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.     

The Effects of ‘Face’ on Listening Comprehension: Evidence from Advanced Jordanian Speakers of English

This empirical study examines the extent to which ‘face’, i.e. (audio visual dialogues), affects the listening comprehension of advanced Jordanian EFL learners in a TOFEL-like test, as opposed to its absence (i.e. a purely audio test) which is the current norm in many English language proficiency tests, including but not limited to TOFEL iBT, TOEIC and academic IELTS. Through an online experiment, 60 Jordanian postgraduate linguistics and English literature students (advanced EFL learners) at the University of Jordan sit for two listening tests (simulating English proficiency tests); namely, one which is purely audio [i.e. without any face (including any visuals such as motion, as well as still pictures)], and one which is audiovisual/video. The results clearly show that the inclusion of visuals enhances subjects’ performance in listening tests. It is concluded that since the aim of English proficiency tests such as TOEFL iBT is to qualify or disqualify subjects to work and study in western English-speaking countries, the exclusion of visuals is unfounded. In actuality, most natural interaction includes visibility of the interlocutors involved, and hence test takers who sit purely audio proficiency tests in English or any other language are placed at a disadvantage.     

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.     

Friends and Family: The Role of Relationships in Community and Workplace Attachment

Purpose

Most work–life research focuses on the spillover of the nuclear family to the workplace, offering little insight into how other family relationships and friendships can spill over to affect employees’ organizational attachment. Past research has also overlooked the role of relationship quality and the mechanisms underlying these life-to-work spillover effects. Addressing these shortcomings, we integrate the systemic model of community attachment with job embeddedness theory to develop a model of community relational embeddedness and then use this model to examine how nonwork relationships connect people to their workplaces.

Design/Methodology/Approach

We used survey data from a national sample of 2025 accounting professionals and tested mediation hypotheses using structural equation modeling.

Findings

Employees’ relationships with friends and family predicted their attachment to their communities, which in turn predicted their workplace turnover intentions. Supporting our theoretical model, bonds with friends and family predicted moving intentions, and community fit and sacrifice mediated these effects. Community fit and sacrifice also predicted work turnover intentions indirectly through moving intentions. Tests also revealed that, surprisingly, friendships had a stronger impact on community attachment than family.

Implications

Employees are connected to their organizations through an array of close community relationships that extend beyond the nuclear family (i.e., spouse, children). Organizations can enhance employees’ workplace attachment by recognizing the role of friends and offering work–life programs that use a broad conceptualization of family (e.g., adult siblings, parents).

Originality/Value

Our study illustrates the importance of community relationships to workplace attachment, and the need to incorporate relational quality, nonnuclear family, and friendships in future research.

     

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.     

My Mentor,My Self: Antecedents and Outcomes of Perceived Similarity in Mentoring Relationships

This study examines the antecedents and outcomes of perceived similarity in mentoring relationships in a sample of 82 matched mentor-protégé dyads. Polynomial regression analyses were used to examine the association between actual and perceived similarity. Protégés were more likely to see themselves as similar to their mentors when they and their mentors shared either higher or lower levels of attachment security. However, sharing similar levels of relational self-construal was unrelated to protégés perceptions of similarity with their mentors. Path analyses revealed that protégés reported more organizational and professional commitment when they saw themselves as similar to their mentors, and that these associations were mediated by protégés’ reports of their mentors providing role modeling functions. These findings suggest that the effects of actual mentor-protégé similarity on perceptions of similarity may depend on the shared attribute, and provide further evidence of the importance of perceived similarity to not only mentoring relationships, but also to organizations.