Voice is a key aspect of gender transition for many gender diverse individuals. Transfeminine people are offered hormone therapies, such as oestrogen to support their transition, however these do not impact laryngeal anatomy. This means that specific voice interventions are a fundamental aspect of voice feminisation. These include behavioural voice therapy and surgical interventions and require a specialist multidisciplinary approach. Otolaryngologists should assess the candidacy of transfeminine patients for surgery, but the evidence base is poorly defined. This scoping review aimed to review the existing literature relating to voice feminisation surgery and identify the current criteria surgeons use to select appropriate patients for the procedures. The inclusion criteria for the review included transfeminine adult patients who had voice feminisation surgery where assessments and surgical criteria were defined. Forty-two studies met the inclusion criteria and were reviewed for their clinical parameters. Most studies were retrospective case series or reports with samples ranging between 1 and 506.Outcomes used as part of the pre-surgical assessment included endoscopic imaging, acoustic parameters – especially fundamental frequency – and perceptual assessment (for example, GRBAS) or clinical judgment by speech-language pathologists. Common patient-reported outcomes included the Voice Handicap Index and Trans Woman Voice Questionnaire. The review showed significant heterogeneity in preoperative criteria between studies, and limited reporting on voice training or psychological factors that are key to successful gender-affirming voice care.
How are clinicians assessing suitability for voice feminisation surgery?
Reviewed by Gemma Clunie
Gender-Affirming Feminization Voice Surgery: A Scoping Review of Preoperative Assessments.
CONTRIBUTOR
Gemma Clunie
BA (Hon), MSc, PhD, MRCSLT, Imperial College Healthcare NHS Trust; Honorary Research Fellow, Imperial College London, UK.
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