21 - Treatment for Transgender Patients

Question 1

What are three procedures that can be used in to treat Transgender Voice Patients?

Answer 1

Lessac-Madsen Resonant Voice Therapy

Approaches conducted by Gelfer

Surgical procedures

Question 2

Who is more likely to seek Transgender surgical intervention: male-to-female (MTF) or female-to-male (FTM)?

Answer 2

Male-to-female (MTF)

Transgender females

Question 3

What are two surgical procedures that can be used in male-to-female (MTF) transgender patients?

Answer 3

Chondrolaryngoplasty Reduction

Cricothroidopexy

Question 4

What is a Chondrolaryngoplasty Reduction?

Answer 4

Reduces thyroid prominence

Shaves down cartilage

Question 5

What is a Cricothroidopexy?

Answer 5

Increases vocal fold tension by closing the space between thyroid and cricoid cartilages

Question 6

What is the goal in Transgender Voice Therapy?

2

Answer 6

Actual: Increasing the likelihood that a patient’s voice will be perceived as the gender they identify with (in self and other)

PPT: Selecting a target pitch by either raising or lowering speaking fundamental frequency to extreme degrees

Question 7

What do we seek to modify in transgender patients?

Answer 7

Oral resonance

Question 8

How can oral resonance be modified in transgender patients?

2

Answer 8

Increasing lip spreading when speaking (as opposed to lip rounding)

Increasing forward carriage of the tongue while speaking

Question 9

How is Oral Resonance Therapy performed in transgender patients?

(3)

Answer 9

Auditory and visual discrimination of techniques modeled by a clinician

Distinguishing between forward/back tongue carriage and lip spreading/rounding

Practicing modification techniques, progressing from isolation -> syllable -> words -> sentences -> conversation

Question 10

What are the five stages to Gelfer’s procedures for MTF transgender patients?

Answer 10

Syllables

Words

Phrases

Sentences

Multiple sentences

Question 11

What is performed in the Syllable stage of Gelfer’s procedures for MTF transgender patients?

(3)

Answer 11

Establishing a target pitch

Use a clear voice to practice production of multiple /m/-initiated CV syllables

Vocal flexibility exercises producing five ascending notes starting at the target pitch (using the syllable /ma/)

Question 12

What is performed in the Word stage of Gelfer’s procedures for MTF transgender patients?

(4)

Answer 12

Clinician initially introduces “chant” words (e.g. “mine”) and provides a flat model at target pitch

Client imitates flat productions

Later, client produces same list of words with rising-falling intonation

Vidi-Pitch can be used for visual feedback.

Question 13

What is performed in the Phrase stage of Gelfer’s procedures for MTF transgender patients?

(5)

Answer 13

Intonation of speech is constantly used

Start with using /m/-initiated words at beginning of each phrase

Later, voiced phonemes /n, w, j, l, r/ are used to initiate phrases until unrestricted initial phoneme use can be achieved

Prosody is increased in activities (e.g., reading) when pt. can maintain the target pitch with proper quality of voice.

Finally, move to functional communication use.

Question 14

What is performed in the Sentence stage of Gelfer’s procedures for MTF transgender patients?

(2)

Answer 14

Simultaneously address quality, pitch, intonation and pitch range.

May use Visi-Pitch
initially, but move to perceptual judgments by patient

Question 15

What is performed in the Multiple Sentence stage of Gelfer’s procedures for MTF transgender patients?

(3+2)

Answer 15

Start with reading paragraphs

Move to describing pictures or participating in role-playing
activities

Carryover and generalization may be challenging due to difficulty

• Producing target pitch
• Accepting new voice with imperfections.