Different measures of fundamental frequency and vocal satisfaction among transgender men and womenABSTRACT
Purpose To verify possible correlations between fo and voice satisfaction among Brazilian transgender people.
Methods An observational, cross-sectional quantitative study was conducted with the Trans Woman Voice Questionnaire (TWVQ), voice recording (sustained vowel and automatic speech) and extraction of seven acoustic measurements related to fo position and variability in transgender people. Participants were divided into two groups according to gender. After descriptive and inferential analysis, comparison between both groups was performed by Student’s t-test and the correlation between fo measurements and the TWVQ protocol was calculated by Pearson’s correlation (p<0.05).
Results A total of 11 transgender women (mean age = 26.91) and seven transgender men (mean age = 26.57) participated in the study. Women desired a slightly feminine voice, scoring 72.8 on the TWVQ, with mean pitch values of 165.2Hz on vowels and 144.5Hz in speech. Men desired a slightly masculine voice, scoring 68.4 on the TWVQ, with mean pitch values of 143.3Hz on vowels and 138.9Hz in speech. Of the seven evaluated measures, only the maximum pitch during number counting by women showed a moderate negative correlation with the TWVQ (p=0.043).
Conclusion Only maximum fo during number counting by transgender women showed a negative correlation with the TWVQ score. Results suggest that although fo may play a role in gender perception by voice, it is not the only determinant of vocal satisfaction in this population.
Keywords:
Voice; Voice Training; Speech Acoustics; Gender Identity; Communication
RESUMO
Objetivo Verificar se existe relação entre medidas acústicas relacionadas fo e a satisfação vocal de pessoas transgênero brasileiras.
Método Estudo quantitativo observacional e transversal, com aplicação do Trans Woman Voice Questionnaire (TWVQ), gravação das vozes (vogal sustentada e fala automática) e extração de sete medidas acústicas relacionadas à posição e variabilidade da fo de pessoas transgênero. Participantes divididos em dois grupos de acordo com o gênero. Realizada análise descritiva e inferencial, a comparação entre os grupos foi realizada pelo Teste T de Student e a correlação das medidas da fo com o protocolo TWVQ foi testada por meio da Correlação de Pearson (p<0,05).
Resultados Participaram 11 mulheres (média de idade= 26,91) e sete homens transgênero (média de idade = 26,57). As mulheres desejavam uma voz um pouco feminina, pontuando 72,8 no TWVQ, com valores médios de fo de 165,2Hz nas vogais e 144,5Hz na fala. Os homens desejavam uma voz um pouco masculina, pontuando 68,4 no TWVQ, com valores médios de fo de 143,3Hz nas vogais e 138,9Hz na fala. Dentre as sete medidas avaliadas, apenas fo máxima durante a contagem de números nas mulheres apresentou correlação negativa moderada com o TWVQ (p=0,043).
Conclusão Apenas a fo máxima durante a contagem de números das mulheres transgênero demonstrou uma correlação negativa com o escore do TWVQ. Os resultados obtidos sugerem que, embora a fo possa desempenhar um papel na percepção do gênero na voz, ela não é o único determinante da satisfação vocal nesta população.
Descritores:
Voz; Treinamento da Voz; Acústica da Fala; Identidade de Gênero; Comunicação
INTRODUCTION
Human voice production is a complex phenomenon that involves physiological, psychological, and behavioral characteristics. Not only are these characteristics fundamental to communication, but they also play a crucial role in shaping an individual’s identity, conveying emotional, linguistic, and social nuances(1,2).
Fundamental frequency, also known as oscillatory frequency(3) (fo), defined as the number of vibratory cycles of the vocal folds in a time interval, is intrinsically linked to pitch, the auditory perception of frequencies that comprises bass and treble sounds(4). In research contexts involving acoustic analysis of voice, fo stands out as a predictor of specific characteristics related to speakers’ age and gender(5). In Brazil, average fo for cisgender adults ranges from 80Hz to 150Hz for men and 150Hz and 250Hz for women(2), but the assumption that female voices are associated with high tones and male voices with low tones persists in the Brazilian culture(6). Such an assumption bolsters a recurrent demand by transgender people in speech therapy clinics(7,8), reflecting the social influence on the construction of gender norms and vocal expression. As a vehicle for gender expression, the voice is a complex element influenced by linguistic and communicative aspects, requiring a more comprehensive approach to understanding the transgender experience(1).
