Nuyen Brian, Kandathil Cherian, McDonald Daniella, Thomas James, Most Sam P
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA.
Int J Transgend Health. 2021 May 4;24(1):99-107. doi: 10.1080/26895269.2021.1919277. eCollection 2023.
The voice signals a tremendous amount of gender cues. Transfeminine individuals report debilitating quality-of-life deficits as a result of their vocal gender dysphoria. We aimed to quantify the potential impact of this dysphoria experienced with quality-adjusted life years (QALYs), as well as associated treatments, through validated health utility measures. Peri-operative phonometric audio recordings of a consented transfeminine patient volunteer with a history of vocal gender dysphoria aided in the description of two transfeminine health states, pre- and post-vocal feminization gender dysphoria; monocular and binocular blindness were health state controls. Survey responses from general population adults rate these four health states via visual analogue scale (VAS), standard gamble (SG), and time tradeoff (TTO). Survey respondents totaled 206 with a mean age of 35.8 years. Through VAS measures, these general adult respondents on average perceived a year of life with transfeminine vocal gender dysphoria as approximately three-quarters of a life-year of perfect health. Respondents also on average would have risked a 15%-20% chance of death on SG analysis and would have sacrificed 10 years of their remaining life on TTO measures to cure the condition. The QALY scores for the post-gender affirming treatments for vocal gender dysphoria (+0.09 VAS, < 0.01) were significantly higher compared to the pretreatment state. There were no differences in the severity of these QALY scores by survey respondent's political affiliation or gender identity. To our knowledge, this study is the first to quantify how the general population perceives the health burden of vocal gender dysphoria experienced by transfeminine patients. Feminization treatments including voice therapy with feminization laryngoplasty appear to significantly increase health utility scores.
声音传递着大量的性别线索。跨性别女性个体报告称，由于她们的嗓音性别焦虑，生活质量出现了令人衰弱的缺陷。我们旨在通过经过验证的健康效用测量方法，量化这种焦虑对质量调整生命年（QALY）以及相关治疗的潜在影响。一名有嗓音性别焦虑病史的跨性别女性患者志愿者在围手术期进行的语音测量音频记录，有助于描述两种跨性别女性健康状态，即嗓音女性化性别焦虑前后的状态；单眼失明和双眼失明作为健康状态对照。来自普通成年人群的调查反馈通过视觉模拟量表（VAS）、标准博弈法（SG）和时间权衡法（TTO）对这四种健康状态进行评分。调查对象共有206人，平均年龄为35.8岁。通过VAS测量，这些普通成年受访者平均认为，患有跨性别女性嗓音性别焦虑的一年生命相当于完美健康状态下四分之三年的生命。在SG分析中，受访者平均也愿意冒15%-20%的死亡风险，在TTO测量中，愿意牺牲剩余生命中的10年以治愈该疾病。与治疗前状态相比，嗓音性别焦虑的性别肯定治疗后的QALY评分（+0.09 VAS，<0.01）显著更高。这些QALY评分的严重程度在调查受访者的政治派别或性别认同方面没有差异。据我们所知，本研究首次量化了普通人群对跨性别女性患者所经历的嗓音性别焦虑的健康负担的认知。包括嗓音治疗联合女性化喉成形术在内的女性化治疗似乎显著提高了健康效用评分。
