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Oestreicher-Kedem Y, Jacob T, Lior Y, Kurzrock A, Goldman M, Wasserzug O, Nachalon Y, Neiderman NNC, Yaish I. Voice Perception and Mental Health in Transgender Women. J Voice 2024:S0892-1997(24)00292-3. [PMID: 39393954 DOI: 10.1016/j.jvoice.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 10/13/2024]
Abstract
OBJECTIVES This study aims to examine the association between voice experience and levels of depression, anxiety, and stage of gender affirmation in transgender women. STUDY DESIGN A cross-sectional study. METHODS Adult transgender women attending a tertiary referral center were recruited between April 2022 and January 2023. They filled in a demographic and health survey, the Hebrew Trans Woman Voice Questionnaire (H-TWVQ), the Hebrew Patient Health Questionnaire, and the Hebrew version of the Generalized Anxiety Disorder Screener. Descriptive statistics and data regarding the associations between voice experience, grades of anxiety and depression, and stage of gender affirmation were compiled. RESULTS Sixty-seven transgender women were included (mean age 26.7 ± 7.78 years, mean time of presenting socially as a woman 5.2 ± 5.2 years). The median H-TWVQ score was 71 (maximal score 120). Most participants reported mild anxiety and mild depression levels. Those who reported a more positive voice experience (H-TWVQ score ≤71) had lower median depression and anxiety scores than participants with a less-positive voice experience (H-TWVQ score >71) (P = 0.028 vs P = 0.044, respectively), complained less of hoarseness (2.9% vs 19.4%, P = 0.045,) and more were employed (78.8% vs 41.9%, P = 0.003). No association was found between voice experience and cross-sex hormone treatment, affirmation surgery undertaken, or number of years presenting socially as a woman. CONCLUSIONS We observed a potential association between better voice experience and lower anxiety and depression levels among transgender women. No association was found between voice experience and the stage of gender affirmation. Physicians treating this population should be aware of these associations and consider therapeutic means for voice adjustment.
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Affiliation(s)
- Yael Oestreicher-Kedem
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Tom Jacob
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Lior
- Division of Anesthesiology and Critical Care, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Anna Kurzrock
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Mia Goldman
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Nachalon
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Narin Nard Carmel Neiderman
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Iris Yaish
- Endocrine Institute, Tel-Aviv Sourasky Medical Center, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Grouthier V, Bachelot A. Long-term outcomes in non-CAH 46,XX DSD. Front Endocrinol (Lausanne) 2024; 15:1372887. [PMID: 38752171 PMCID: PMC11095110 DOI: 10.3389/fendo.2024.1372887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
Differences/disorders of sex development (DSD) comprise a large group of rare congenital conditions. 46,XX DSD, excluding congenital adrenal hyperplasia (CAH), represent only a small number of these diseases. Due to the rarity of non-CAH 46,XX DSD, data on this sex chromosomal aberration were confined to case reports or case series with small numbers of patients. As the literature is still relatively sparse, medical data on the long-term effects of these pathologies remain scarce. In this review, we aim to provide an overview of current data on the long-term follow-up of patients with non-CAH 46,XX DSD, by covering the following topics: quality of life, gender identity, fertility and sexuality, global health, bone and cardiometabolic effects, cancer risk, and mortality. As non-CAH 46,XX DSD is a very rare condition, we have no accurate data on adult QoL assessment for these patients. Various factors may contribute to a legitimate questioning about their gender identity, which may differ from their sex assigned at birth. A significant proportion of gender dysphoria has been reported in various series of 46,XX DSD patients. However, it is difficult to give an accurate prevalence of gender dysphoria and gender reassignment in non-CAH 46,XX DSD because of the rarity of the data. Whatever the aetiology of non-CAH 46,XX DSD, fertility seems to be impaired. On the other hand, sexuality appears preserved in 46,XX men, whereas it is impaired in women with MRKH syndrome before treatment. Although there is still a paucity of data on general health, bone and cardiometabolic effects, and mortality, it would appear that the 46,XX DSD condition is less severely affected than other DSD conditions. Further structured and continued multi-center follow-up is needed to provide more information on the long-term outcome of this very rare non-CAH 46,XX DSD condition.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Universitaire de Bordeaux, Haut Leveque Hospital, Bordeaux, France
- Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Anne Bachelot
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, and Centre de Référence des Pathologies Gynécologiques Rares, Department of Endocrinology and Reproductive Medicine, Sorbonne Université, Paris, France
- Sorbonne Université Médecine, Paris, France
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Nordenström A, Lajic S, Falhammar H. Long-Term Outcomes of Congenital Adrenal Hyperplasia. Endocrinol Metab (Seoul) 2022; 37:587-598. [PMID: 35799332 PMCID: PMC9449109 DOI: 10.3803/enm.2022.1528] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022] Open
Abstract
A plethora of negative long-term outcomes have been associated with congenital adrenal hyperplasia (CAH). The causes are multiple and involve supra-physiological gluco- and mineralocorticoid replacement, excess adrenal androgens both intrauterine and postnatal, elevated steroid precursor and adrenocorticotropic hormone levels, living with a congenital condition as well as the proximity of the cytochrome P450 family 21 subfamily A member 2 (CYP21A2) gene to other genes. This review aims to discuss the different long-term outcomes of CAH.
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Affiliation(s)
- Anna Nordenström
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Lajic
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Corresponding author: Henrik Falhammar. Department of Endocrinology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden Tel: +46-851776411, Fax: +46-851773096, E-mail:
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Stogowska E, Kamiński KA, Ziółko B, Kowalska I. Voice changes in reproductive disorders, thyroid disorders and diabetes: a review. Endocr Connect 2022; 11:EC-21-0505.R1. [PMID: 35148272 PMCID: PMC8942322 DOI: 10.1530/ec-21-0505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 11/12/2022]
Abstract
The subject of vocal changes accompanying pathological conditions, although still not well explored, seems to be promising. The discovery of laryngeal receptors for sex hormones and thyroid hormones can strongly support the hypothesis of changes in voice due to various endocrinopathies. On the other hand, the impairment of the proper function of the vocal apparatus can also be caused in the process of the microvasculature complications of diabetes mellitus. This review was a comprehensive summary of the accessible literature concerning the influence of selected endocrinopathies on subjective and objective voice parameters. We analysed a total number of 16 English-language research papers from the PubMed database, released between 2008 and 2021, describing vocal changes in reproductive disorders such as polycystic ovary syndrome and congenital adrenal hyperplasia, thyroid disorders in shape of hypo- or hyperthyroidism and type 2 diabetes mellitus. The vast majority of the analysed articles proved some changes in voice in all mentioned conditions, although the detailed affected vocal parameters frequently differed between research. We assume that the main cause of the observed conflicting results might stem from non-homogeneous methodology designs of the analysed studies.
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Affiliation(s)
- Ewa Stogowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Karol Adam Kamiński
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | | | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
- Correspondence should be addressed to I Kowalska:
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