Phonetograms, Aerodynamic Measurements, Self-Evaluations, and Auditory Perceptual Ratings of Male-to-Female Transsexual Voice *Eva B. Holmberg, †Jennifer Oates, †Georgia Dacakis, and †Cameron Grant, *Stockholm, Sweden, yVictoria, Australia Summary: Objectives. This exploratory study reports instrumental and subjective data for 25 male-to-female transsexual (M-F TS) individuals using their attempted female voice. The aim was to examine the usefulness of phoneto- grams and aerodynamic measures for voice assessment of this client group. Study Design. Descriptive and correlational. Methods. Phonetogram speech-range profiles (SRPs) were recorded for the M-F TS participants’ attempted female voice. Transglottal air pressure and airflow were estimated from oral recordings. All recordings were made in typical- and loud-voice conditions. Relationships among acoustical and aerodynamic measurements, background data, self-evaluations, and auditory perceptual ratings were examined. M-F TS data were compared with male and female normative data. Results. Agreement between naive and voice-expert listeners as well as intra- and interlistener reliability was good. Fundamental frequency (F 0 ) accounted for 41–49% of variation in gender ratings for the group, but individual excep- tions were found. Background data did not account for female voice success. Perceptual ratings of strain and breathiness were low. No data indicated hyperfunctional vocal behavior. The aerodynamic data agreed with normative male high- pitch data. The speech sound pressure level (SPL) was higher than the female norms. Phonetogram speech-range data fell between male and female data. Conclusions. The importance of speaking fundamental frequency (SFF) in perception of gender was confirmed. Instrumental and subjective data suggested that the use of low speech intensities and avoidance of vocal fry could help contribute to a successful female voice. Phonetograms were suggested to be useful for visual feedback and docu- mentation of changes in voice therapy for M-F TS clients. Key Words: Transsexual–Gender–Phonetogram–Speech-range profile–Fundamental frequency (F 0 )–Vocal intensity– Transglottal air pressure–Glottal airflow–Self-evaluations–Auditory perceptual voice ratings. INTRODUCTION ‘‘Transsexualism is a complex problem of gender identity in which the individual feels that his or her anatomic gender is the opposite of his or her psychological gender.’’ 1 Most (75%) transsexual (TS) clients are males wishing to be reas- signed as females. 2,3 The transition process of changing one’s gender presentation is complex and usually involves hormonal treatment and sex-reassignment surgery. In addition, as the voice is an important gender marker, acquiring a sex-appropri- ate voice is an imperative part of the transition toward gaining acceptance in the TS individual’s new gender. Vocal pitch is a strong gender marker, 4 and male-to-female TS (M-F TS) individuals who are perceived as females generally have higher mean speaking fundamental frequency (SFF) than those perceived as males. 5,6 Thus, much focus has been on helping M-F TS clients achieve and maintain female pitch characteris- tics. Hormone supplements of estrogen have no known biolog- ical effect on the male larynx and do not help to raise the fundamental frequency (F 0 ). 5,7 Sometimes, surgical procedures are used to achieve a higher fundamental frequency (F 0 ). These procedures include cricothyroid approximation, 8 anterior com- missure advancement, and endolaryngeal shortening of the vo- cal folds. 9 However, although surgery can assist in raising the F 0 , it is not problem-free and seldom sufficient to create a to- tally female voice. 10,11 Most of the M-F TS clients do not un- dergo pitch-raising surgery. For most M-F TS clients, voice therapy is essential to bring the voice closer to a female voice, and much of the focus is on increasing SFF toward a female range. Oates and Dacakis 4 reported SFF for adult female (non-TS) Australian speakers to be between 145 and 275 Hz, with mean SFF values ranging between 196 and 224 Hz. Studies of M-F TS individuals have shown that, to be perceived as female, SFF needs to be between 155 and 160 Hz. 12,13 Gelfer and Schofield 5 showed that, for speakers who were perceived as women, SFF was between 164 and 199 Hz. However, the pitch target has to be carefully set for each M-F TS client, 4 and voice therapy needs to be in- dividually designed. 14 In addition, although SFF is important for gender association, M-F TS individuals’ own satisfaction with their voices is not necessarily related to their SFFs. 15 Voice features other than mean SFF, such as intonation pattern, articulation, formant patterns, and manner of speaking, are also gender markers. 1,13,16,17 Accepted for publication February 17, 2009. Different aspects of this research were presented at: (1) The 7th Pan European Voice Congress (PEVoC07), Groningen, The Netherlands, August 29 to September 1, 2007. (2) ‘‘Reflecting Connections,’’ 2nd Conference hosted by the New Zealand Speech- Language Therapists Association and Speech Pathology Australia, Auckland, New Zealand, May 25–29, 2008. From the *Clinical Science, Intervention, and Technology—CLINTEC, Division of Logopedics and Phoniatrics, Karolinska Institute, Stockholm, Sweden; and the ySchool of Human Communication Sciences, La Trobe University, Victoria, Australia. Address correspondence and reprint requests to Eva B. Holmberg, Division of Logope- dics and Phoniatrics, B09, Karolinska University Hospital, Huddinge, Stockholm, SE 141- 86, Sweden. E-mail: eva.holmberg@ki.se Journal of Voice, Vol. 24, No. 5, pp. 511-522 0892-1997/$36.00 Ó 2010 The Voice Foundation doi:10.1016/j.jvoice.2009.02.002