The Experiences of Transgender and Gender Diverse Individuals after Intonation Training for a More Feminine-Sounding Voice: A Qualitative Study.

backgroundTransgender and gender diverse (TGD) individuals presumed male at birth often pursue voice and communication training (VCT) to develop a more feminine-sounding voice, as hormone therapy does not affect the voice. Previous research supports the integration of intonation training into gender-affirming VCT for TGD individuals seeking a more feminine-sounding voice. However, TGD individuals' experiences with intonation training for a more feminine-sounding voice remain unexplored.

aimThe aim of the present study was to explore the experiences of TGD individuals who underwent intonation training for a more feminine-sounding voice before, during and after the training period, with participants reflecting on these experiences more than 1 year after completing the intonation training. METHODS AND PROCEDURES: TGD individuals presumed male at birth, who participated in 4 weeks of intonation training focused on a more feminine-sounding voice and communication, were included. Semi-structured interviews were conducted and transcribed. Data were coded using NVivo 11 and data were analyzed using Reflexive Thematic Analysis. Trustworthiness was supported through investigator triangulation, member checking, and audit trail. OUTCOMES AND

resultsTen TGD individuals, all identifying as (trans)feminine, were interviewed. The findings show that TGD individuals generally experienced gender-affirming intonation training positively, noting improvements in voice, communication, and well-being. Key factors included a client-centred approach, a strong therapeutic relationship and a supportive environment. Ongoing challenges with technique internalization and dissatisfaction with vocal outcomes of the training were also experienced. CONCLUSIONS AND IMPLICATIONS: This study shows that intonation training can improve vocal control, reduce misgendering and enhance well-being for TGD individuals, but lasting success depends on individualized support, therapeutic alliance and social feedback. The results highlight the need for specialized voice care, including counselling, in gender-affirming VCT. Future research should explore experiences across diverse socio-cultural backgrounds. WHAT THIS PAPER ADDS: What is already known on this subject It was already known that intonation contributes to perceptions of vocal femininity and that intensive intonation training can increase gender congruence in the short term. However, previous studies largely relied on quantitative outcomes, which did not fully capture participants' satisfaction or lived experiences. This created a need for qualitative research to understand the experiences of TGD individuals who underwent intonation training for developing a more feminine-sounding voice.What this study adds to existing knowledge This study shows that TGD individuals experience benefits from gender-affirming intonation training, including improved vocal control, reduced misgendering and enhanced well-being. It also reveals that lasting success depends on individualized support, a strong therapeutic relationship, and ongoing social feedback, highlighting the need for specialized, holistic voice care within gender-affirming VCT.What are the clinical implications of this study? This study indicates that intonation training can be an effective component of gender-affirming training for TGD individuals, improving vocal control, reducing misgendering and supporting well-being. Clinically, it underscores the importance of individualized approaches, strong therapeutic relationships and ongoing social support, as well as integrating counselling into gender-affirming VCT.