Treatment & assessment

Voice and speech changes in transmasculine individuals following circumlaryngeal massage and laryngeal reposturing

Voice is an important means of expressing gender for many transmasculine people. Gender-affirming hormone treatment with testosterone (T) can lead to voice changes, but not for everyone. And not all transmasculine people take T. So we need non-hormonal options for voice care for those who want a more masculine-sounding voice. Could laryngeal manipulation approaches be such an option? For some folks, yes! After a single session, most transmasculine speakers saw changes in their pitch, the position of their larynx, and how masculine their voice sounded to others. 

Here's a short read from Inside Sargent—an interview with BU speech-language pathology alum Felicia François, who completed part of this project for a master's thesis.

Dahl, K. L., François, F. A., Buckley, D. P., & Stepp, C. E. (2022). Voice and speech changes in transmasculine individuals following circumlaryngeal massage and laryngeal reposturing. American Journal of Speech-Language Pathology, 31(3), 1368-1382. https://doi.org/10.1044/2022_AJSLP-21-00245

Graph of two frequency spectra showing differences between the original voice recording and the recording transmitted via a telepractice platform

Reliability and accuracy of expert auditory-perceptual evaluation of voice via telepractice platforms

Telepractice platforms substantially change the acoustics of a patient's voice. So can voice clinicians trust what they hear when listening to a patient by telepractice? They can! Speech pathologists and laryngologists (ENTs) evaluated speakers with a variety of voice disorders as reliably and accurately by telepractice as in person. Expert clinicians seem to distinguish between the "noise" of platforms like Zoom and the "noise" of a voice disorder.

Here's a quick write-up on this project from Inside Sargent magazine.

Dahl, K. L., Weerathunge, H. R., Buckley, D. P., Dolling, A. S., Díaz-Cadiz. M., Tracy, L. F., & Stepp, C. E. (2021). Reliability and accuracy of expert auditory-perceptual evaluation of voice via telepractice platforms. American Journal of Speech-Language Pathology, 30(6), 2446-2455. https://doi.org/10.1044/2021_AJSLP-21-00091

A four-panel plot showing the relationships between voice femininity ratings and four acoustic measures of voice and speech.

Acoustic features of transfeminine voices and perceptions of voice femininity

Many features of voice and speech contribute to the perception of gender and femininity. Are certain features particularly important in determining how the voices of transgender women are perceived? Seems so! Trans women with higher pitched and louder voices were perceived as more feminine by both unfamiliar listeners and by trans women themselves. Trans women rated their voices as less feminine than did listeners, revealing the importance of self-perceptions in this population.

Dahl, K. L., & Mahler, L. A. (2020). Acoustic features of transfeminine voices and perceptions of voice femininity. Journal of Voice, 34(6), 961.e19-961.e26. https://doi.org/10.1016/j.jvoice.2019.05.012

Coauthored publications in treatment & assessment

Norotsky, R.L., Dahl, K.L, Cocroft, S., Sauder, C., Tracy, L.F., & Stepp, C.E. (2023). Does implicit racial bias affect auditory-perceptual evaluations of dysphonic voices?  Journal of Voice, e-pub ahead of print. doi.org/10.1016/j.jvoice.2023.11.023

Marks, K.L., Dahl, K.L., & Stepp, C.E. (2023). The impact of foreign language accent on expert listeners’ auditory-perceptual evaluations of dysphonia. The Laryngoscope, e-pub ahead of print. doi.org/10.1002/lary.31160

Buckley, D.P., Dahl, K.L., Cler, G.J., & Stepp, C.E. (2020). Transmasculine voice modification: A case study. Journal of Voice, 34(6), 903-910. doi.org/10.1016/j.jvoice.2019.05.003