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.     

Prototypes and same-gender bias in perceptions of hiring discrimination

The present study investigated the relative importance of two explanations behind perceptions of gender discrimination in hiring: prototypes and same-gender bias. According to the prototype explanation, people perceive an event as discrimination to the extent that it fits their preconceptions of typical discrimination. In contrast, the same-gender bias explanation asserts that people more readily detect discrimination toward members of their own gender. In four experiments (n = 797), women and men made considerably stronger discrimination attributions, and were moderately more discouraged from seeking work, when the victim was female rather than male. Further, a series of regressions analyses showed beliefs in discrimination of women to be moderately correlated with discrimination attributions of female victims, but little added explanatory value of participant gender, stigma consciousness, or feminist identification. The results offer strong support for the prototype explanation.     

Community Gender Norms Change as a Part of a Multilevel Approach to Sexual Health Among Married Women in Mumbai,India

Inequitable gender norms in societies and communities negatively contribute to women’s sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender norms, the design of community level intervention, community participation and the assessment of intervention impact in a low income, predominately Muslim community of 600,000 people in Mumbai, India. Formative research focused on in‐depth interviews with women, men and couples yielding gender normative statements and assessment of community resources to facilitate change. A Gender Equity Scale (GES) based on this formative research was developed and administered annually for a three‐year period to random, cross‐sectional samples in the intervention and control communities, and to community based, non‐governmental organizations (NGO) staff and Imams (religious leaders) in the intervention community. NGO staff disseminated gender oriented messages to their female constituency through their regular outreach activities and through special events and festivals in the community. Imams disseminated gender messages through lectures on social issues for men attending Friday prayers. The results showed that the NGO staff and Imams, assumed more gender equitable attitudes across time. The intervention was associated with a significant improvement in attitudes towards gender equity in the intervention relative to the control community. Men showed a dramatic change in more positive gender attitudes, while women lagged behind in their GES scores. The meaning of these results are explored and the implications assessed for the generalizability of the methodology for other countries, cultures and communities.     

Gender difference in emotional reactions and sexual coercion in casual sexual relations: An evolutionary perspective

This study tested four predictions derived from (evolutionary) sexual conflict theory. The central hypothesis was that men and women possess different emotional mechanisms that motivate and evaluate sexual activities. Women’s mechanisms are associated with their perception of partners’ ability and willingness to invest. For men these associations are weaker or inverse. Regression analyses of survey data from 194 college students revealed the following. As incidence of casual sexual relations increased (SOI Behavior), men reported less concern about partners’ intentions and less Worry–Vulnerability in response to casual sexual relations than women did; these gender interactions were significant. Regular sexual relations with partners with whom they did not desire emotional involvement showed the same pattern of gender differences. The Sexual Experiences Survey (SES) measured the incidence of sexual coercion in casual sexual relations. For women, but not for men, SOI Behavior was associated with all levels of sexual coercion. Limitations and implications are discussed.     

Social representations associated with men and women drivers among French adolescents and adults. Effects of the perceiver’s age,sex, and socioeconomic status

The aim of this study was to investigate the specific contents of the social representations (SR) associated with men and women drivers and examine the effects of the social insertions of individuals (i.e., age, sex and socio-economic status) on the content and structure of these SR. A preliminary study with 414 French participants identified thematic content associated with men and women drivers using the verbal association method. Based on these themes, 833 French participants, equally distributed by age group (from 12 to 50 years-old and over), sex and socioeconomic status (SES), were asked to answer a questionnaire on men (N = 422) or women (N = 411) drivers. The results show that each of these SR is organized around three factors: incompetence, prudence and lack of self-control for women drivers; carelessness, skills and self-control for men drivers. In-group favoritism bias can be noted in both groups as male participants, more than female ones, rated men drivers as having self-control and women drivers as lacking self-control, whereas female participants, more than male ones, perceived men drivers as careless and women drivers as prudent. Despite this phenomenon, more male respondents than female ones in all age groups seemed to believe that women are not competent at driving, whereas both sexes seem to agree that men have good driving skills. Among most age groups, three characteristics associated with men drivers (confidence, speed and pleasure of driving) and four characteristics associated with female drivers (caution, civil, compliance with rules and vigilance) emerged as central in the SR. The SR associated with men drivers appeared to be stable and shared across age groups, whereas the SR associated with women drivers appeared more mixed, heterogeneous and unstable with age. Female participants with higher SES consider women drivers as more incompetent, less prudent and more lacking self-control than female participants with lower SES.     

