of TGD individuals
What This Means
This research suggests that for transgender and gender diverse (TGD) adults who have concerns about their voice, receiving gender-affirming care — such as hormone therapy, counseling, and speech therapy — is associated with better voice-related quality of life compared to those who are still planning to pursue these interventions. The study surveyed 313 TGD adults online, with an average age of 26, and used specialized questionnaires designed for trans women, trans men, and nonbinary individuals to measure how much voice difficulties affect daily life. Mental health therapy was the most commonly used form of care, followed by hormone therapy and counseling.
One particularly notable finding is that people who were interested in phonosurgery (surgical procedures to alter the voice) had significantly worse voice-related quality of life scores than those who were not interested in such surgery. The researchers interpreted this as those individuals being motivated to seek surgery because of greater dissatisfaction with their voice. By contrast, those who had already completed hormone therapy, speech therapy, or counseling reported better voice-related quality of life than those who had not yet started these interventions.
This research suggests that gender-affirming interventions, including hormone therapy and speech therapy, may play an important role in improving how TGD individuals experience and feel about their voices. The findings also highlight that voice-related concerns are a meaningful part of gender experience and well-being for many TGD people, and that understanding a person's voice-related goals should be considered an important part of their overall gender-affirming care.
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Erin Y. Y. Shen, G. Nic Rider, S. Lunos, B. Parchem, D. Weinstein, Lisa Butcher, et al.. (2026). Voice-Related Quality of Life and Psychological Well-being in Transgender and Gender Diverse Adults: Associations with Gender-Affirming Care.. Journal of Voice. https://doi.org/10.1016/j.jvoice.2026.05.005