The Trans Woman Voice Questionnaire (TWVQ)

Dr Georgia Dacakis and Shelagh Davies

The TWVQ is a self report questionnaire designed for use with women who were assigned male at birth and who identify and live full time as their authentic female gender. Its purpose is to measure the women's experiences with their voices. The TWVQ is available for free download by speech-language pathologists/speech-language therapists, speech and voice researchers and trans women who wish to monitor or evaluate their own experiences with their voices.

At the time of its development, the TWQV was named the Transsexual Voice Questionnaire (Male to female, TVQ MtF) With the ever-evolving language used in the trans and gender diverse space came sufficient report that the original title with its use of 'transsexual' and 'male-to-female', was considered by some as offensive. The name was officially changed in July 2020 and the authors feel confident that the name change has not compromised the integrity or the validity of the questionnaire.

For psychometric evaluation of the TWVQ see:

  • Dacakis, G., Davies, S., Oates, J., Douglas, J., & Johnston, J. (2013). Development and preliminary evaluation of the Transsexual Voice Questionnaire for male-to-female transsexuals. Journal of Voice. 27(3), 312-320. doi:10.1016/j.jvoice.2012.11.005
  • Dacakis, G., Oates, J., & Douglas, J. (2016). Exploring the validity of the Transsexual Voice Questionnaire (male-to-female): Do TVQMtF scores differentiate between MtF women who have had gender reassignment surgery and those who have not? International Journal of Transgenderism. 17(3-4), 124-130. doi:10.1080/15532739.2016.1222922
  • Dacakis, G., Oates, J., & Douglas, J. (2017). Further evidence of the construct validity of the Transsexual Voice Questionnaire (TVQMtF) using Principal Component Analysis. Journal of Voice. 31(2). doi:10.1016/j.jvoice.2016.07.001
  • Dacakis, G., Oates, J., & Douglas, J. (2017). Associations between the Transsexual Voice Questionnaire (TVQMtF) and self-report of voice femininity and acoustic measures. International Journal of Language & Communication Disorders. doi:10.1111/1460-6984.12319
  • Davies, S., Johnston, J.R. (2015). Exploring the Validity of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals. Canadian Journal of Speech-Language Pathology and Audiology. Vol. 39, No. 1, pp. 40 - 51

Contact first author for further information regarding the availability of the articles.

TWVQ Downloads

Want to translate the TWVQ?

Please follow these guidelines to produce an authorised, accurate translation.

  1. Obtain written permission from the authors prior to translation.
  2. Follow the guidelines published by the World Health Organization

Currently being translated/finalized

  • Catalan
  • Greek
  • Icelandic
  • Indian – Hindi
  • Indian - Kannada
  • Indian – Malayalam
  • Indian/Sri Lankan – Tamil
  • Norwegian
  • Polish
  • Spanish Rioplatense's (Argentinia)
  • Urdu - Pakistan

Frequently asked questions

Can the TWVQ be scored and are there ‘norms’ for the questionnaire?

It would be nice to be able to simply add the scores of the questionnaire and then compare the total pre- and post-voice training result as a measure of change, however, as the total is a very broad measure of perceptions of voice functioning and the impact of voice on the individual’s life, any change in the score reveals little. The total score does not tell us which areas have improved and which require further focus and it may measure an experience that is not relevant to an individual at one point in their lives but relevant at another. Shelagh often gives the example of the item “I feel uncomfortable talking to friends, neighbours and relatives because of my voice” pointing out that someone who is socially isolated might not feel this is a problem but as their situation changes and they wish to engage with these groups, they may rate their response very differently.

If you look at the ‘clinical implications’ section of the below article*** you will see reference to how the scores could be used. Essentially, progress can be viewed by comparing responses to individual items (and a statement about the number of items that ‘improved’) or by scoring according to each of the components of the questionnaire and commenting on which component has improved e.g., social participation versus vocal functioning.

We are sometimes asked whether there are ‘norms’ or if the questionnaire has been ‘standardised’. There are far too many factors that impact on the individual’s perception of their voice for this to be possible.

***Dacakis, G., Oates, J. M., & Douglas, J. M. (2017). Further evidence of the construct validity of the Transsexual Voice Questionnaire (TVQMtF) using Principle Components Analysis. Journal of Voice, 31(2), 142-148. doi:10.1016/j.jvoice.2016.07.01

Can the TWVQ be modified by changing pronouns and direction of voice change so that it can be used for people who are:

  • Assigned male at birth but don’t identify as trans women (i.e., other gender diverse, non-binary, or gender fluid transfeminine identities) ?
  • Assigned female at birth but identify as male or transmasculine?

