Efficacy of Pitch Elevation Training for Mandarin‐Speaking Transgender Women
Zhen Chen, Jiahe Zhang, Yichen Liang, Jie He, Lu Wang, Xingjie ShiABSTRACT
Background
Mandarin is a tonal language in which pitch patterns at the syllable level distinguish lexical meaning.
Aims
This study aimed to develop and evaluate the efficacy of a pitch elevation training protocol adapted for Mandarin‐speaking transgender women.
Methods and Procedures
Twenty‐six Mandarin‐speaking transgender women completed ten 40‐min sessions of pitch elevation training incorporating tone‐specific pitch adjustments. Participants completed the Simplified Chinese version of the Trans Woman Voice Questionnaire (TWVQ‐SC), which included a total score, six module scores, and a 5‐point self‐rating of vocal gender. Acoustic measures were also obtained before and after training. For sustained vowels, median f o was measured; for sentence reading (SR) and spontaneous speech (SS), median f o as well as the 5th and 95th percentiles of f o were extracted. Linear mixed‐effects models examined the effects of training on f o measures, and paired t tests evaluated changes in TWVQ‐SC scores.
Outcomes and Results
The TWVQ‐SC total score and four of the six module scores decreased significantly, and self‐rated vocal gender shifted toward the feminine end of the scale. Median f o increased significantly across all speech tasks post‐training: 62 Hz for sustained /a/, 60 Hz for sustained /i/, 74 Hz for SR, and 72 Hz for SS. The 5th and 95th percentiles of f o also increased significantly for SR and SS.
Conclusions and Implications
The Mandarin‐adapted pitch elevation training protocol was associated with increases in f o and improvements in self‐reported voice outcomes in Mandarin‐speaking transgender women. Further controlled studies are warranted to examine the relative efficacy of this protocol compared with other approaches and to determine the contribution of its specific components (e.g., tone‐specific training techniques) to pitch elevation.
WHAT THIS PAPER ADDS
What is already known on this subject
Behavioural pitch‐elevation protocols for transgender women reliably raise speaking
f
o
and improve patient‐reported outcomes. Standard programs use hierarchical targets (e.g., humming or nasal syllables progressing to words, sentences, and conversation), often alongside resonance and intonation training. Previous research shows mean
f
o
gains of about 25–50 Hz across speech tasks, with improvements in TWVQ scores and listener‐rated femininity, and short‐term gains maintained at 3 months. For tonal languages such as Mandarin, Tones 3 and 4 often reach the modal‐register floor and creaky voice. Whether existing protocols generalize to tonal‐language speakers or require adaptation remains underexplored.
This prospective single‐group study evaluated a Mandarin‐adapted pitch‐elevation protocol in 26 Mandarin‐speaking transgender women who completed ten 40‐min sessions over 5 weeks. The protocol incorporated tone‐specific strategies for T3/T4, a practical lower f o floor, real‐time visual pitch feedback, and on‐target humming. Median f o increased by about 62–74 Hz across sustained vowels, sentence reading, and spontaneous speech; the 5th and 95th percentiles of f o also increased in connected speech. TWVQ‐SC total scores decreased by 26.35 points, indicating improved self‐perceived voice outcomes.