title: A preliminary study on the use of vocal function exercises to improve voice in male-to-female transgender clients.
abstract: OBJECTIVE
  This study explores the outcomes of symptomatic voice treatment plus Stemple's vocal function exercises (VFEs) for a group of male-to-female (MTF) transgender (TG) clients seeking voice feminization. Both acoustic and perceptual outcomes were assessed, in addition to the clients' attitudes toward VFE.
  
  
  METHODS
  Prospective treatment study.
  
  
  METHODS
  Three MTF TG clients plus three control female speakers and three control male speakers served as subjects. All provided a variety of speech samples. The TG clients underwent symptomatic voice therapy for 6 weeks, while simultaneously performing the VFE protocol. At the end of therapy, the TG clients provided posttreatment voice samples. All voice samples were analyzed for speaking fundamental frequency (SFF), SFF upper and lower limits, and the first three formants of /i/. A CD of pre- and posttreatment voice samples plus the control voices was presented to listeners for gender judgments and masculinity and femininity ratings.
  
  
  RESULTS
  For acoustic measures, the TG subjects appeared more similar to the male control speakers in the pretest, and more similar to the female controls in the posttest. Perceptually, listeners continued to identify the TG subjects as male following therapy, although they were rated as significantly less masculine and more feminine. TG subjects were generally positive about the addition of VFE to their therapy experience.
  
  
  CONCLUSIONS
  The addition of VFE did not appear to improve posttreatment outcomes compared with previous literature. It was suggested that both number of sessions and experience living full-time as a woman might be important variables in predicting progress in therapy.
authors.affiliation: Department of Communication Sciences and Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA. gelfer@uwm.edu
authors.forename: Marylou Pausewang
authors.initials: MP
authors.lastname: Gelfer
authors.forename: Bethany Ramsey
authors.initials: BR
authors.lastname: Van Dong
mesh_terms: D000162:Acoustics; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005262:Feminization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012649:Self Concept; D012737:Sex Factors; D013018:Sound Spectrography; D013061:Speech Acoustics; D013067:Speech Perception; D013997:Time Factors; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014833:Voice Quality; D014834:Voice Training