Effectiveness of Speech Therapy in Trans Women.

NCT04708600 | Completed

• 1 other identifier: B670201941335
• Study Type: interventional
• Target: 78
• Locations: 1 country
• Sites: 1

Brief Summary

One of the greatest hurdles in the transition of transgender persons is that voice, speech and communication are not congruent with the desired gender. Since hormone treatment does not affect the voice in male-to-female transgender persons (trans women), speech therapy is the treatment of choice to develop a more feminine communication. Speech therapy must focus on aspects of communication that play an important role in listener perceptions of the speakers gender. Results of a systematic review and meta-analysis showed that those aspects are primarily fundamental frequency of the voice and resonance. However, effectiveness studies of speech interventions in transwomen are extremely limited and show methodological limitations. The purpose of this project is to investigate the short-term and longterm impact of speech exercises for pitch and resonance on (a) acoustic voice characteristics, (b) listener perceptions of femininity using a visual analogue scale and binary gender identification (male versus female voice), and (c) self-perception and psychosocial functioning in trans women using a randomized sham-controlled trial and cross-over design.

Conditions

Transgenderism; Gender Dysphoria; Speech Therapy; Voice Disorder Due to Transsexualism

Outcome Measures

Primary Outcomes (4)

• Acoustics: change in speaking fundamental frequency

  Median Speaking fo, fo upper limit (pc95), fo lower limit (pc25)

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

• Acoustics: change in formant frequencies

  Median Formant Frequencies F1-F5 of the vowels /a/, /i/, /u/

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

• Change in listeners perceptions

  masculinity/femininity ratings (using a VAS) and gender identification

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

• Change in self-assessment

  Trans women voice questionnaire

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

Secondary Outcomes (3)

• Change in Dysphonia Severity Index

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

• Change in Acoustic Voice Quality Index

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

• Change in Voice Range Profile

  pre, post 1 (immediately after sham), post 2 (immediately after intervention 1), post 3 (immediately after intervention 2), follow-up 1 (after 3 months), follow-up 2 (after 1 year)

Study Arms (2)

Group 1

EXPERIMENTAL

Sham therapy Intervention 1: PET Intervention 2: ART

Behavioral: Pitch Elevation Therapy; Behavioral: Articulation Resonance Therapy; Behavioral: Sham therapy

Group 2

EXPERIMENTAL

Sham therapy Intervention 1: ART Intervention 2: PET

Behavioral: Pitch Elevation Therapy; Behavioral: Articulation Resonance Therapy; Behavioral: Sham therapy

Interventions

Pitch Elevation Therapy BEHAVIORAL

Goal: mean fundamental frequency of 180Hz (range 140 and 300Hz); Doses and duration: 5 one hour sessions (5h), 5 weeks Content: * auditory discrimination of lower and higher tones * pitch glides * pitch glides using straw phonation and resonance tube phonation * practice of higher pitch voice (target: 180Hz) in isolated vowels - syllables - mono and bisyllabic words -phrases - sentences and texts - conversation (generalization to spontaneous speech)

Also known as: PET

Group 1; Group 2

Articulation Resonance Therapy BEHAVIORAL

Goal: increase in lipspreading, forward tongue carriage, larynx elevation, forward resonance, precise articulation; 5 sessions Doses and duration: 5 one hour sessions (5h), 5 weeks Content: * auditory and visual discrimination of forward vs backed tongue carriage and lip spreading vs lip rounding) * practice of technique on isolated vowels -syllables -mono and bisyllabic words - phrases - sentences and texts - conversation (generalization to spontaneous speech) * practising larynx elevation through the twang technique, isolated vowels -syllables -mono and bisyllabic words - phrases - sentences and texts - conversation (generalization to spontaneous speech) * forward resonance, focusing on oral forward resonance rather than chest resonance, isolated vowels -syllables -mono and bisyllabic words - phrases - sentences and texts - conversation (generalization to spontaneous speech) * clear, precise articulation and cork exercise

