Measures of supraglottic constriction: comparing visual-perceptual and quantitative measures in trans and gender-nonconforming individuals taking testosterone
OA Version
Citation
Abstract
PURPOSE: The purpose of this study was to determine which quantitative measures of supraglottic constriction were most closely related to visual-perceptual measures of supraglottic activity in transgender and gender-nonconforming (TGNC) people who are using testosterone (T) as a form of gender-affirming hormone therapy (GAHT). Specifically, we wanted to explore whether instances of vocal hyperfunction as measured by supraglottic constriction, occur alongside acoustic changes in fundamental frequency (fₒ), which may be associated with structural laryngeal changes.METHOD: Eleven participants who were assigned female at birth (AFAB) and taking T for the first time, were required to complete 13 monthly visits to the lab (baseline prior to starting T and then monthly for the year following onset) and be willing to undergo flexible laryngoscopy. Acoustic recordings and laryngoscopic images were analyzed to determine at which visit the largest monthly decrease in fₒ occurred in semitones (ST) and to evaluate anteroposterior (AP) and mediolateral (ML) constriction at baseline, 1-month following the start of T, and at the visit following the largest monthly decrease in fₒ using quantitative and visual-perceptual (Voice-Vibratory Assessment With Laryngeal Imaging; VALI) measures of supraglottic constriction. Linear mixed-effects models were utilized to determine if the independent variables (quantitative measures) predicted the VALI. β values were used to determine significant effects.
RESULTS: This study found that in the AP direction, two out of two quantitative measures significantly predicted VALI outcomes, whereas in the ML direction, only two out of four quantitative measures significantly predicted VALI outcomes. There was more variation across the range of VALI ratings in the AP direction as compared to the little variation found in the ML direction.
CONCLUSION: These results suggest that AP measures can be used to determine variation in constriction clinically, but that ML measures should be used with caution. The results also help to explain more about what is occurring in the larynx during large and fast changes to its structure in individuals who were AFAB and take GAHT with T. Rather than variation occurring at an expected timepoint (following a large decrease in fₒ), variation occurred throughout the first year on T. These findings, in conjunction with more research regarding constriction and self-reported symptoms, can aid in individualizing evaluation and treatment of voice in TGNC people on T.
Description
2025
License
Attribution-NonCommercial 4.0 International