In the context of gender diversity, fo has been a prominent object of study and intervention in gender affirmation procedures. Particularly, trans individuals who identify with a gender other than the one assigned at birth(9) often seek specialized support in the search for a voice aligned with their identity(10). Hormone therapy, a common procedure in this context, triggers different effects in genders. Transgender women undergoing estrogen hormone therapy do not present evident voice transformations(11), whereas transgender men experience fo alterations due to muscle increase caused by testosterone, resulting in voice virilization(12,13). But even with positive results from the testosterone effect, changes in pitch are not always enough for a voice to be considered as masculine by listeners(14,15).
International studies highlight that despite changes in pitch and fo, the vocal satisfaction of transgender women may be more related to social acceptance of their voice than to fo itself(16,17). Voice satisfaction among trans men may be related to lower fo values, although not all are satisfied with the voice changes promoted by hormone therapy alone(18). This complex relation between fo and vocal satisfaction, combined with the influence of cultural and linguistic factors, reinforces the need for investigations in populations such as the Brazilian one and the inclusion of transgender men in research on gender diversity.
Although voice studies constantly investigates fo due to its robustness(19), this research innovates by studying a set of fo descriptors in a sample of Brazilian transgender men and women. It verified whether there are significant correlations between seven acoustic measures related to fo position and variability and the vocal satisfaction of Brazilian transgender people.
METHOD
A quantitative observational, cross-sectional study was submitted to and approved by the Research Ethics Committee, under opinion 4,730,175. Data collection was conducted from August 2021 to January 2022 at a school clinic in Campinas city, São Paulo, Brazil. All participants signed the informed consent form.
Participants were recruited via invitation on social networks, Facebook groups and e-mail for dissemination at LGBTQ+ reference centers, which configures a non-probabilistic sample by convenience.
Self-reporting transgender men and women aged from 18 to 49 years who were native Brazilian Portuguese speakers were invited to participate in the research. Age group delimitation was a methodological choice to avoid including people who had already gone through menopause in the sample, considering the possible resulting effects on the voice.
As exclusion criteria, the following was established: self-reported health problems that may affect voice quality on the day of data collection (e.g., flu, cold, gastroesophageal reflux or airway infections) and smoking. Additionally, participants should not self-report vocal health complaints on the day of data collection by answering the following question: “Do you have any voice health complaints?” Participants who reported dysphonia signs and symptoms such as hoarseness, vocal fatigue, pain and discomfort when speaking, among others, were excluded.
A total of 18 transgender people, 11 women and seven men, participated in the study. Participants were aged from 18 to 41 years, with a mean age of 26.91 for women and 26.57 for men. Fourteen participants were on hormone therapy, of which nine (81.81%) were trans women and five (71.43%) were trans men. None of the participants underwent gender affirmation vocal therapy prior to data collection. Table 1 presents the detailed characterization of the participants.
Procedures
Recording protocol consisted of uttering three sustained vowels [a], glissando using the vowel [a] and automatic speech (counting from one to ten). These tasks were selected to ensure production standardization among all study participants. Researchers demonstrated the tasks beforehand so the participants could practice and later the samples were recorded.
Production was recorded on a Dell Desktop computer using a unidirectional microphone Shure® model SM58 coupled to a sound card Tascam® model US100. Speakers were recorded directly by the Praat software (version 6.2.14)(20) in mono channel, with a sampling rate of 44.1kHz and in .wav format. During the recording, participants were standing inside a soundproof booth with environmental noise below 50dB with the microphone positioned at a 90° angle ten centimeters from their mouths, as recommended by Dejonckere(21).
The acoustic measurements fo mean, fo minimun (fomin) and fo maximun (fomax) for the vowel samples; median (fomed), standard deviation (fosd), fo minimun (foMin) and fo maximum (fomax) for counting numbers were extracted and computed. These measurements were selected to understand the vocal range, predominant frequency and melodic variation of fo in the voice and automatic speech samples.
