Assessment Tools for Gender Affirming Voice Training

Updated: Jun 19

Assessment tools developed specifically for gender-affirming voice training are typically client self-report measures that examine the wide range of potential needs among transgender and gender diverse people seeking gender affirming voice and communication training. While these questionnaires can provide valuable information for gender affirming voice and communication training, medically-oriented voice questionnaires, such as the Voice Handicap Index may be needed to assess experiences when there are vocal pathology symptoms (Shefcik & Pei-Tzu, 2021). However, self-rating scales of vocal health tailored to the trans* population may be more accurate, as they separate out whether vocal concerns are indicative of the speakers’ vocal health or self-perceptions of voice congruence (Hancock, 2017).

Gender Spectrum Voice Inventory (GSVI) (Van Hook, E, & Duffy, S., 2021)

The GSVI is being developed to serve as a comprehensive assessment for gender diverse clients looking to change their voice to be more congruent with their gender identity. The GSVI can be used when providing voice services for any gender diverse person, regardless of their gender identity. The GSVI contains four subtests that aim to collect all necessary information needed to provide gender affirming voice and communication training. The SLP begins the assessment by establishing rapport, then administers the four components: a pretest case history, two self-report measures tailored to trans* people: vocal congruence (how aligned one’s voice is to their gender identity) and vocal health scales, and acoustic analysis of the client’s voice. The information gained from the assessment allows the SLP to design a personalized treatment plan based on the client’s self-perceived vocal congruence, vocal health, vocal impairment, and situational challenges with using their voice, and objective acoustic and perceptual differences between the client’s voice goal and gendered norms, as well as to screen for dysphonia.

The gender norms for pitch range were derived from Davies et al., 2015 review, which used the terminology masculine, nonbinary, and feminine. In this assessment, these terms were translated to low range, mid-range, and high range. The formant values of the vowels /a,i,u/ were compared to masculine and feminine norms for oral resonance, referencing data from a study by Gallena et al. in 2017. The vocal health score used to determine the vocal impairment level was derived from the Voice Handicap Index. In a small study, the researchers found that the GSVI was a comprehensive, useful preliminary tool to evaluate areas such as vocal congruence and vocal health. While their findings suggested strong face validity, further refinement and validation of the measure with clients from the full spectrum of gender identities was needed (Van Hook, E, & Duffy, S., 2021).

Utah Gender Presentation Scale for Communication (U-GPS)

The U-GPS assesses a person's self-perception of gender incongruence in voice and communication. Client's self-rate their current score and their goal score for each of 10 variables: pitch, intonation, resonance, loudness, speech smoothness, speech clarity, word choice, facial expression, gesture, and posture (Myers, et al, 2024).

Gender Speech-Voice Presentation Form

By Boone, et al., 2009. Captures numerous therapy concepts and presents them on a spectrum-based scale. The SLP rates the client on 10 parameters: altered lexicon, breathiness, facial expression, gesture, intonation, pitch, pitch flexibility, rate, volume and loudness, and vowel prolongation (Myers, et al., 2024).

Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW)

19-item questionnaire published in 2022 designed to quantify a person's self-efficacy beliefs related to voice modification (Myers, et al., 2024).

Transgender Self-Evaluation Questionnaire (TSEQ) (Davies, S., 2012)

The TSEQ is a self-report measure based on the Voice Handicap Index that was developed for the transgender population. The TSEQ can be used when providing voice services to binary-identifying transgender men and women. The TSEQ is designed to assess the function, physical, and emotional impacts of the client’s voice. SLPs use the overall score to ascertain the extent to which the client’s voice impacts life participation or restricts activities (Shefcik & Pei-Tzu, 2021). There is a correlation between transgender womens’ scores on the TSEQ and perception of one’s vocal femininity by themselves and others that is not entirely there with F0 (Hancock, et al., 2011). Thus, subjective perception of one’s voice and vocal quality of life as measured by the TSEQ can be used to establish goals, begin the counseling process, and as an outcome measure of voice training (Van Hook, E, & Duffy, S., 2021).

Trans Woman Voice Questionnaire (TWVQ) (Dacakis, G., & Davies, S., 2013)

The TWVQ is a validated self-report measure based on the TSEQ that assesses additional and more nuanced voice-related concerns and experiences. The TWVQ can be used when providing voice services to binary-identifying trans women. Analysis of the questionnaire found that the TWVQ has strong internal consistency and test-retest reliability. The TWVQ was formerly known as the Transsexual Voice Questionnaire and the Transsexual Voice Questionnaire Male to Female (TVQ, or TVQ-MtF); the name was changed in 2020 (Shefcik & Pei-Tzu, 2021, Bultynck, et al., 2020). Dacakis, et al., 2016 found that two components, vocal functioning (questions about voice production and the associations between voice and gender identity) and social participation (questions about avoidance or restriction in social participation and about a negative emotional response to voice that could impact social participation) were identified in the TVQ. Bultynck, et al., 2020 further narrowed in on three common factors that were measured in both the TVQ-MtF and TVQ-FtM: anxiety and avoidance, vocal identity, and vocal function. They also suggested SLPs may find it difficult to score questions 15, 16, and 18 if clients have not begun transitioning publicly.

