Perception of voice in the transgender client.

Fundamental frequency (F(0)) of speech is used to measure the success of voice therapy in male-to-female transgender clients. This study evaluates the relationship between F(0) and patients' happiness with their voice. The study design used was a cross-sectional evaluation of client satisfaction questionnaires and voice recordings from transgender clients. This study was a comparative evaluation of voice recordings by voice professionals and lay observers. Twelve male-to-female transgender participants completed visual analogue scales (VASs), rating happiness with self-perceived femininity of their voice. Fifteen speech and language therapists (SLTs) and 40 naïve observers evaluated the anonymized recordings, using the same rating system. The correlation between mean F(0) and participant happiness was established. Relationships between participant happiness and rater opinions were explored. A significant relationship between F(0) and participant happiness could not be demonstrated (r=0.32, P=0.32). There was a moderately strong positive correlation between self-perception of vocal femininity and perception of femininity by SLTs and naïve observers (r=0.76 and 0.68, P=0.003 and P=0.01, respectively). This study demonstrates that happiness with voice in male-to-female transgender clients is not directly related to F(0). Clients can assess femininity of their voice in the form of perceived pitch. This may not affect happiness scores. Voice satisfaction may not correlate with perceptions of supervising voice professionals. However, professionals can reliably evaluate how the voice will be received by the lay public. Subjective measures of patient satisfaction, including VASs, are reliable and valid tools in evaluating therapeutic success.