JMIR Publications

ABSTRACT

Background:

Transgender people often experience distress due to a mismatch between their gender and the way their voice is perceived (e.g., trans women with low pitch), which significantly reduces their mental health and quality of life. This is especially a problem for transfeminine people and can be reduced with gender-affirming voice training (GAVT), but such training is often inaccessible due to factors like price and geographical constraints.

Objective:

To improve the limited availability of GAVT, this study aimed to develop and test a free web-based software platform (named TruVox) that would combine real-time feedback about the user’s voice with structured vocal pitch exercises for transfeminine people.

Methods:

The current publicly accessible TruVox prototype focuses on vocal pitch training with five structured exercises that provide real-time pitch visualizations as well as supporting videos and text. It was tested in two evaluation stages: initial online usability evaluations and a later single-session in-person evaluation with N=21 transfeminine participants under supervision of two researchers. In online evaluations, participants reported bugs and usability issues that were iteratively addressed. In the in-person evaluation, participants tested the final software prototype and filled out the System Usability Scale, then performed 10 repetitions of different exercises to gauge performance improvement with practice. They also filled out the Intrinsic Motivation Inventory for each exercise.

Results:

The System Usability Scale score was 79.8 ± 12.8 (mean ± SD) on a 100-point scale, Intrinsic Motivation Inventory scores were high (e.g., interest/enjoyment over 11/14), and exercise performance significantly improved in all but one exercise (p-values ranging from below 0.001 to 0.095). As qualitative feedback, participants requested to be able to use the software without much preparation and suggested several desirable future features such as performance tracking and goal-setting.

Conclusions:

While the pitch training module should not be considered a complete GAVT package, TruVox represents a promising foundation for further GAVT software since it was perceived as usable and motivating and allowed participants to improve their exercise performance. To our knowledge, TruVox is the first GAVT software that combines real-time voice visualization with structured exercises, and the current study represents the first quantitative human subjects evaluation of GAVT software. In the future, TruVox will be expanded with additional modules like resonance training, then tested in longer-term trials. Clinical Trial: The human subjects work described in this paper does not meet the definition of a clinical trial, as it is intended to verify the usability and functionality of the software prior to later clinical trials.