Meta-Analysis of Validated Quality of Life Outcomes Following Voice Feminization in Transwomen

Objectives: For transwomen undergoing voice feminization interventions, fundamental frequency (F0; vocal pitch) is a commonly reported functional outcome measure in the literature. However, F0 may not correlate well with improvement in quality of life (QoL). Several validated voice-related QoL instruments have been used to assess QoL improvement in these patients, yet there is no consensus on the most appropriate instrument. This systematic review and meta-analysis aimed to assess the relationship between change in F0 and QoL improvement following voice feminization, and to compare validated QoL instruments commonly used in this population.Data Sources: PubMed, Cochrane, and Embase.Review Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary studies of transwomen undergoing voice feminization, reporting validated QoL outcomes were included. Meta-analyses for associations between mean change in QoL score and mean change in F0, as well as variations in mean change in QoL score by QoL instrument, were performed using a multilevel mixed effects model.Results: No statistically significant correlation was found between change in F0 and QoL score improvement post-intervention. Different validated instruments showed statistically significant variation in QoL score change, with the Trans Women Voice Questionnaire (TWVQ) capturing a greater improvement in QoL score relative to other instruments.Conclusions: Lack of correlation between changes in F0 and QoL improvement further supports that F0 alone is insufficient to assess the efficacy of voice feminizing interventions. Validated QoL measures are useful adjuncts. Of these, the TWVQ appears to be the most sensitive for measurement of QoL improvement following voice feminization.