Links between family gender socialization experiences in childhood and gendered occupational attainment in young adulthood

Gendered occupational segregation remains prevalent across the world. Although research has examined factors contributing to the low number of women in male-typed occupations – namely science, technology, engineering, and math – little longitudinal research has examined the role of childhood experiences in both young women's and men's later gendered occupational attainment. This study addressed this gap in the literature by examining family gender socialization experiences in middle childhood – namely parents' attitudes and work and family life – as contributors to the gender typicality of occupational attainment in young adulthood. Using data collected from mothers, fathers, and children over approximately 15 years, the results revealed that the associations between childhood socialization experiences (~ 10 years old) and occupational attainment (~ 26 years old) depended on the sex of the child. For sons but not daughters, mothers' more traditional attitudes toward women's roles predicted attaining more gender-typed occupations. In addition, spending more time with fathers in childhood predicted daughters attaining less and sons acquiring more gender-typed occupations in young adulthood. Overall, evidence supports the idea that childhood socialization experiences help to shape individuals' career attainment and thus contribute to gender segregation in the labor market.     

Gender Role Attitudes across the Transition to Adolescent Motherhood in Mexican‐Origin Families

Using longitudinal data collected at four time points from 191 dyads of Mexican‐origin adolescent first‐time mothers and their mother figures, we examined changes in and socialization of traditional gender role attitudes across the transition to parenthood using latent growth curve modeling and actor – partner interdependence modeling. Longitudinal growth models indicated that, regardless of nativity status, adolescent mothers' and their foreign‐born mother figures' gender role attitudes became more egalitarian across adolescents' transition to parenthood, spanning from the 3rd trimester of pregnancy to 36 months postpartum. Furthermore, actor‐partner interdependence modeling suggested that adolescents' and their mother figures' gender role attitudes during adolescents' third trimester of pregnancy equally contributed to subsequent increases in one another's gender role attitudes at 10 months postpartum. Importantly, this reciprocal socialization process was not moderated by adolescent mothers' nor by their mother figures' nativity status. Findings suggest that it is important to understand the cultural and intergenerational family processes that contribute to the development of gender role attitudes during the transition to parenthood for adolescent mothers and their mother figures in Mexican‐origin families.     

Beyond the Binary: Trans‐Negotiations in Couple and Family Therapy

Dualistic notions about gender and sexuality have permeated the field of couple and family therapy. These binary constructions have been limiting for everyone, especially those who fall outside the male/female dichotomy. This article examines the impact of these binary notions, especially on transgender and gender‐creative individuals, couples, and families. Current theory and research in the field as they relate to gender identity, sexuality, and gender minority stress in couples and families are presented. Case examples are used to illustrate affirmative approaches to treatment issues such as coming out, safety, grief and loss, redefining relationships, and social/medical transitions that may arise for transgender or gender nonconforming (TGNC) individuals, couples, and families.     

Values for gender roles and relations among high school and non‐high school adolescents in a Maya community in Chiapas,Mexico

In the current study, I describe values for gender roles and cross‐sex relations among adolescents growing up in a southern Mexican Maya community in which high school was introduced in 1999. A total of 80 adolescent girls and boys, half of whom were attending the new high school, provided their opinions on two ethnographically derived vignettes that depicted changes in gender roles and relations occurring in their community. Systematic coding revealed that adolescents not enrolled in high school tended to prioritise ascribed and complementary gender roles and emphasise the importance of family mediation in cross‐sex relations. Adolescents who were enrolled in high school tended to prioritise equivalent and chosen gender roles, and emphasised personal responsibility and personal fulfillment in cross‐sex relations. Perceptions of risks and opportunities differed by gender: girls favourably evaluated the expansion of adult female role options, but saw risks in personal negotiations of cross‐sex relations; boys emphasised the loss of the female homemaker role, but favourably evaluated new opportunities for intimacy in cross‐sex relations.     

Gender differences in STEM undergraduates' vocational interests: People–thing orientation and goal affordances

This study addressed why women have greater representation in some STEM (science, technology, engineering, and mathematics) fields compared to others by linking two theoretical approaches, people–thing orientation (PO, TO) and role congruity theory, which emphasizes occupation goal affordances associated with traditionally feminine and masculine roles. Vocational interest and goal affordance ratings (having a positive social impact, family, and occupation status) for occupations characterized as working with people or things were assessed in 1848 students (42% female; 81% white non-Hispanic) majoring in biology (gender balanced), non-biology STEM (male-dominated), and female-dominated health fields. Participant PO and TO interests were also collected. Results indicated that non-biology STEM majors showed lower PO and higher TO interests than biology and health majors. Non-biology STEM majors also endorsed PO and TO interests at similar levels, but the other two major groups indicated higher PO than TO. People Jobs were perceived to more likely afford goals related to family and positive social impact; whereas Thing Jobs were perceived to more likely afford status goals. Interest in People Jobs was similar for women in both STEM major groups. Female non-biology STEM majors were equally interested in People and Thing Jobs; whereas biology majors preferred People Jobs. PO, TO, and goal affordance ratings independently predicted interest in People and Thing Jobs, and gender accounted for very little additional variance. Taken together, the findings point to the importance of using both person–thing orientation and role congruity theory when explaining varied gender representations in different STEM fields.