Voice Characteristics at Presentation in Nonbinary Individuals Seeking Gender-Affirming Voice Care.

Abstract

Gender-affirming voice care has primarily focused on trans women with limited research on nonbinary (NB) individuals. This study aims to describe baseline characteristics of NB individuals seeking gender-affirming voice treatment to enhance clinicians' understanding and improve patient care. A retrospective review of NB individuals seeking voice treatment at a tertiary laryngology center was conducted. Data on demographics, medical history (including hormone therapy), presenting concerns, and baseline voice-related outcome measures were collected. Twenty-five NB individuals (13 assigned male at birth (AMAB)) are described. Mean age was 32.3 years (range: 21-50) with the majority (84%) identifying as white, non-Hispanic. 80% were on gender-affirming hormone replacement therapy, with 56% receiving feminizing hormones. Most had previously engaged in gender-affirming treatments, including surgery, voice therapy, and mental health services. All patients presented for gender-related voice concerns: 92% reported dissatisfaction with voice quality, and 52% utilized gendered language when describing their voice goals. Voice-related experiences of nonbinary individuals (VENI) survey was completed by 8 patients, mean score 45 out of 68. Mean overall grade of dysphonia was 29.4 (0, 85). No organic changes were noted on videostroboscopy. All patients were stimulable for improvement toward patient-expressed goals based on SLP assessment, and voice therapy was recommended to all patients. This study offers the first comprehensive description, at presentation, of NB individuals seeking gender-affirming voice care. Understanding their voice concerns and goals is essential for providing personalized, effective care that aligns with their unique experiences and aspirations.