Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.     

Supervision in Community Mental Health: Understanding Intensity of EBT Focus

The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision.     

Parameters of Time-out: Research Update and Comparison to Parenting Programs,Books, and Online Recommendations

In reviews published more than 30 years ago, eight parameters important to the use of time-out were identified and available research was summarized. The purpose of the current paper is to provide an updated summary of existing research for each parameter of time-out. Within each parameter, we conducted a thorough review of the published literature and identified all peer-reviewed articles addressing each parameter. We identified and summarized a total of 46 articles across the eight parameters, including 32 not cited in previous reviews. Sufficient findings were available to draw conclusions regarding time-out warning, schedule of time-out, contingent versus noncontingent release, and duration. Tentative conclusions based on only a few studies could be drawn in regard to instructional versus physical administration and verbalized reason for time-out. No conclusions could be drawn regarding time-out signal and specific time-out location. While we know much more today regarding effective implementation of time-out, there is a clear need for further exploration within these identified parameters. In addition to summarizing the literature, we reviewed recommendations made by behavioral parent training programs, parenting books, and parenting Web sites, and compared how well their recommendations matched current research based on the conclusions drawn from our review. We found that parenting sources made strong and specific recommendations on several of the parameters that were either not consistent with available research or simply lacked a sufficient research base.     

The Individual Career Counseling Needs and Experiences of Female Survivors of Partner Violence

The impact of partner violence on women's employment and career development is profound. Career counselors may contribute substantially to these women's rehabilitation. This study examined employment and career counseling needs, barriers experienced, and counseling satisfaction of female survivors of partner violence (N = 71). The women participated in community‐ and research‐based individual career counseling services designed to promote their short‐ and long‐term career development. The authors conducted correlational, t‐test, and logistic regression analyses and found that barriers differed by race/ethnicity, age, number of children, and career service needs. Results provide important information about survivors' career counseling service access and needs.     

Identity Fusion,Extreme Pro‐Group Behavior,and the Path to Defusion

Identity fusion refers to a visceral sense of oneness with an ingroup. For fused individuals, group membership is not a means to an end (e.g., a positive social identity). Rather, membership is an all‐absorbing goal in itself; little other than the group matters. Group membership is also seen as enduring, sustained by chronically activated psychological structures as well as features of the context. Fellow group members are likewise seen as permanent members of the group, as they are members of the ingroup “family”. And just as family members are compelled to make extreme sacrifices for their family, so too are highly fused individuals – including even the ultimate sacrifice. These efforts to protect the ingroup can have negative consequences when, for example, people become strongly fused to groups that are devoted to extreme, anti‐social behaviors. In such instances, it may be prudent to encourage “defusion” from the group, but the emotional investment associated with fusion may thwart such efforts. We discuss the implications of these and related considerations.     

Psychological management and body image issues in facial transplantation

Facial transplantation, although controversial, is proposed as a major advance in facial reconstructive surgery, with the first partial transplant having taken place in France in November 2005. Although the psychological impact of facial transplantation will not be understood until several procedures have been carried out, this article examines the psychological issues likely to arise with particular reference to body image. A detailed framework for anticipation and management of psychological change is proposed. Pre-operative preparation must include thorough psychological preparation for the patient and their family. The immediate post-operative period is likely to be challenging, and a detailed management plan is proposed emphasising early return to function; subsequent psychological issues including altered body image, anxiety, shame, depression, communication and behavioural avoidance are discussed and a management strategy based on cognitive behavioural principles is proposed for the first post-operative year. Previous discussion frames psychological outcome in terms of complication and risk, tending to downplay the potential advantages of a successful procedure; the focus of this paper is on ensuring psychological adjustment as an inevitable consequence of change.     

Realities and Myths of Safety Issues for Community Researchers Working in a Marginalized African American Community

Community psychologists often conduct research in collaboration with marginalized communities in which safety is an issue. However, we rarely talk about what specific safety issues we experience and how we deal with them. Our story describes the realities and myths of neighborhood safety that were experienced in a low-income African American neighborhood of Chicago, while collaborating on a project designed to increase access to the Internet to obtain health information. We examine both the challenges experienced and our responses in the context of a community intervention planned, implemented, and evaluated by a partnership team composed of various stakeholders. Critical lessons such as the importance of building on community strengths and the need to be aware of our own biases are discussed.