A requirement of developing a valid questionnaire is that members of the population for whom the questionnaire is being developed contribute to the questionnaire and that once developed it is validated on that population. The TWVQ was developed at a time when the majority of trans individuals who asought support from speech pathologists for voice training were those assigned male at birth and identified as female. The questionnaire was guided by in depth interviews of this population and validated with women who were assigned male at birth but identified as female. The questionnaire is therefore most suitable for this population. While we are aware that the questionnaire has been used with other trans and gender diverse populations there has been no validation with these populations. Earlier work to provide a companion TWVQ for transmasculine people was abandoned following the realisation of the authors that simply flipping the pronouns did not produce items that accurately represented the experiences of this population.

I need permission to translate the questionnaire into another language, but do I need permission to validate the questionnaire?

While you must seek permission from the first author to translate the questionnaire (, you do not need permission to validate the questionnaire however, you may want to let us know of your intentions in case we are aware of a similar project already underway. If you believe that your validation process will result in modifications to the authorised translation then please contact Georgia to discuss. Please note that if you are validating the questionnaire you should clearly identify the gender positioning of the population that you are recruiting. This will allow for valid comparisons with current findings or new information about the use of the questionnaire with people of a range of gender identities.

Voice Care for Teachers – DVD

by Dr Alison Russell, Dr Jenni Oates and Ms Cecilia Pemberton

The Voice Care for Teachers DVD provides you with the information you need to look after your voice.

Teaching is a vocally demanding profession. Few teachers receive any advice on how to look after their voices. Research throughout the world has concluded that school teachers are three times more likely than the general population to develop voice problems, with up to 20% of teacher's experiencing voice problems each year.

The Voice Care for Teachers DVD has been designed to provide you with the information you need to look after your voice and help you prevent problems. It has been written and produced by speech pathologists: Dr. Alison Russell (Adelaide), Ceclillia Pemberton (Sydney) and Dr. Jenni Oates (Melbourne) who have all worked extensively with teachers with voice problems.

For further information or to order the DVD visit the Voice Care for teachers [external link].

Voice Care for Teachers - Program

by Dr Jenni Oates

Voice Care for Teachers - Program Document [PDF 1MB]

In 1998, the Department of Education and Training (DET) in Victoria contracted Dr Jenni Oates to work with their Occupational Health and Safety Unit to develop a web-based educational program designed to promote vocal health and prevent voice problems in school teachers. The high prevalence of voice problems among teachers, the negative impact of such problems on teachers, students and the school system, and the preventable nature of most voice disorders had indicated to DET that allocating resources to develop an effective prevention and voice education program was warranted. The resulting Voice Care for Teachers Program was completed and implemented in schools throughout Victoria in 2000. The program is now also used widely by teachers in non-government schools and by other professionals who rely on an effective and reliable voice for their occupations (e.g., singers, actors, television and radio presenters, auctioneers, barristers etc). The Voice Care for Teachers program is comprised of 3 components:

  • Implementation Guide for School Management
  • Action Planning Guide with Voice Assessment Tools for Teachers
  • Voice Care Training Materials (Anatomy and Physiology of voice production, symptoms and causes of voice problems, effective voice production techniques, minimising harmful vocal behaviours, maximising physical and emotional health, optimising the physical school environment for healthy voice use).


Assessment of Phonological Awareness and Reading (APAR)

By Teresa Iacono and Linda Couples

The APAR is a phonological awareness and reading assessment suitable for children through to adults with complex communication needs (it does not require spoken responses). View details and materials [external link].

Note, the APAR has not been standardised. It was designed to provide a profile of skills relevant to reading single words and beyond, especially when the Peabody Picture Vocabulary Test is also administered to assess receptive vocabulary. As a result, it can be administered in whole or part, and yields information to inform intervention planning.

In order to use the APAR, the materials should be downloaded, printed and converted to an assessment kit.

Parts of the APAR were used in the following study:

Iacono, T., & Cupples, L. (2004). Assessment of the phonological awareness and word reading skills of people with complex communication needs. Journal of Speech-Language Hearing Research, 47, 437-449.