A review of various approaches to voice feminisation for transgender women reveals two conflicting philosophies concerning voice and gender identity: determinism and constructivism. While the determinist philosophy equates sex with gender and posits that physiology determines vocal output, the constructivist philosophy views gender and vocal differences as more dependent on socio-cultural factors. Much of past research has relied on the deterministic perspective to define the voice as a set of masculine or feminine acoustic measures. This binary categorisation poses a challenge for adult transgender women who must overcome significant laryngeal changes attributed to puberty to modify their voices. Certain studies indicate voice feminisation interventions are more effective when they incorporate the self-perceived identities of transgender women into treatment strategies instead of relying solely on acoustic voice measures to label a voice as either masculine or feminine. Further research suggests that social factors – including class, ethnicity and upbringing – impact vocalisation. In light of this evidence, this paper acknowledges the need for more holistic treatments of the voice through a better integration of the constructivist perspective into voice feminisation practices. In certain reports of patient outcomes, transgender women who rate their voice as more feminine are also perceived as such by listeners. This finding demonstrates the efficacy of a patient-centred approach, which is best accomplished through a synergistic application of both determinist and constructivist philosophies to voice modification. By doing so, therapeutic interventions will likely be more effective at alleviating incongruences between the voice and self-identity for transgender women.
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