Thyroplasty Type III to Lower the Vocal Pitch in Trans Men.

About 20% of trans men do not achieve cisgender male frequencies (F0≤131 Hz) after gender-affirming hormone treatment (GAHT) with testosterone. The surgical procedure Isshiki thyroplasty type III (TPIII) is described to lower F0, but data on this technique in trans men are lacking. In this study, 8 trans men, unsatisfied with their voice after a minimum of 12 months of GAHT, underwent TPIII to lower F0 at the Department of Head and Neck Surgery at Ghent University Hospital. TPIII was performed by 1 surgeon using the same method each time. Pre- and postoperatively, an acoustic evaluation of the voice took place. The F0 dropped significantly from the preoperative mean of (154.60 ± 12.29) Hz to the postoperative mean of (105.37 ± 10.52) Hz (t = 9.821, P < .001). TPIII is an effective method for lowering the F0 in trans men who are not satisfied with their voice after long-term GAHT.

Organizing the voice questionnaire for transgender persons.

Background: The validated Transsexual Voice Questionnaire Male to Female (TVQMtF) and the adapted TVQ Female to Male (FtM) (TVQFtM) are both 30-item-long questionnaires used to evaluate self-perception of voice in transgender persons. They are part of a series of questionnaires completed by transgender persons during follow-up of cross-sex hormone therapy (CSHT). Aim: The aim of this study was to examine if these questionnaires can be organized. Methods: The TVQMtF or the TVQFtM was filled out at the start of CSHT, by 145 trans women and 83 trans men. Data were analyzed by factor analyses on both the questionnaires. Results: The factor analyses resulted in a three-factor solution for both the TVQMtF and the TVQFtM. The three factors were labeled as anxiety and avoidance, vocal identity, and vocal function. Conclusion: Both the questionnaires can be organized into three factors. This could contribute to making shorter versions of the questionnaires. Shorter versions would be useful to hormone prescribing physicians to track down more quickly voice problems in trans people undergoing virilizing or feminizing hormone treatment.

Self-perception of voice in transgender persons during cross-sex hormone therapy.

OBJECTIVE: Self-perception of voice has a significant psychosocial impact on transgender persons. Research about the evolution of self-perception of voice during cross-sex hormone therapy (CSHT) is lacking. The aim of this study was to examine if self-perception of voice changes during CSHT, and if a change of serum testosterone levels as a result of CSHT can predict a change of self-perception of voice. STUDY DESIGN: Prospective longitudinal study. METHODS: The Transsexual Voice Questionnaire (TVQ), consisting of three factors-anxiety and avoidance (AA), gender identity (GI), and voice quality (VQ)-was used. Transgender persons completed the TVQ at baseline (80 trans men and 103 trans women), after 3 and 12 months of CSHT follow-up. RESULTS: Trans men: From 0 to 3 months, 0 to 12 months, and 3 to 2 months of CSHT, the AA and GI scores improved. From 0 to 3 months of CSHT, the increasing testosterone level was predictive for the improvements of AA and GI scores. Trans women: From 0 to 3 months, the GI score improved. From 0 to 12 months, the AA, GI, and VQ scores improved. Improvements of self-perception of voice could not be predicted by changing serum testosterone levels. CONCLUSION: During CSHT, self-perception of voice improves in both trans men and trans women. In trans men only, the improving self-perception of voice during the first 3 months can be attributed to the CSHT. For trans women, this study supports that testosterone has acted irreversibly virializing to the voice before CSHT, if they already went through male puberty. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2796-2804, 2017.

12-months metabolic changes among gender dysphoric individuals under cross-sex hormone treatment: a targeted metabolomics study.

Metabolomic analyses in epidemiological studies have demonstrated a strong sexual dimorphism for most metabolites. Cross-sex hormone treatment (CSH) in transgender individuals enables the study of metabolites in a cross-gender setting. Targeted metabolomic profiling of serum of fasting transmen and transwomen at baseline and following 12 months of CSH (N = 20/group) was performed. Changes in 186 serum metabolites and metabolite ratios were determined by targeted metabolomics analysis based on ESI-LC-MS/MS. RandomForest (RF) analysis was applied to detect metabolites of highest interest for grouping of transwomen and transmen before and after initiation of CSH. Principal component analysis (PCA) was performed to check whether group differentiation was achievable according to these variables and to see if changes in metabolite levels could be explained by a priori gender differences. PCA predicted grouping of individuals-determined by the citrulline/arginine-ratio and the amino acids lysine, alanine and asymmetric dimethylarginine - in addition to the expected grouping due to changes in sex steroids and body composition. The fact that most of the investigated metabolites did, however, not change, indicates that the majority of sex dependent differences in metabolites reported in the literature before may primarily not be attributable to sex hormones but to other gender-differences.