Also known as: ART

Group 1; Group 2

Sham therapy BEHAVIORAL

Goal: active sham treatment, 4 sessions Doses and duration: 4 one hour and 15 minutes sessions (5h), 4 weeks Content: * providing information about vocal function, vocal surgery, vocal hygiene, transgender health care * discussing communication aspects and patterns, possible exercise contexts, communication partners, expectations of voice modification, conversational subjects * active intervention on nonverbal communication (Kinesics, gestures and sign language, facial expression, haptics, proxemics, occulsics, and physical appearance) * practising costo abdominal breathing patterns

Group 1; Group 2

Eligibility Criteria

• Age: 18 Years - 70 Years
• Gender Eligibility Details: Study population are trans women or AMAB (assigned male at birth). Inclusion criteria are established diagnose and gender identity confirmed by the gender team, under hormonal treatment (confirmed by blood analysis), female gender role, perceived as male speaker at the beginning of the therapy by the investigators and speaking fo within the male or ambiguous zone (\<180Hz).
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• established diagnose and gender identity confirmed by the gender team,
• aged between 18 and 70 years,
• self-reported normal hearing,
• native Dutch speaker,
• under hormonal treatment (confirmed by blood analysis),
• female gender role, perceived as male speaker at the beginning of the therapy by the investigators
• speaking fo within the male or ambiguous zone (\<180Hz).

You may not qualify if:

• history of neurological disorders, previous phonosurgery or speech therapy
• pathology of the vocal folds (observed by videolaryngostroboscopic examination of the vocal cords),
• smokers.
• to form a homogeneous study population gender non-binary persons will not be included in this study.

Sponsors & Collaborators

• University Ghent: lead

Study Sites (1)

Evelien D'haeseleer

Ghent, 9000, Belgium

Location

Related Publications (6)

• Gelfer MP, Tice RM. Perceptual and acoustic outcomes of voice therapy for male-to-female transgender individuals immediately after therapy and 15 months later. J Voice. 2013 May;27(3):335-47. doi: 10.1016/j.jvoice.2012.07.009. Epub 2012 Oct 22.

  PMID: 23084812 BACKGROUND

• Dacakis G. Long-term maintenance of fundamental frequency increases in male-to-female transsexuals. J Voice. 2000 Dec;14(4):549-56. doi: 10.1016/s0892-1997(00)80010-7.

  PMID: 11130111 BACKGROUND

• Leung Y, Oates J, Chan SP. Voice, Articulation, and Prosody Contribute to Listener Perceptions of Speaker Gender: A Systematic Review and Meta-Analysis. J Speech Lang Hear Res. 2018 Feb 15;61(2):266-297. doi: 10.1044/2017_JSLHR-S-17-0067.

  PMID: 29392290 BACKGROUND

• Gelfer MP, Mikos VA. The relative contributions of speaking fundamental frequency and formant frequencies to gender identification based on isolated vowels. J Voice. 2005 Dec;19(4):544-54. doi: 10.1016/j.jvoice.2004.10.006.

  PMID: 16301101 BACKGROUND

• Carew L, Dacakis G, Oates J. The effectiveness of oral resonance therapy on the perception of femininity of voice in male-to-female transsexuals. J Voice. 2007 Sep;21(5):591-603. doi: 10.1016/j.jvoice.2006.05.005. Epub 2006 Jul 5.

  PMID: 16822646 BACKGROUND

• Soderpalm E, Larsson A, Almquist SA. Evaluation of a consecutive group of transsexual individuals referred for vocal intervention in the west of Sweden. Logoped Phoniatr Vocol. 2004;29(1):18-30. doi: 10.1080/14015430310021618.

  PMID: 15089001 BACKGROUND

MeSH Terms

Conditions

Transsexualism; Gender Dysphoria; Communication Disorders

Condition Hierarchy (Ancestors)

Sexuality; Sexual Behavior; Behavior; Sexual Dysfunctions, Psychological; Mental Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurodevelopmental Disorders

Study Officials

• Evelien D'haeseleer, PhD

  University Ghent

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 14, 2020
• First Posted: January 14, 2021
• Study Start: September 1, 2019
• Primary Completion: March 30, 2023
• Study Completion: March 30, 2023
• Last Updated: December 13, 2023

Record last verified: 2023-12

Data Sharing

• IPD Sharing: Will not share

Locations

BE (1)