Endoscopic and stroboscopic presentation of the larynx in male-to-female transsexual persons.

BACKGROUND Male-to-female transsexual (MFT) persons often attempt to produce a female-sounding voice as part of the transition process. Endoscopic and stroboscopic data about how they accomplish this with an anatomically male larynx are lacking. OBJECTIVES To describe vocal fold activity in MFT persons producing their feminine voice and identify signs of vocal misuse or hyperfunction in MFT speakers, if any. STUDY DESIGN Prospective, nonrandomized, descriptive study of a convenience sample of MFT persons. METHODS All MFT persons had endoscopic and stroboscopic procedures completed. Images were rated on a range of parameters by two experienced voice therapists to derive the descriptions. MFT participant self-report of voice use/symptoms and listener identifications of speaker gender from a perceptual task were also obtained. RESULTS Incomplete glottal closure was common with a posterior glottal gap predominating. Phase closure ratios also were skewed toward more "open" time for nearly half of the group. Supraglottic constriction was seen to varying degrees in all, and voice complaints were reported by 67% of the group. CONCLUSIONS MFT speakers who reported a "passing" feminine voice had glottal gap configurations more similar to anatomic females than males and tended toward more open phase closure ratios, perhaps consistent with breathy or soft voice production. Indications of vocal hyperfunction were present for all participants either by self-report or on the laryngeal examination.