The English-language TWVQ has been translated into Croatian, Danish, Dutch, Finnish, French, German, Hebrew, Italian, Persian, Portuguese, Simplified Chinese, Spanish, Swedish, Traditional Chinese, and Turkish. Many of these translated versions have demonstrated via research that the translations have high reliability and validity (Wang, et al., 2022).

Transsexual Voice Questionnaire [Female to Male] (TVQ-FtM)

The TVQ-FtM is a non-validated adapted version of the validated TVQ-MtF that modifies only the gender-specific words so that it can be used with trans men (Bultynck, et al., 2020). The TVQ-FtM can be used when providing voice services to binary-identifying trans men. This is the only assessment for transgender men released before 2021 (Van Hook, & Duffy, 2021). Bultynck, et al., 2020 found that three common factors were measured in both the TVQ-MtF and TVQ-FtM: anxiety and avoidance, vocal identity, and vocal function. They suggested SLPs may find it helpful to leave out questions 11 and 16, as they appear less relevant in trans men.

An author-approved version of the English-language TVQ-MtF was translated and adapted into Dutch (Bultynck, et al., 2020).

Voice-related Experiences of Nonbinary Individuals (VENI) (Shefcik & Pei-Tzu, 2021)

The VENI is a self-report measure based on the International Classification of Functioning, Disability and Health (ICF) that was developed for the non-binary population. The VENI can be used when providing voice services to nonbinary identifying people. The VENI is a valid and reliable questionnaire for nonbinary people that provides insightful information about nonbinary clients’ voice-related concerns, experiences, and target voice(s). It can provide initial information to identify client’s needs, track progress, and document changes in clients’ self-perception of voice-related experiences over time. The VENI only asks questions about voice-related experiences, and thus does not examine the overall communication experience, considering both verbal and nonverbal communication. Given the varied target voices of the nonbinary population, this measure does not assume a singular desired voice for nonbinary people (Shefcik & Pei-Tzu, 2021).

References:

Bultynck, C., Pas, C., Defreyne, J., Cosyns, M., and T'Sjoen, G. (2020). Organizing the voice questionnaire for transgender persons. International Journal of Transgender Health, 21(1), 89-97.
Davies, S., 2012 Available at: https://sphs.indiana.edu/documents/clinic-forms/transgender-self-evaluation-questionnaire.pdf
Dacakis G, & Davies S. (2012) The transsexual voice questionnaire (Male to Female).
Dacakis, G., Davies, S., Oates, J. M., Douglas, J. M., & Johnston, J. R. (2013). Development and preliminary evaluation of the Transsexual Voice Questionnaire for male-to-female transsexuals. Journal of Voice, 27, 312–320.
Dacakis, G., Oates, J.M., & Douglas, J.M. (2016). Exploring the validity of the Transsexual Voice Questionnaire (male to female): do TVQ-MtF scores differentiate between MtF women who have had gender reassignment surgery and those who have not? Canadian Journal of Speech-Language Pathology and Audiology, 39(1).
Davies, S., Papp, V., & Antoni, C. (2015). Voice and communication for gender nonconforming individuals: Giving voice to the person inside. International Journal of Transgenderism, 1, 117–159.
Hancock, A. B., Childs, K. D., & Irwig, M. S. (2017). Trans male voice in the first year of testosterone therapy: Make no assumptions. Journal of Speech, Language, and Hearing Research, 60, 2472–2482.
Hancock, A.B., Krissinger, J., & Owen, K. (2011). Voice perceptions and quality of life of transgender people. Journal of Voice, 25,5.553-558.
Myers, B.; Pierce, J.; and Mathy, P. The Utah Gender Presentation Scale for Communication: Development and Validation of a Measure of Voice-Related Gender Incongruence (2024).Journal of Speech, Language and Hearing Research, Vol 67, Issue 2, Pages 415-428.
Shefcik, G., & Tsai, Pei-Tzu. (2021). Voice-related Experiences of Nonbinary Individuals (VENI) Development and Content Validity. Journal of Voice, 37(2), 294.e5-294.e14.
Van Hook E., & Duffy, S. (2021). Gender Spectrum Voice Inventory, a Pilot Study. Perspectives of the ASHA Special Interest Groups, 6, 1900-1908.
Wang, L., Zhang, J., Wang, C., Zhang, Z., Hu, R., Jin, Y., Ding, H., and Chen, Z. (2022). A study on reliability and validity of the Simplified Chinese version of the Trans Woman Voice Questionnaire. Journal of Speech, Language, and Hearing Research, 54, 3264-3275.

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