Can ambulatory biofeedback help a transgender woman speak at a higher pitch?

Abstract

Purpose: Voice feminization for transgender women remains a challenge. The fundamental frequency of the voice (f_o) is one of the main parameters contributing to the perception of gender. One of the aims of voice therapy is to help transgender women acquire a new vocal motor behavior to increase their f_o. We hypothesized that ambulatory biofeedback could help extend the new vocal behavior to daily life.

Materials and methods: This prospective case study assessed the impact of two weeks of ambulatory vibrotactile biofeedback (VTBF) applied to one transgender woman, following two weeks of voice therapy (three 60-minute sessions). The VTBF was activated when the participant’s voice was lower than 150 Hz for more than 500 ms and was accompanied by two 60-minute counseling sessions.

Results: The results showed that mean f_o monitored in daily activities tended to increase following the two weeks of voice therapy (Δ = 8 Hz or 1 semitone) and then increased significantly immediately after the two weeks of VTBF (Δ = 13 Hz or 1.5 semitones). The increase in mean f_o from day to day and the decrease in the activation percentage from the first to the second week of VTBF (Δ = 6%) indicated a gradual integration of the motor behavior, making it possible to achieve the targeted female frequency.

Conclusions: The results suggest that ambulatory VTBF helped the participant to generalize the techniques acquired during the voice therapy sessions to real-life communication situations. These results are promising for therapeutic programs that integrate tools that can be used outside the clinical context. Design: Prospective case study.

Keywords:

• Vocal motor behavior modification
• voice feminization
• transgender male to female
• fundamental frequency
• ambulatory vibrotactile biofeedback
• voice monitoring

Acknowledgements

The authors thank Clémentine Jacquet for her help in collecting the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Note that the mean of a non-normal distribution is sensitive to extreme values. Due to the skewed distribution of f_o, it would have been more informative to provide the mode. This was not possible because the VoxLog dosimeter and VoxLog Discovery software have not been operational or supported by the manufacturer since 2017.

Additional information

Funding

Angélique Remacle was supported by the Fund for Scientific Research – FNRS (F.R.S.-FNRS, Brussels, Belgium).

Notes on contributors

Dominique Morsomme

Dominique Morsomme is a professor in the Faculty of Psychology, Speech and Language Therapy, and Educational Sciences at the University of Liège, Belgium. She heads the Voice Unit in the Department of Speech and Language Therapy. She also works as a vocologist at the Hospital of Liège. Her clinical and research activities focus on evidence-based practice in voice, voice disorders evaluation and voice feminization.

Angélique Remacle

Angélique Remacle is a speech therapist. She holds a PhD in psychological sciences. Her research takes place at the Department of Speech therapy, Université de Liège, Belgium. She conducts fundamental and applied research on the production and perception of human voice. She is a visiting professor in speech and language therapy at the Université libre de Bruxelles, Belgium.