{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:45:31Z","timestamp":1782470731779,"version":"3.54.5"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Prior literature has examined vocal characteristics that transgender individuals may modify to align voice and gender identity, including pitch, resonance, and intonation. These factors, however, do not fully capture the effect of voice on quality of life. Vocal effort, a multidimensional phenomenon which includes mental and physical demand components, correlates with quality of life in adductor laryngeal dystonia (ADLD) but has not been quantitatively assessed in the transgender population. This study aims to evaluate differences in vocal effort among trans women compared to cisgender individuals and those with voice disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study recruited four groups: an experimental and negative control group, trans women and cisgender individuals without laryngeal pathology, and positive control groups, ADLD, and unilateral vocal fold paralysis (UVFP), conditions associated with elevated vocal effort. Participants completed a spontaneous speaking task followed by the NASA Task Load Index (NASA\u2010TLX) and VHI\u201010. The NASA\u2010TLX has been explored as a novel tool to evaluate vocal effort components, including mental and physical demand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants included 15 trans women, 16 cisgender individuals, 12 ADLD patients, and 9 UVFP patients. Trans women reported significantly increased mental demand compared to both cisgender (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and ADLD patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Trans women, ADLD, and UVFP participants exhibited increased physical demand compared to cisgender individuals (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01, respectively). VHI\u201010 scores were elevated in the trans women, ADLD, and UVFP participants compared to cisgender individuals (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests that trans women experience greater vocal effort, including both physical and mental components, compared to cisgender individuals. These findings provide another perspective to understand the effects of gender affirming voice care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70471","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:46:43Z","timestamp":1781506003000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Components of Vocal Effort in Transgender Women"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5171-7594","authenticated-orcid":false,"given":"Kayen","family":"Tang","sequence":"first","affiliation":[{"name":"Department of School of Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1112-2674","authenticated-orcid":false,"given":"Tanya","family":"K Meyer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1538","authenticated-orcid":false,"given":"Joseph","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.11.010"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.54292"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03625.x"},{"issue":"12","key":"e_1_2_10_5_1","first-page":"2277","article-title":"Happiness and Mental Health in Pre\u2010Operative and Post\u2010Operative Transsexual People","volume":"48","author":"Fallahtafti E.","year":"2019","journal-title":"Iranian Journal of Public Health"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.0978"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1044\/2017_JSLHR-S-17-0067"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28764"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2024.11.022"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.70310"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_JSLHR\u201019\u201000057"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.70122"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0166-4115(08)62386-9"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/154193120605000909"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/s0892\u20101997(03)00067\u20105"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200409000\u201000009"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318160d093"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525\u20101497.2001.016009606.x"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1109\/THMS.2023.3263482"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0891988720933358"},{"issue":"12","key":"e_1_2_10_21_1","first-page":"614","article-title":"Biostatistics 104: Correlational Analysis","volume":"44","author":"Chan Y. 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