Vocal-Gender Incongruence, wellbeing, and safety: The medical necessity of gender-affirming vocal training

27/03/2026

Int J Transgend Health. 2025 Mar 6;27(2):888-901. doi: 10.1080/26895269.2025.2475183. eCollection 2026.

ABSTRACT

BACKGROUND: Voice is a gender signifier, and incongruence between a person’s gender identity and others’ perception of their gender based on their voice can trigger dysphoria in transgender/gender diverse (TGD) individuals. Vocal-gender incongruence (VGI) can also signal one’s TGD identity, which may be unsafe given the prevalence of discrimination and victimization experienced by TGD persons.

METHODS: To understand the impact of VGI on wellness and safety, a cross-sectional electronic survey was developed. The Quality-of-Life Scale (QOLS), a modified version of the Transgender Self-Evaluation Questionnaire (TSEQ), and questions assessing experiences of violence, discrimination and misgendering were included. Differences in safety and wellness measures between participants with and without VGI were assessed using t-tests and chi-squared tests. Linear and logistic regression analyses were conducted to examine the relationships between VGI and safety, quality of life, and experiences of discrimination or misgendering.

RESULTS: Of 187 TGD participants, 127 (68%) reported VGI. Participants with VGI had significantly lower scores on the QOLS (70 vs 76; p=.02) and were significantly more likely to have been misgendered based on their voice in the past year (p < .001; 85% vs. 33%). Higher TSEQ scores (indicating higher impact of VGI on daily life) were associated with lower QOLS scores (β = 0.06; 95% CI 0.04, 0.09; p < .001) and with greater likelihood of having experienced public discrimination (β = 0.03; 95% CI 0.02, 0.05; p < .001), medical discrimination (β = 0.04; 95% CI 0.02, 0.06; p < .001), and verbal harassment (β = 0.03; 95% CI 0.01, 0.04; p < .001) but not physical harm (β = 0.03; 95% CI 0.002, 0.06; p = 0.05).

CONCLUSION: VGI is associated with lower quality of life and experiences of discrimination and verbal harassment for TGD individuals. Therefore, healthcare that alleviates VGI, including gender-affirming vocal training, is medically necessary.

PMID:41891066 | PMC:PMC13015075 | DOI:10.1080/26895269.2025.2475183

Document this CPD