Gender-Incongruent Voice Significantly Contributes to Gender Dysphoria in Transgender Individuals

Introduction: Features that cause gender incongruence (gender identity not aligning with assumptions based on sex assigned at birth) in transgender individuals often motivate them to seek out gender-affirming treatments. Voice has rarely been included as a major contributor to gender dysphoria (psychological distress secondary to gender incongruence). The primary objective of this study is to understand the significance of voice-related compared to dysphoria secondary to other features.

Methods: A prospective online survey was posted to transgender social media communities in January 2024. The survey requested a ranking of features that contribute to gender dysphoria, whether the features were bothersome due to external or internal perception, and self-reported ideal order for pursuing gender-affirming treatments. The categories of features included upper body, lower body, face, neck, voice, and height.

Results: In this sample, 90.9% of transgender individuals experience gender dysphoria secondary to their voice, which was exceeded only by lower body (100%). Vocal incongruence contributed to gender dysphoria in 87.5% of trans women with 42.8% citing voice as the number one cause, 57.1% indicating that their own perception of voice was more significant than how it sounded to others, and 57.1% that would choose gender-congruent voice as the top priority in their transition. In trans men, 66.7% experienced dysphoria secondary to voice. Despite none ranking voice as the most bothersome feature, 66.7% of trans men would address their voice as the first intervention in their transition. Among all trans respondents, voice was ranked as the most desired change compared to all other features (selected by 60% of this sample). Qualitatively, subjects cite the necessity of daily voice use as a contributor to dysphoria.

Conclusions: Voice is the second most common cause of gender dysphoria and over half of the subjects would choose to address it first if resources were available. Healthcare providers must be aware that voice interventions are critical to improve gender dysphoria experienced by transgender individuals.