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.

PROJECT NARRATIVE This proposal is relevant to public health because it will provide critical insight into how smartphone- or computer- based software can be used to help transgender people train their voices. Transgender people often wish to modify their voice to match their gender, but voice training administered by experts is expensive and often inaccessible. Our project will thus create and evaluate the first transgender voice training software that combines real-time information about vocal pitch and resonance with structured exercises.