Efficacy and Patient Satisfaction in Voice Feminization Procedures: A Systematic Review and Meta-Analysis.

Objective: To evaluate the efficacy and quality of life impact of voice feminization interventions in transgender women.

Data sources: We searched PubMed, EMBASE, Scopus, and Web of Science for RCTs and retrospective studies published between 2008 and 2023 that quantitatively evaluated any voice feminization procedure.

Review methods: Studies in English reporting quantitative measures of efficacy were included. Studies using qualitative methodology were excluded. Risk of bias was assessed using Cochran tools and a random-effects model was applied using inverse-variance pooling. Primary outcomes were fundamental frequency [F0]/speaking fundamental frequency [SF0] and patient-reported outcomes (PROs) (PROSPERO: CRD42023476192).

Results: Twenty-four studies involving 893 participants showed significant SF0 improvements for voice therapy (VT, g = 0.86, [0.46, 1.26], P < .0001), Wendler glottoplasty (WG, g = 1.21, [0.65, 1.77], P < .0001), feminization laryngoplasty (FL, g = 3.05, [2.24, 3.86], P < .0001), and laser reduction glottoplasty (LRG, g = 12.28, [8.19, 15.64], P < .0001). PROs indicated enhanced quality of life for VT (g = 1.32, [0.68, 1.96], P < .0001), WG (g = 1.82, [1.07, 2.57], P < .0001), and LRG (g = 1.90, [0.72, 3.07], P = .0015), with a strong correlation between pitch alteration and QoL (r² = 0.83, P = .0001).

Conclusion: Our results indicate that both VT and surgical procedures enhance vocal pitch and strongly correlate with improved QoL. Our findings validate the role of voice feminization in gender-affirming care, though methodological limitations prevent evaluation of newer interventions.