Suzanne Coomer | Rush University Medical Center
Researcher and Speech-Language Pathologist Suzanne Coomer is a recipient of the 2022 Dysphonia International Research Travel Award in partnership with The Voice Foundation. Suzanne participated in the 2022 Voice Foundation Conference and presented research entitled, “Transmasculine Attitudes Toward Voice.” Suzanne said that “this work helps clinicians working with transmasculine people (transgender men and non-binary people) to better understand the vocal needs of this underserved population.”
When asked what it meant for Suzanne to attend this conference, Suzanne shared “Without this Research Travel Award it is unlikely that I could have afforded attendance at The Fall Voice Conference. As an attendee, I was able to make connections with other voice professionals doing research in the same area, attend talks by other researchers in gender affirming voice care, and generate a number of potential new avenues for my research project.” Below is an abstract of Suzanne’s presentation.
Additional Authors: Inna Husain, MD; Lisa LaGorio, PhD, MPH, CCC-SLP; Cynthia Hildner, CCC-SLP; Shannon M. Theis, PhD, CCC-SLP
Objectives: Transgender men and transmasculine non-binary people have been largely overlooked by the field of speech language pathology (Block et al., 2019). There is an influential perception that because testosterone therapy influences the vocal folds and causes vocal changes, voice therapy is not a high priority for this population (Hancock et al., 2017; Zeigler, 2018; Azul et al., 2017). This qualitative study was designed to obtain subjective information from the transmasculine community, with the aim of contributing to a small but growing corpus of data related to the vocal health and priorities of community members themselves.
Methods/Design: Eight transmasculine individuals aged between 19 and 38 participated in hour-long semi-structured interviews exploring their attitudes towards voice and how voice interacts with their experiences of gender expression, gender presentation, and gender dysphoria, as well as their experiences of vocal health. Participants included both transgender men and transmasculine non-binary people. Seven of the eight participants are currently receiving hormone replacement therapy (HRT) for periods ranging from four months to 11 years. These interviews were transcribed and then coded using a combination of qualitative methods, including in vivo, process, and initial coding (Saldaña, 2009) in order to identify 3 main themes: When voice matters; Making decisions, making changes; and What happens and what helps.
Results: The three overarching themes that emerged from the study were “When voice matters; Making decisions, making changes; and What happens and what helps. When voice matters captures data on times and situations where voice matters to participants. This includes specific moments or phases of the transition process as well as situations that are more episodic, such as using the phone and during hostile or unwelcoming interactions. Making decisions, making changes explores how participants make transition-related changes and how voice plays into those decisions. What happens & what helps captures the social, emotional, physical and psychological impact of voice gender-affirming change. Participants identified two key points of intervention when voice became particularly important: early transition (that is, prior to or in the early stages of medical or social transitioning); and later transition, after social, surgical, and/or hormonal interventions have made a significant difference to an individual’s visual appearance. In early transition, having more control over the voice was described by participants as a measure that could alleviate anxiety and distress associated with gender incongruence and the experience of being misgendered. In later transition, the voice was identified as a characteristic that frequently led to being misgendered, even when the participant’s facial features and/or physical profile were significantly masculinized by medical intervention. In addition, voice was identified as playing a key role in gender presentation in a number of other scenarios. The most significant of these were when participants were in a hostile or non-affirming environment, when the ability to “pass” vocally as a cisgender man was cited as important for physical or psychological safety; and, more mundanely, while speaking over the phone, a scenario in which other gendered signifiers (e.g. facial hair, masculine body shape, body language, etc.) are not available to the listener.
Discussion: The results of this study demonstrate that although the intrinsic importance of voice varied from participant to participant, all eight participants identified ways in which their voices played an important role in their lives. In addition, the study shows that voice use and vocal changes have vocal, social, and psychological consequences for transmasculine adults: it can help people to feel safe or unsafe, be a barrier or a facilitator to engagement, and may also help to play a role in self-acceptance. Most interestingly, voice can play an important role even in the lives of those who don’t identify it as a top priority. This suggests that SLPs and other voice professionals could play an important role in gender-affirming interventions for transgender men and masculine-presenting non-binary people. Future directions include exploring specific interventions that could be beneficial for this population and their impact on areas such as social engagement and perceived safety and wellbeing.
The Fall Voice Conference is designed to encourage and educate professionals on a multi-disciplinary approach to the management of vocal disorders. The focus of this conference is the clinical care of patients with voice-related difficulties and how clinical and basic science research guide clinical care. For more information: fallvoice.org.
Dysphonia International is dedicated to improving the lives of people with spasmodic dysphonia and related voice conditions through research, education, awareness, and research.