Measurements of the sustained vowel [a] were extracted by the get pich function in Praat(20), with windowing adjustment of the minimum and maximum parameters by gender (from 75 to 600 Hz(22)). Measurements related to number counting were extracted using the Prosody Descriptor script(23). The script requires the audios to be tagged in Praat(20), generating a TextGrid with the pauses and number of phonetic syllables identified in each speech excerpt. After its execution, the Prosody Descriptor script generated a text file report of all the extracted measurements which were then tabulated.
All participants answered the Transgender Woman Voice Questionnaire (TWVQ) originally proposed by Dacakis and Davies(24), translated into and adapted for the Brazilian Portuguese by Santos and collaborators(25). This 30-item instrument targets transgender women and addresses gender and voice satisfaction and its impact on daily life.
Each TWVQ question is scored on a four-point Likert scale according to the occurrence of the problem, where 1= never/rarely, 2= sometimes, 3= often, and 4= usually/always. Final score is calculated via simple summation, ranging from 30 to 120 points, and the higher the final score, the greater the impact of the voice on the respondent’s life. In addition to these 30 questions, the questionnaire has two final questions addressing individuals’ self-perception regarding gender expression in the voice: “currently my voice is” and “my ideal voice could sound,” which can be classified as ”very feminine,” “somewhat feminine,” “neutral,” “somewhat masculine,” and “very masculine.” We also adapted the questionnaire for application with trans men (Appendix A).
Descriptive and inferential analysis were performed using the Jamovi software, version 2.3.18. Shapiro-Wilk test showed that the samples are normal, thus comparison between groups was performed using Student’s t-test and the correlation of fo measurements with the total TWVQ score was estimated using Pearson’s correlation. Significance level was set at 5%.
RESULTS
Analysis of the means to the final TWVQ questions’ answers (Currently my voice is; My ideal voice should sound) showed that trans women consider their voice to be somewhat masculine (average score 4) and would like their voice to be more feminine (average score 2); whereas trans men consider their voice to be somewhat feminine (mean score 2) and would like their voice to be more masculine (average score 4). Table 2 summarizes the mean, minimum, maximum and standard deviation of the TWVQ scores and acoustic measurements extracted. Statistical analysis showed no differences between the groups.
Table 3 shows the correlations between fo measurements and the total TWVQ score, calculated using Pearson’s correlation coefficient. Importantly, interpreting these coefficients involves the parallelism of measurements on different scales. For the group of transgender women, we observed a moderate negative correlation between the maximum fo number counting and the TWVQ (r = −0.584, p = 0.043).
Correlation between each extracted acoustic measurement and the final TWVQ score for both genders
DISCUSSION
Our study brings significant contributions to the field of gender and voice diversity research by exploring the correlation between fo descriptors and vocal satisfaction among Brazilian transgender people. By considering a more comprehensive set of fo descriptors, this study broadens the analysis to include transgender men, a population little explored in the scientific literature.
Results revealed that higher fo values for trans women and lower fo values for trans men had no direct relation with vocal satisfaction in the study sample, contrary to the common association between these values and gender expression in the voice(26). Importantly, despite equal and unsatisfactory vocal perception, the mean fo for the vowel [a] of trans men and women were within the expected ranges for the self-reported genders, but close to the limits of intersection between male and female voices(2) known as the neutral range, between 145 and 175 Hz(27). This definition is based on the results of studies derived from the project Genderless voice (27).
Although pitch is often associated with gender identification, gender and voice are heavily influenced by social factors(5). A study conducted in Brazil observed that trans people, cisgender people, and speech therapists have different perceptions about gender expression in the voice(28).
Regarding the self-perception of gender expression in the voice, both groups were dissatisfied as evidenced by the total TWVQ score (Table 2). Although the TWVQ protocol has yet to be validated in Brazil, the dissatisfaction found in our study is consistent with other recent studies conducted in the country(29,30). Notably, the search for voices that are not extremely feminine nor masculine suggests a wider range of possibilities beyond the traditional gender dichotomy, indicating social influences that may contribute to trans women’s higher TWVQ scores.
