Virtual Reality as a Tool in Gender-Affirming Voice Training: A Pilot Study.

Abstract

Objectives: The pilot study aimed to explore the potential of virtual reality (VR) speaking situations in generalizing elevated pitch to spontaneous speech and reducing speaking anxiety in trans women, as part of a voice feminization training program.

Study design: A randomized controlled trial design was used, with an experimental group exposed to VR training (VRT) and a control group receiving traditional training without VR (TT).

Methods: Eleven trans women were included, of which five were randomly assigned to the control group and six to the experimental group. All participants received four weekly 30-minute one-on-one training sessions. A Meta Quest 2 VR headset was used, in combination with the Therapy withVR web app. Outcome measures before and after training included the Trans Woman Voice Questionnaire (TWVQ), Willingness to Communicate (WTC), and median fundamental frequency (f_o) during reading and spontaneous speech. Descriptive analyses and figures were conducted in RStudio.

Results: The TWVQ total scores showed a slight decrease for both groups, indicating minimal improvement in voice-related quality of life. In the VRT group, WTC scores increased across contexts, particularly in interactions with strangers and public speaking, while TT scores remained stable. For f_o, both groups demonstrated increased pitch. However, individual results show high variability between participants across the questionnaires.

Conclusions: This pilot study suggests that VRT might potentially increase pitch and WTC among trans women, particularly in interactions with strangers. However, improvements in voice-related quality of life were modest. Larger, mixed-methods, and long-term studies are needed to better understand VR's potential as a supportive tool for gender-affirming voice training in the transgender and gender diverse population.