Effects of exogenous testosterone therapy on communication in gender diverse speakers

项目摘要 性别多样化的个人得不到充分的服务，是暴力的目标，而且健康状况不良的风险更高 结果。尽管高达66%的GD个体在出生时被分配为女性（AFAB）， 个人有性别相关的声音问题，没有证据为基础的治疗声音 男性化是性别肯定医疗干预和人身安全的一个关键因素。大多数临床医生 许多患者认为，用睾酮（T）进行的性别肯定激素治疗是唯一的治疗方法。 改变声音的道路。目前的推测是T导致声带尺寸的增加， 导致较低的基频（f0），并因此导致声音男性化。然而，这一理论并没有 直接评估，T可能会导致喉和声道的额外结构变化， 可能会影响自我和听众的声音性别感知（VPoG）。总之，尽管健康状况危急， 需要在高危人群中，缺乏证据支持GD-AFAB的这种常见声音治疗 个体这个建议的目的是评估我们的概念模型的声音和语音在GD-AFAB 扬声器：1）T导致声带长度，声带厚度和声道的解剖变化 长度，降低语音fo和语音共振峰，这导致VPoG的变化;以及2）个体 特征与VPoG随T的变化程度有关。本观察性研究将遵循GD- 正在接受T治疗的AFAB成人作为其正常临床护理的一部分，以系统地测试该模型。 在目标1中，我们将纵向描述T在GD-AFAB个体中的作用，提供前所未有的 了解这种共同治疗在群体层面的实际影响。除了解剖学， 生理和声学测量，自我和他人的感知将被包括在内，以解释 这些看法的潜在不一致，这是同样重要的声音的结果措施 修改[8，99]。这一目标将提供关于声音男性化的基于证据的期望， 考虑使用T.目标2和3将检查个人层面的VPoG变化， 无论目标1中的组级结果如何。在目标2中，我们将定义解剖学、生理学和 听觉变化与T.这个目标将确定T如何修改 沟通，这将允许在未来的临床试验的客观结果和治疗目标。最后， 在目标3中，我们将确定与VPoG随T变化相关的参与者特征， 提供关于个体治疗反应的更精确预期。 总之，这些目标将为未来的循证治疗提供路线图：临床医生将能够 在什么时候，什么时候，什么时候。

Project Summary Gender-diverse (GD) individuals are underserved, targets of violence, and at higher risk for negative health outcomes. Although up to 66% of GD individuals are assigned female at birth (AFAB) and up to 97% of these individuals have gender-related voice problems, there is no evidence-based treatment for voice masculinization, a critical factor in gender-affirming medical intervention and personal safety. Most clinicians and many patients are left to assume that gender-affirming hormone therapy with testosterone (T) is the only path toward voice change. The current speculation is that T leads to an increase in the size of the vocal folds, leading to lower fundamental frequency (fo), and thus to voice masculinization. However, this theory has not been directly assessed, and T is likely to cause additional structural changes to the larynx and vocal tract that may impact both self- and listener vocal-perception of gender (VPoG). In summary, despite a critical health need in an at-risk population, there is a lack of evidence supporting this common voice treatment for GD-AFAB individuals. The goal of this proposal is to evaluate our conceptual model of voice and speech in GD-AFAB speakers: 1) that T results in anatomical changes in vocal fold length, vocal fold thickness, and vocal tract length, decreasing voice fo and speech formants, which leads to changes in VPoG; and 2) that individual characteristics are related to the degree of VPoG changes with T. This observational study will follow GD- AFAB adults who are being treated with T as part of their normal clinical care to systemically test this model. In Aim 1, we will longitudinally characterize the effects of T in GD-AFAB individuals, providing unprecedented understanding of the actual impact of this common treatment at the group level. In addition to anatomical, physiological, and acoustical measures, perceptions of both self and others will be included to account for potential misalignment of these perceptions, which are equally important outcome measures of voice modification [8, 99]. This aim will provide evidence-based expectations about voice masculinization for individuals considering the use of T. Aims 2 and 3 will examine changes in VPoG at the individual level, regardless of group-level findings in Aim 1. In Aim 2, we will define the anatomical, physiological, and acoustical changes associated with changes in VPoG with T. This aim will identify how T modifies communication, which will allow for objective outcomes and therapeutic targets in future clinical trials. Finally, in Aim 3, we will determine participant characteristics that are associated with changes in VPoG with T, providing more precise expectations about individual treatment responses. Together, these aims will provide a roadmap for future evidence-based treatment: clinicians will be able to provide guidance about when, how, and in whom communication will be impacted by T.