Published on September 12th, 2016


SAC Clinical Research Grant in Action: Developing the Transsexual Voice Questionnaire (Male to Female)

By Felicity Feinman, SAC Communications Officer

The motivations that lead transgender people to seek out voice therapy are diverse. “Some people have said they just don’t want heads to turn when they say ‘thank-you’ to the bus driver. Other people are concerned for their safety,” says Shelagh Davies, S-LP(C). Davies specializes in voice and communication therapy for transgender people.

Shelagh Davies

Shelagh Davies

“The people that we work with [are] undergoing enormous upheavals in their lives. It’s hard to imagine a change more profound than finally expressing the gender that you really are. Having a voice that fits is so important,” Davies says.

Davies first became involved in transgender voice therapy 15 years ago. In 2004, she developed Changing Keys, a voice and speech feminization program that is now offered throughout British Columbia through the Provincial Health Services Authority.

As she was developing Changing Keys, Davies realized there was limited research on transgender voice therapy and no trans-specific outcome measures. This led her to create her own tool to assess the subjective experiences of transgender people with their voices. Davies began with the Vocal Handicap Index, a questionnaire designed for people to assess the impact of a voice disorder on their quality of life. With the input of some transgender people, she adapted the Vocal Handicap Index to be trans-specific. She then started using the questionnaire as an outcome measure for Changing Keys. Davies’ questionnaire caught the eye of other researchers and was published as an appendix in Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide.

At this point the questionnaire had not undergone any psychometric testing and it lacked the validity of a properly designed instrument. A group of Australian researchers took note and asked Davies if she would like to be involved in a research study to evaluate the psychometric properties of the questionnaire. Davies agreed, but she needed funding, so she applied for an SAC Clinical Research Grant. (Launched in 2007, SAC’s Clinical Research Grants aim to increase the clinical evidence base in the fields of speech-language pathology and audiology in Canada.) In 2008, Davies’ application was accepted and she received an SAC Clinical Research Grant.

Davies and her team at UBC hired an interviewer to speak with transgender people about their experiences with their voices to determine the main areas of concern. Davies’ clinical research grant also paid for a transcriber as well as honoraria for the study participants and a statistician. Davies’ own work on the research project was self-funded.

Initially, the research project included five participants who were transitioning from male to female and five participants who were transitioning from female to male. However, Davies quickly realized that transgender women and transgender men have very different experiences with their voices. The questionnaire was originally designed to apply to transgender women and Davies realized that simply “flipping the pronouns” would not make the questionnaire relevant to transgender men. Some trans men take testosterone, which deepens the voice, and for many that change produced an acceptable voice. Some men reported feelings of anticipation and delight as their voices deepened. As the questionnaire was designed to document only negative aspects of voice it could not reflect these positive experiences.

After the research was complete, the Canadian and Australian research teams modified the questionnaire substantially, creating the Transsexual Voice Questionnaire (Male to Female) or TVQ MtF, an improved version of Davies’ first questionnaire. The development of the TVQ MtF , is discussed in an article published in the Journal of Voice. Davies was also the lead author on a study of the psychometric evaluation of the TVQ MtF, which was published in the Canadian Journal of Speech-Language Pathology and Audiology.

The TVQ MtF is now used around the world. “This questionnaire [has] become huge!” Davies says. It has been translated into Swedish, Portuguese, German, Danish and Croatian. Davies and her Australian colleague, Georgia Dacakis, continue to get requests to translate the questionnaire into more languages. Translations are currently underway in French, Hebrew, Finnish, Tamil and Dutch.

Davies’ expertise in transgender voice therapy led her to become one of the founding members of the Voice and Communication Standing Committee for the World Professional Association for Transgender Health (WPATH). One of the committee’s greatest achievements was writing a companion document to the WPATH Standards of Care. This companion document, entitled Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside, was published in the International Journal of Transgenderism last fall.

The evidence base for transgender voice therapy has undoubtedly grown due to Davies’ contributions to the field. She says working in transgender voice therapy has also impacted her as a person. “I’ve met fascinating people. I’ve learned so much. I feel that I’ve grown so much by being able to work in the field.”

Read more of Davies’ research on transgender voice:

For more information about SAC Clinical Research Grants, please visit our website.

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