67例跨性别女性嗓音女性化训练效果分析

Effect of voice feminization training in 67 male-to-female transgender individuals

钟静婷;杨菁菁;李革临;侯倩;张驰

1:首都医科大学附属北京友谊医院耳鼻咽喉头颈外科中心

摘要

目的探究嗓音女性化训练对跨性别女性(male-to-female transgender, MtF)的音调提升效果，并分析其影响因素。方法回顾性分析67例接受嗓音女性化训练的MtF临床资料，训练前后完成主客观嗓音评估，包括基频(fundamental frequency, F_0)、频率微扰(jitter)、振幅微扰(shimmer)、最长发声时间(maximal phonation time, MPT)、嗓音障碍严重指数(dysphonia severity index, DSI)、最高音、最低音、汉化MtF嗓音问卷(trans woman voice questionnaire, TWVQ)、嗓音障碍指数(voice handicap index-10,VHI-10)等。采用多元线性回归分析训练后F_0和F_0提升幅度的相关影响因素。按照训练前F_0分为男性音调组(29例，F_0<135 Hz)、中性音调组(22例，F_0:135～160 Hz)和女性音调组(16例，F_0>160 Hz),行单因素方差分析。结果 67例MtF平均训练次数为4.76±1.65次(2～10次);训练后F_0为220.21±30.28 Hz,平均提升75.78±37.34 Hz; TWVQ和VHI-10评分均显著下降(P<0.001),响度、最高音、最低音、音域跨度、DSI较训练前显著提升(均为P<0.05),但MPT下降(P<0.001)。多元线性回归分析显示，训练前F_0是F_0提升幅度最强的预测因子，训练前F_0越低，F_0提升幅度越大；方差分析结果显示女性音调组F_0提升幅度显著小于男性和中性音调组(P<0.001),但三组训练后F_0差异无统计学意义(P=0.094);男性音调组训练前jitter显著高于女性音调组(P=0.011),训练后显著改善。三组VHI-10和TWVQ训练后均显著下降，但降幅无显著差异。结论嗓音女性化训练可有效提升MtF嗓音女性化特征，改善嗓音稳定性与发声功能。训练前F_0越低，训练后F_0提升幅度越大，但不影响受训者主观评分的变化。

关键词

跨性别女性;嗓音女性化;基频;嗓音训练

基金项目(Foundation):

北京友谊医院“青才计划”(yyqcjh2023-8)

作者

钟静婷;杨菁菁;李革临;侯倩;张驰

参考文献

[1] COLEMAN R O.A comparison of the contributions of two voice quality characteristics to the perception of maleness and femaleness in the voice[J].Journal of Speech and Hearing Research,1976,19(1):168-180.

[2] 刘恒鑫，郝建萍，高立群.跨性别者的嗓音调整[J].听力学及言语疾病杂志，2019,27(3):335-339.

[3] LANHAM K,MELNICK B A,O'CONNOR M J,et al.Efficacy and patient satisfaction in voice feminization procedures:a systematic review and meta-analysis[J].Otolaryngology-Head & Neck Surgery,2025,172(5):1521-1538.

[4] SCHWARZ K,CIELO C A,SPRITZER P M,et al.Speech therapy for transgender women:an updated systematic review and meta-analysis[J].Systematic Reviews,2023,12(1):128.

[5] 王路，张嘉禾，王晨希，等.MtF嗓音问卷简体中文版信度和效度评价[J].中华耳鼻咽喉头颈外科杂志，2022,57(11):1311-1318.

[6] MEISTER J,K??HN H,SHEHATA-DIELER W,et al.Perceptual analysis of the male-to-female transgender voice after glottoplasty-the telephone test[J].The Laryngoscope,2017,127(4):875-881.

[7] TANGPRICHA V,den HEIJER M.Oestrogen and anti-androgen therapy for transgender women[J].Lancet Diabetes & Endocrinology,2017,5(4):291-300.

[8] 郭婷婷，李革临，侯倩，等.MtF的嗓音特点分析[J].听力学及言语疾病杂志，2021,29(6),608-612.

[9] 张驰，侯倩，郭婷婷，等.声带截短术用于MtF音调提升的疗效分析[J].中华耳鼻咽喉头颈外科杂志，2023,58(2):139-144.

[10] 孙子慧，孟玮，孙国燕，等.经口显微镜下声带截短和前连合后移技术在嗓音女性化手术中的疗效观察[J].中华耳鼻咽喉头颈外科杂志，2025,60(5):520-526.

[11] HANCOCK A B,GARABEDIAN L M.Transgender voice and communication treatment:a retrospective chart review of 25 cases[J].International Journal of Language & Communication Disorders,2013,48(1):54-65.

[12] CHADWICK K A,COLEMAN R,ANDREADIS K,et al.Outcomes of gender-affirming voice and communication modification for transgender individuals[J].The Laryngoscope,2022,132(8):1615-1621.

[13] ANTONI C.Voice and speech training for the transgendered patient:what the otolaryngologist should know[J].Otolaryngologic Clinics of North America,2022,55(4):749-756.

[14] ADESSA M,WESTON Z,RUTHBERG J,et al.Gender-affirming voice modification for transgender women:characteristics and outcomes[J].Transgender Health,2023,8(4):352-362.

[15] GELFER M P,TICE R M.Perceptual and acoustic outcomes of voice therapy for male-to-female transgender individuals immediately after therapy and 15 months later[J].Journal of Voice,2013,27(3):335-347.

[16] CASADO J C,RODR??GUEZ-PARRA M J,ADRI??N J A.Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs.without voice therapy support[J].European Archives of Oto-Rhino-Laryngology,2017,274(4):2049-2058.

[17] BROWN S K,CHANG J,HU S,et al.Addition of wendler glottoplasty to voice therapy improves trans female voice outcomes[J].The Laryngoscope,2021,131(7):1588-1593.

[18] 刘恒鑫，李朝阳，郝建萍.ICF理论框架下的跨性别者嗓音管理[J].听力学及言语疾病杂志，2023,31(6):554-559.

本文信息

PDF(164K)

本文关键词相关文章

跨性别女性嗓音女性化基频嗓音训练

本文作者相关文章

钟静婷杨菁菁李革临侯倩张驰