Effect of producing a desired fundamental frequency on measures of vocal hyperfunction in transgender speakers

项目摘要 跨性别者（TG;性别认同与出生时的性别分配不匹配）个人得不到充分的服务， 暴力，并有更高的风险为负面的健康结果。许多TG个体报告说， 与她们的性别认同一致，对确认她们的性别认同至关重要。有多种性别 确认可用的服务，但医疗干预，如手术或激素不确保 对声音性别的满意度。语音修改通常是首选的干预措施。主要目标之一 语音修改是改变基本频率（fo）向性别标准值，但知之甚少 关于使所需的fo习惯化所需的发声的潜在变化。研究表明 TG个体为获得理想的fo而使用的补偿策略的特征是非典型的模式， 发声，与发声功能亢进（VH）一致。这可能解释了高频率的口头投诉 在TG扬声器中。总之，尽管高危人群有关键的健康需求，但在严格的 以前的研究，缺乏证据表明，在语音产生的子系统之间的变化， TG个体的习惯性和期望性行为。因此，本提案的目的是评估我们的概念 语音修改模型：1）改变fo以使其更符合性别将导致效率降低 发声，从而增加VH的迹象;以及2）实现发声所需的fo变化的幅度 性别满意度将与VH指标的变化幅度相对应。这项观察性研究 将测量TG成年人的VH，这些成年人对他们的习惯性声音不满意，并希望有更多的性别- 一致的声音。 只有那些表达了改变他们的信仰以变得更加性别一致的愿望的TG个体才会被 为这项研究招募。在目标1中，我们将收集呼吸运动学，声学，空气动力学，喉镜， 自我感知，和听众的听力感知措施VH时，个人产生他们的习惯和 欲为。这一目标将确定TG个体用来改变其行为的补偿策略。目标2将 检查需要达到满意度的声音性别的期望变化与 产生所需fo所需的VH测量的变化程度。这一目标将确定关系 声音性别满意度和补偿策略之间的关系。 总之，这些目标将为未来的循证治疗提供路线图：临床医生将获得基线 关于TG人群中发声功能的信息，这对于提供基于证据的 评估和治疗声音障碍。

Project Summary Transgender (TG; gender identity does not match sex-assigned at birth) individuals are underserved, targets of violence, and at higher risk for negative health outcomes. Many TG individuals report that producing a voice congruent with their gender identity is crucial to affirming their gender identity. There are a variety of gender affirming services available, but medical interventions, such as surgery or hormones do not do not ensure satisfaction with vocal gender. Voice modification is often the preferred intervention. One of the primary goals for voice modification is to alter fundamental frequency (fo) towards sex-normative values, but little is known about the underlying changes to vocalization required to habituate a desired fo. Research suggests that the compensatory strategies used by TG individuals to attain a desired fo are characterized by atypical patterns of vocalization, consistent with vocal hyperfunction (VH). This may explain the high frequency of vocal complaints in TG speakers. In sum, despite a critical health need in an at-risk population, there is a gap in the rigor of the prior research, with a lack of evidence identifying changes in the subsystems of voice production between the habitual and desired fo of TG individuals. Therefore, the goal of this proposal is to evaluate our conceptual model of voice modification: 1) that altering fo to be more gender congruent will result in less efficient vocalization, thus increasing signs of VH; and 2) the magnitude of the change in fo required to achieve vocal gender satisfaction will correspond to the magnitude of change in measures of VH. This observational study will measure VH in TG adults who are not satisfied with their habitual voice and desire a more gender- congruent voice. Only TG individuals who have expressed a desire to change their fo to become more gender congruent will be recruited for this study. In Aim 1, we will collect respiratory kinematic, acoustic, aerodynamic, laryngoscopic, self-perceived, and listener auditory-perceptual measures of VH when individuals produce their habitual and desired fo. This aim will identify the compensatory strategies used by TG individuals to alter their fo. Aim 2 will examine the relationship between the desired change in vocal gender needed to achieve satisfaction and the degree of change in measures of VH necessary to produce a desired fo. This aim will identify the relationship between vocal gender satisfaction and the compensatory strategies used when producing a desired fo. Together, these aims will provide a roadmap for future evidence-based treatment: clinicians will gain baseline information about vocal function within the TG population, which is critical for providing evidence-based assessment and treatment of voice disorders.