One study(29) found a positive relation between satisfaction with gender expression and Quality of Life in the voice of trans people and an average of 70.6 points in the total TWVQ score. Another study(30) also noted a dissatisfaction of this population with their voice, showing mean TWVQ scores of 69.93 for men and 69.46 for women. Both studies assessed trans people’s self-perception without investigating the correlation with acoustics. Our mean score converged with the aforementioned findings. Additionally, none of the participants attended speech therapy, suggesting that they had not yet undergone specific interventions that influenced vocal satisfaction.
A study considering fo analysis observed a negative correlation between the mean fo of vowel [ɛ] and TWVQ scores in trans women(31); however, this study disregarded other fo descriptors and did not include trans men.
As for the extracted measurements, our analysis of the sustained vowel presented no sufficient information to correlate with vocal satisfaction (Table 3). However, maximum fo during the automatic speech of trans women showed a moderate negative correlation with the TWVQ score, indicating that greater fo variations during speech may contribute to greater voice satisfaction. Importantly, the difference between fo values obtained by men and women during automatic speech was not statistically significant. This may be related to the difficulty that trans women have in maintaining the desired phonatory adjustments during speech when compared to vowel adjustments, for example(32-34).
Our findings corroborate international studies which suggest that voice satisfaction in trans women is not strictly related to fo, but rather to a combination of factors such as the other’s perception of their voice(16,35). For the population studied, gender perception and vocal satisfaction may be influenced by Brazilian cultural and linguistic aspects.
Voice pitch and prosody are shaped by sociocultural practice and, thus, identifying characteristics that distinguish gender perception and theorizing from where gender differences in the voice come from must be closely linked to social factors(5). But despite the particularities that the preferred voice assumes in different cultures, fo alone, even with the analysis of its descriptors, cannot be associated with vocal satisfaction in transgender people and this should be considered in speech-language practice.
Transgender people’s satisfaction with their voice depends on the respective social acceptance(5,16,17). Gender expression in the voice does not depend only on the speaker’s utterance, but also on the listener’s context(28); thus, recent studies have discussed the need to consider a structure outside the binary in judging gender expression in the voice(28,36,37). This study has some important limitations to be considered when interpreting the results. First, the absence of otorhinolaryngological evaluation required that all general health information be self-reported, but none of the participants had any complaints related to vocal health.
Second, the predominance of female participants may be related to the greater demand from this group for health services given the restricted results of hormone therapy(11). Moreover, not all participants were undergoing hormone therapy, which may be related to the barriers to accessing health services such as discrimination and disrespect of social name(38).
Finally, the use of automatic speech by number counting as an analysis sample may not represent the participants’ daily communication pattern but was an important methodological choice for standardizing data collection. New studies could benefit from spontaneous speech analysis, even with the standardization difficulties for all participants. We highlight the need for validating specific assessment and self-assessment instruments for this population, as well as developing a specific instrument for trans men. These limitations stress the need for caution when generalizing the present findings and highlight the importance of considering the participants’ social and individual context when analyzing their vocal characteristics.
Changes in the fo alone may not guarantee full vocal satisfaction among transgender people. The need for training and improving individual communicative aspects combined with the promotion of visibility and social acceptance emerge as crucial aspects. Although speech therapy can offer benefits in the search for a more representative voice, the need for public policies and social measures aiming at promoting visibility and respect for the transgender population is evident, reflecting on the fullness of vocal satisfaction.
CONCLUSION
Only maximum fo during number counting by transgender women showed a moderate negative correlation with the TWVQ score. Research participants had mean fo values within the expected ranges for the self-reported genders. TWVQ scores suggest dissatisfaction with the voice for both genders. Results demonstrate that although fo may play a role in gender perception by voice, it was not determinant of vocal satisfaction in the studied population.
The complex relation between voice and gender identity transcends the voice’s physical characteristics and is strongly influenced by social, cultural, and individual factors. It is crucial to recognize that changes in fundamental frequency alone, even with hormone and surgical therapy, may not guarantee full vocal satisfaction for transgender people. Speech-language therapy follow-up is therefore crucial.
