Defining Goals of Transfeminine Individuals Seeking Gender-Affirming Voice Therapy: A Qualitative Study.

Purpose: The purpose of this study was to examine transfeminine individuals' goals for gender-affirming voice care and what they consider success in gender-affirming voice therapy.

Method: Fifteen transfeminine individuals completed semistructured interviews prior to commencement of gender-affirming voice care. Interviews explored individuals' voice goals, expectations for treatment, and desired treatment outcomes. Interviews were transcribed and analyzed by four speech-language pathologists with experience in gender-affirming voice using a grounded theory approach. Line-by-line, open, and axial coding were conducted to identify themes and subthemes.

Results: Four dominant themes and 12 subthemes were identified from the interviews. Dominant themes included the following: (a) Individuals hope that voice therapy will reduce adverse voice-related experiences, (b) individuals expect successful voice therapy to facilitate specific voice goals, (c) individuals expect successful voice therapy to facilitate communication across varying contexts, and (d) individuals want specific guidance in voice therapy. Past adverse experiences included being misgendered or feeling isolated due to vocal function. Specific voice goals included having a voice that was perceived as more feminine, higher in pitch, and produced with less mental and phonatory effort. Participants hoped that success in voice therapy would facilitate occupational voice use, phone use, and interactions with strangers. They also expressed a desire for specific strategies or exercises to achieve desired voice changes.

Conclusions: Transfeminine individuals seeking gender-affirming voice training have specific goals and expectations for voice therapy, which are driven by past experiences, interactional partners, and communicative context. Future study should continue to clarify the manner in which patient experiences drive voice outcomes in this population.