ABSTRACT
Transgender and gender diverse people exhibit a significantly lower quality of life than the general public. One
reason for this is voice dysphoria: distress because a person’s voice does not match their gender identity (e.g.,
trans women with deep voices). Reducing this voice-gender incongruence can improve quality of life, but is
difficult to achieve. It can be done with surgery, but the process is expensive and invasive. Alternatively, gender-
affirming voice and communication training (GAVT) guided by a speech-language pathologist (SLP) can be
effective, but is time-consuming, costly, and has additional barriers such as lack of qualified GAVT providers.
One way to provide more accessible GAVT would be through smartphone- or computer-based software that
delivers information about voice, suggests exercises, and provides feedback on exercise performance. However,
while some smartphone apps have been developed for GAVT, they are limited in scope and not accepted by
transgender people. A critical reason for this is lack of visual-acoustic biofeedback: visual information about how
the user’s voice “sounds” and how this should be modified during exercises.
This project will first develop novel GAVT software that combines visual-acoustic biofeedback about pitch and
resonance (two main indicators of voice femininity/masculinity) with exercises for these targets. The software
will be based on preliminary work by our team, which already created real-time pitch and resonance visualization
software. Multiple exercises and feedback visualizations will be developed modularly and iteratively evaluated
in lab sessions. Pitch and resonance modification performance as well as System Usability Scale and Intrinsic
Motivation scores will be collected to verify usability, motivation, and ability to induce short-term voice alterations.
The software will then be evaluated in a practical setting: as a supplement to SLP-led GAVT sessions over a 3-
week period. Forty trans women will be randomly assigned to either an experimental group (which will use our
prototype software) or a control group (which will use a generic voice analysis app). They will meet an SLP once
a week virtually for remotely administered GAVT, and the SLP will prescribe homework (type and difficulty of
exercises) to be performed between sessions. Self-reported amount of daily practice (primary outcome) as well
as self-reported self-efficacy and intrinsic motivation scores will be compared between groups.
Upon completion, the project will result in the first GAVT software that combines visual-acoustic biofeedback of
pitch and resonance with structured exercises – highly requested but currently unavailable features of such
software. The software will be released for free and thus immediately provide transgender people and SLPs with
free interactive tools for GAVT; furthermore, it can later be expanded with other important features. In the long
term, GAVT software may become an essential tool to reduce gender dysphoria in transgender and gender
diverse individuals, thus improving quality of life for this marginalized population. Furthermore, advancements in
this area may generalize to computer-aided therapy for communication disorders, increasing potential impact.
