Beyond Pitch: Exploring Acoustic and Psychosocial Factors Shaping Voice Perception in Transmasculine Individuals.

Abstract

Purpose: Self-perception of voice is a critical outcome for individuals seeking gender-affirming care; however, the variables associated with vocal self-perception remain unclear. While masculinizing gender-affirming hormone therapy (GAHT) contributes to voice masculinization and overall well-being, its relationship with multidimensional factors warrants further investigation. This study aimed to (a) evaluate longitudinal changes in acoustic parameters, body image, and psychosocial status during the first 6 months of GAHT and (b) identify the extent to which these factors predict the variance in self-perception of voice and its daily living impact.

Method: Twenty-six transmasculine individuals beginning hormone therapy were followed for 6 months and assessed at three time points. At each point, serum testosterone level, self-perception of voice and its daily living impact, body image, and psychosocial status were measured. Participants' voice recordings were collected for acoustic analysis.

Results: Significant changes were found in fundamental frequency (F0), voice quality, and resonance, as well as in perceived social support following the initiation of GAHT. Statistical modeling revealed that body image, state anxiety, and F0 served as significant predictors, accounting for the variation in self-perception of voice and its daily living impact.

Conclusions: Beyond the acoustic parameters commonly used in gender-affirming voice therapy, body image and anxiety levels are significantly associated with patient self-perception and voice-related quality of life. This suggests that voice-related outcomes are linked to a multidimensional array of psychosocial variables, necessitating a holistic approach by voice specialists during gender-affirming voice care. Considering both domains may improve assessment and intervention in gender-affirming voice care, and future research should explore these dynamic associations over longer follow-up periods.