Appendix A TWVQ adapted for transgender men
| Rating Scale | ||||||||||
| 1 = never or rarely | ||||||||||
| 2 = sometimes | ||||||||||
| 3 = often | ||||||||||
| 4 = usually or always | ||||||||||
| Name: _____________________________________________________________________________ | Date: ____________ | |||||||||
| Based on your experience living as a man, please select the response that best applies to you. | ||||||||||
| 1 | 2 | 3 | 4 | |||||||
| 1. | People have difficulty hearing me in a noisy room. | □ | □ | □ | □ | |||||
| 2. | I feel anxious when I know I have to use my voice | □ | □ | □ | □ | |||||
| 3. | My voice makes me feel less masculine than I would like. | □ | □ | □ | □ | |||||
| 4. | The pitch of my speaking voice is too high. | □ | □ | □ | □ | |||||
| 5. | The pitch of my voice is unreliable. | □ | □ | □ | □ | |||||
| 6. | My voice gets in the way of me living as a man. | □ | □ | □ | □ | |||||
| 7. | I avoid using the phone because of my voice. | □ | □ | □ | □ | |||||
| 8. | I’m tense when talking with others because of my voice. | □ | □ | □ | □ | |||||
| 9. | My voice gets croaky, hoarse or husky when I try to speak in a masculine voice. | □ | □ | □ | □ | |||||
| 10. | My voice makes it hard for me to be identified as a man. | □ | □ | □ | □ | |||||
| 11. | When I speak the pitch of my voice does not vary enough. | □ | □ | □ | □ | |||||
| 12. | I feel uncomfortable talking to friends, neighbours and relatives because of my voice. | □ | □ | □ | □ | |||||
| 13. | I avoid speaking in public because of my voice. | □ | □ | □ | □ | |||||
| 14. | My voice sounds artificial. | □ | □ | □ | □ | |||||
| 15. | I have to concentrate to make my voice sound the way I want it to sound. | □ | □ | □ | □ | |||||
| 16. | I feel frustrated with trying to change my voice. | □ | □ | □ | □ | |||||
| 17. | My voice difficulties restrict my social life. | □ | □ | □ | □ | |||||
| 18. | When I am not paying attention my pitch rises. | □ | □ | □ | □ | |||||
| 19. | When I laugh I sound like a woman. | □ | □ | □ | □ | |||||
| 20. | My voice doesn’t match my physical appearance. | □ | □ | □ | □ | |||||
| 21. | I use a great deal of effort to produce my voice. | □ | □ | □ | □ | |||||
| 22. | My voice gets tired quickly. | □ | □ | □ | □ | |||||
| 23. | My voice restricts the sort of work I do. | □ | □ | □ | □ | |||||
| 24. | I feel my voice does not reflect the ‘true me’. | □ | □ | □ | □ | |||||
| 25. | I am less outgoing because of my voice. | □ | □ | □ | □ | |||||
| 26. | I feel self-conscious about how strangers perceive my voice. | □ | □ | □ | □ | |||||
| 27. | My voice ‘gives out’ in the middle of speaking. | □ | □ | □ | □ | |||||
| 28. | It distresses me when I’m perceived as a woman because of my voice. | □ | □ | □ | □ | |||||
| 29. | The pitch range of my speaking voice is restricted. | □ | □ | □ | □ | |||||
| 30. | I feel discriminated against because of my voice. | □ | □ | □ | □ | |||||
| Please provide an overall rating of your voice: | ||||||||||
| Currently, my voice is: | ||||||||||
| □ | □ | □ | □ | □ | ||||||
| Very feminine | Somewhat feminine | Gender neutral | Somewhat masculine | Very masculine | ||||||
| My ideal voice would sound: | ||||||||||
| □ | □ | □ | □ | □ | ||||||
| Very feminine | Somewhat feminine | Gender neutral | Somewhat masculine | Very masculine | ||||||
ACKNOWLEDGEMENTS
We would like to thank all the participants who contributed to this research. The willingness and engagement of each individual were fundamental to investigating the relationship between acoustic measures and vocal satisfaction among transgender individuals in Brazil.
We also extend our gratitude to CAPES, whose generous funding made the development of this study possible.
-
Study conducted at Universidade Estadual de Campinas – UNICAMP - Campinas (SP), Brasil.
-
Financial support: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (001).
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