transgender/transexual client

Question 1

What is the most common terminology used to address them?

Answer 1

gender identity problem or dysphoria

Question 2

What constitutes a diagnosis of Gender Identity Disorder (GID), Previously labeled Transsexualism?

Answer 2

• When the client meets the criteria established in ICD-10 or DSM-IV

Question 3

Why may the prevalence of cases be higher?

Answer 3

undiagnosed cases attributed to anxiety, depression, bipolar disorder, substance abuse, etc.

• Plus other groups within gender distress population such as transvestites, homosexuals, etc. may have form of GID

Question 4

What are the three phases of treatment?

Answer 4

Triadic treatment

1) Real life experiences in the desired gender
2) Hormone therapy
3) Surgery to change genitalia and other sex characteristics

Question 5

hormone tx- what three hormones are needed for male to female?

Answer 5

estrogens,
progesterones,
anti-androgens

Question 6

hormone tx- what two hormones are needed for female to male?

Answer 6

androgens

anti-estrogens

Question 7

What are the 3 criteria for HTx?

Answer 7

1) 18 years or older
2) advised on benefits, risks, limits
3) lived as new gender x3 months or in therapy 3 months

Question 8

What are the effects of masculinizing hormones? (female to male)

Answer 8

deepening of voice, enlarging of clitoris, breast atrophy, facial/body hair growth, increased upper body strength, weight gain, increased sexual desire, acne, increased risk of cardiovascular disease due to lipid changes

Question 9

What are the effects of feminizing masculinizing hormones? (male to female)

Answer 9

• Softening of skin, breast development (irreversible), female body fat distribution, reduce body hair, reduced upper body mass, reduced fertility, reduced erections

Question 10

Contraindications of H tx?

Answer 10

not compliant, substance abuse, emotional disorders, age, medical conditions (e.g., obesity, CVD, htn, clotting problems, family history of cancer)

Question 11

What is tx for transgender clients?

Answer 11

•	1) Vocal Hygiene:History of vocal abuse, Psychosocial stresses
•	2) Pitch Change: Female to male issues and surgery, Male to female issues and surgery, Gender ambiguous levels, Establishing a target level, Establish range around average fundamental pitch, Developing a conversational range
•	3) Intonation Walk-jump-step-fall
•	Intonation: borrows from LRVT
Phase I
Phase II
Phases III, IV, etc.
Include work with easy onset and breath support
•	Articulation:
Vowels
Consonants
•	Loudness
•	Rate
•	Language: a) syntax
                       b) Semantics
                       c) Pragmatics
•	Non-verbal Communication:
Gender differences appear early
Kinesics
Facial Expression
Eye movements
Haptics (touching)
Proxemics (space)
Physical Appearance and Fashion
Smell
Etiquette

Question 12

Assessment of transgender clients?

Answer 12

Impact of current voice status: sample scale (Transgender Self-Evaluation Questionnaire (TSEQ) ). 
pscyhosocial factor. 
•	Behavioral and Objective Measures
•	Speech-language samples
•	Articulation test
•	Hearing screening
•	Oral mechanism exam
•	Respiratory function
•	Pitch/loudness function testing
•	Objective measures of average fundamental frequency, pitch range, jitter, shimmer
•	Client Goals