Feature Story | 5-Jun-2024

Life-changing impact

Student research shows the positive effects of gender-affirming voice therapy on trans individuals

University of Cincinnati

Have you ever listened to a recording of yourself and thought that it didn’t sound like you? Or maybe you didn’t like the way your voice sounded in the recording?

Mary Wilkens uses this simple analogy to help others understand the complexities of vocal dysphoria — the feeling that one’s voice doesn’t align with their gender identity. She said vocal dysphoria can be mentally exhausting for a transgender person as they transition from one gender identity to another and potentially cause feelings of unhappiness, stress, anxiety and depression.

“I’ve always felt that this is a really important thing that isn’t talked about during a lot of people’s transitions,” Wilkens said. “Vocal dysphoria is really huge, and people struggle to understand what it is and how it would feel.”

As a member of the LGBTQ+ community and a third-year speech language hearing sciences student at the University of Cincinnati, Wilkens is motivated to serve her community by advocating for the importance of gender-affirming voice therapy.

In January, she was accepted to present a case study from her research on the subject at the Voice Foundation’s 53rd Annual Symposium, which will take place in Philadelphia at the end of May. In January, Wilkens also received a $700 Undergraduate Research Fellowship Award from UC to help offset conference presentation–related costs.

How she came to research

While she’s always been interested in gender-affirming voice therapy and anything related to voice studies, Wilkens said research was “actually a surprise interest,” one that stemmed from a conversation with a professor during her first semester at UC.

In a success in allied health class, Wilkens and her classmates were tasked with sharing what interested them in the wide field of speech pathology. After sharing her passion for voice studies, her professor Amy Hobek, PhD, connected her with Victoria McKenna, PhD, an assistant professor and director of UC’s Voice and Swallow Mechanics (VSM) Lab — a research lab that aims to increase access to clinical tools and improve the efficiency of diagnosis and treatment for voice and swallowing disorders.

The faculty encouraged Wilkens to apply for UC’s UPRISE (Undergraduates Pursuing Research in Science and Engineering) program, which is focused on increasing the pipeline of individuals from underserved communities into the STEMM fields. Wilkens was accepted and participated in a paid 12-week research opportunity in the VSM Lab the following summer, with McKenna serving as her mentor.

“I knew right away that Mary had an aptitude for voice research,” McKenna said. “The UPRISE program provided us an avenue to explore her different interests in voice science, and now we are working together on treatment outcomes for gender-affirming voice services.”

Though the UPRISE program was only a 12-week experience, Wilkens never stopped working with McKenna in the VSM Lab. Throughout her time in the lab, Wilkens has enjoyed working on a variety of research projects, but her favorite — the one that will inform her poster presentation at the Voice Foundation’s symposium in May — has been the Gender Diversity Project.

Her hands-on experience

When transgender individuals transition from one gender identity to another, they may seek gender-affirming medical care, including voice therapy or voice surgery to align their voice with their gender identity. The Gender Diversity Project was created to explore how specific speech and voice characteristics influence gender-perception and how socioeconomic and psychosocial factors influence access to transgender voice care and vocal outcomes.

“This project is really awesome because we’re looking throughout a person’s voice therapy process to see how their voice changes both perceptually and physically and proving that therapy is effective,” Wilkens said. “We’re proving that there is significant change and that the therapy is important and has a positive effect on their life.”

Wilkens joined the Gender Diversity Project in its early stages when the team was focused on spreading awareness of the project and surveying transgender people locally and throughout the United States about their experiences with voice therapy.

As the project gained participants — individuals undergoing gender-affirming voice therapy and surgery at UC Voice and Airway Center who were referred to the VSM Lab by a clinician — Wilkens began helping collect evidence to prove that the voice intervention the participants were receiving was effective. This involved taking baseline measurements of how an individual’s pitch had changed as a result of their therapy.

Wilkens’s role in this process was to help record an individual's larynx (or voice box) while McKenna used a scope (a high-speed camera) to assess the larynx’s anatomy. Wilkens also helped conduct questionnaires that measured the participants’ quality of life before and after receiving voice therapy, which helped further prove the positive impact the therapy had on their lives.

Life-changing impact

Wilkens’ upcoming national presentation will highlight a comprehensive case study on a participant who received vocal feminization surgery but developed a large granuloma (a growth on the vocal cord) during the healing process. Wilkens presented her preliminary findings of how the granuloma affected the participant’s healing and subsequent voice therapy at the VSM Lab’s biannual symposium in December and will present additional findings at the Voice Foundation’s symposium in May.

“Mary has collected physiological, acoustical and quality-of-life outcomes over one whole year since our patient received gender-affirming voice surgery,” McKenna added about the case study. “Mary’s dedication to the project has been so important to its success. Very few studies are able to follow patients that long, and we are getting really important data on how transition impacts the lives of our patients long-term.”

Beyond the symposium, Wilkens looks forward to continuing researching transgender voice and working on her fourth-year capstone project in the VSM Lab. And while she still has graduation, graduate school and other challenges to tackle before entering the field as a full-time clinician, Wilkens has her sights set on working in a medical setting.

“I really enjoy medical work, and I love that they get to work with wide varieties of populations,” she said, “and if I’m in a clinical setting, I can continue my research, and I really love being able to research.”

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