COMDIS415 GENDER

Question 1

Sex (Biological construct)

Answer 1

Attributes that characterize a natal male and natal female:
 Sex determined by genes/chromosomes
 Hormones
 Reproductive anatomy

Question 2

Gender (Social construct)

Answer 2

“The attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex” (APA, 2011)
- they choose their own pronouns

Question 3

Gender Identity refers to

Answer 3

• An individual’s personal sense of self as male, female
• Psychologically rooted and internally determined
• Most children have a strong sense between ages 4-6
• May or may not be outwardly expressed or apparent

Question 4

Gender Expression refers to

Answer 4

• How gender identity is externalized and communicated to others
• e.g.,one’sname,genderpronoun,styleofdress,interests,etc.
• Conformity: masculinity in natal males, femininity in natal females
• Expectations vary across cultures and over time

Question 5

Gender Expression: Appearance

Answer 5

 Dress/Clothing
 Hairstyle
 Make-Up, Jewelry

Question 6

Gender Expression: Roles

Answer 6

 Roles
 Career / Work
 Family
 Relationships
 Behavior
 Time/culture dependent

Question 7

Gender Expression: Behavior

Answer 7

 Posture & Body language
 Tone & pitch of voice - at least 165 Hz
 Prosody
 Assertive vs. passive

Question 8

Transgender definition

Answer 8

Refers to a person who is born with the genetic traits of a natal male or female but the internalized identity of the alternate gender.

Question 9

Transgender female (MTF):

Answer 9

 Natal male with an affirmed female gender identity
 Biological males who wish to live and be recognized as women
 MTF prevalence: 1 in 30,000

Question 10

Transgender male (FTM):

Answer 10

 Natal female with an affirmed male gender identity
 Biological females who wish to live and be recognized as men
 FTM prevalence: 1 in 100,000

Question 11

Gender Dysphoria

Answer 11

a formal medical diagnosis for individuals who show considerable discontent (mood/affect disturbance) when their gender identity is incongruent with their natal sex

Not all individuals will experience persistent discomfort (dysphoria) related to their gender identity

Question 12

Transgender individuals who are rejected and not supported are at increased risk of the following:

Answer 12

Depressive symptoms, low life satisfaction, self-harm, isolation, post traumatic stress, incarceration, and suicide.

• “41% of respondents reported attempting suicide, compared to 1.6% of general population” (American Psychological Association, 2009).

Question 13

 Family acceptance and support during the transition are tied to:

Answer 13

Positive self-esteem, high social support, positive mental health, less depressive symptoms, greater self-esteem, greater life satisfaction (compared to families who were non-supportive).

Question 14

THE PROCESS OF TRANSITIONING

Answer 14

Process by which an individual begins living in their desired gender role.

 In working with a transgendered client, it is helpful for the speech- language pathologist to have an awareness of the transition process.

Question 15

The individual seeking gender change may

Answer 15

begin taking some form of estrogen/testosterone in order to stimulate the development of secondary female/male characteristics.

 The transitioning individual may still retain their natal identity at home and at work.

Question 16

When and if an individual feels they are ready to proceed with the transition, we may see changes in:

Answer 16

 Social gender roles
 Alterations to dress
 Legal name change
 Changing preferred pronouns
Going “full-time” is a major step in the transition process, and one that may last for many years.

Question 17

Barriers to Treatment for Transgendered Individuals

Answer 17

Regardless of their socioeconomic status all transgendered individuals are medically underserved.
 Geographic Isolation
 Social Isolation
 Fear of Exposure/Avoidance
 Denial of Insurance Coverage/Socioeconomic Status  Lack of Transgender Education in Medical Training
 Lack of Clinical Research/Medical Literature

Question 18

VOICE MODIFICATION TREATMENT OPTIONS

Answer 18

Laryngeal surgery
- MTF Transition

Question 19

Cross-sex hormones

Answer 19

FTM Transition

Question 20

Behavioral voice therapy

Answer 20

MTF transition

Question 21

Surgical Options (For MTF Transition)

Answer 21

Ways to attempt to increase pitch surgically
1. Decreasing the vibrating length of the vocal folds
- Voice Feminization Surgery (efficient) – Audio example on next slide
2. Increasing tension of the vocal cord – Cricothyroid Approximation (less efficient) - brings thyroid forward which lengthens the vocal folds,
change tension and automatically raise pitch

Question 22

Cross-Sex Hormone Therapy

Answer 22

Although hormone therapy alters the voice for female-to-male transitions, it does not work for male-to-female transitioning individuals.

Question 23

Behavioral Voice Therapy

Answer 23

Since hormone treatment does not alter the adult male vocal mechanism, voice change for these individuals must be effected behaviorally.

 An important part of the transition process, especially for the male-to- female transgendered individual, is attaining an acceptable feminine voice.

 Males and females differ primarily in their pitch (fundamental frequency), resonance, and prosody.

 The characteristic pitch or fundamental frequency of the male voice ranges from about 100 to 150 Hz and from 170 to 220 Hz for females.

Question 24

Behavioral Voice Therapy

Answer 24

• Interview
   Select Target Pitch
   Habituating the Target Pitch * Syllable-Level
• Words
• Phrases
• Sentences * Dialogue

Question 25

Interview

Answer 25

It is important when meeting the client for the first time to establish what name they prefer to be called, and which pronoun the client prefers.

 In addition, ask how the client wishes to be addressed during telephone contact. A client in the early stages of transition may request that you ask for John on the phone, particularly if you call their place of employment, even though in therapy you may call your client Mary.

Question 26

Critical things to find out during the clinical interview:

Answer 26

I. Is the client receiving counseling for gender dysphoria?
II. Have they initiated hormone therapy
III. Where are they in the transition process?

Question 27

Other important questions relate to the individual’s communication with family members and co-workers regarding their transition;

Answer 27

• Have family members been told?
• Are they supportive?
• What about their employment setting?

Question 28

Health history is also important component of the interview

Answer 28

• A positive history of neurological disorders, respiratory ailments, or
  hearing loss can significantly affect progress in therapy.
• Clients who smoke, have frequent upper respiratory allergies, or a history of vocal hyperfunction also are likely to make slower progress in altering pitch and quality.

Question 29

Interview

Answer 29

Gain understanding of what the client hopes to accomplish in therapy.
 Therapies done to try and effect vocal change?
 Many clients have unrealistic expectations about what their feminine voice will sound like – “I want to sound like you.”

Question 30

By the end of the interview:

Answer 30

• You should have a good idea of the client’s level of motivation.
• The environmental supports or hindrances they are likely to encounter.
• Potential health-related complications to voice change.
• The amount of therapy the client is likely to require to achieve an acceptable-sounding female voice.

Question 31

Select a Target Pitch:

Answer 31

The most important initial therapy goal is to raise speaking fundamental frequency (SFF).

Question 32

Pitch to be identified as a female

Answer 32

Individual’s SFF must be at least at 160-165 Hz or higher for the voice to be identified as female.

Question 33

VOICE THERAPY

Answer 33

Potential for variability (particularly in an upward direction) is an important consideration in the selection of a target pitch. You want to make sure upward inflections are possible.

 Excessively tense or breathy voice should be avoided.

Question 34

Behavioral Voice Therapy

Answer 34

• Be sensitive to the possibility of fear of disclosure or discrimination – patients may have a heightened level of anxiety

 As with all clients, listen supportively and with acceptance, not judgment

 Use correct name/pronoun– if unsure, ask the patient (don’t assume)