Professor Zumbansen’s role in this innovative study was to assess the impact of activities the Opéra de Montréal organized for these two groups, who face marginalization and a high risk of social isolation. The study was funded by the Social Sciences and Humanities Research Council of Canada. It ran from February to July 2024, and it’s starting up again in 2025 after promising preliminary results revealing the benefits singing can have on mental and physical health.
Opera as a gender-affirming treatment for trans women
According to Zumbansen, the sound of trans women’s voices can contribute to marginalization, social isolation and poor mental health. Unlike trans men, trans women experience no voice changes due to gender-affirming hormone therapy. And research has shown that the more feminine their voices are perceived to sound, the higher their quality of life.
To address this, the Opéra de Montréal worked with a speech-language pathologist who specializes in gender-affirming voice therapy, known as “voice feminization,” to develop a series of singing workshops based on opera techniques. Around 10 trans women took part in 12 sessions to help them find their voice and explore what it can do.
After the study, the workshops could be followed up with speech therapy treatments. In fact, Zumbansen says, “These workshops will help speech-language pathologists do their job since the women will have already tried out ways of using their voices that go beyond ordinary habits.”
An example of this involves exploring participants’ head voice — or a falsetto, it’s a higher register of the voice that we tend not to use very often. “We all have several tools in our arsenal in terms of the things our voices can do, but for cultural reasons, we only use a small portion of those abilities,” Zumbansen explains. In encouraging participants to discover that range of abilities, the workshops could help trans women find a way of speaking that’s more in tune with their gender.
Breathing easier through song
Trans women aren’t the only people who can benefit from singing. People with symptoms of long COVID were also included in the study. This group featured around 10 participants, who also attended 12 opera-singing workshops (held online due to transportation-related challenges).
As Zumbansen explains, opera techniques require especially masterful breath control. The workshops were created by an opera singer who also works as a yoga instructor. The creator’s dual career background meant participants could work on different aspects of their breathing in the exercises to help them get the most out of their voices again.
Measuring the benefits of singing
For both of the groups studied, the goal was to improve mental health and feelings of wellbeing — benefits reinforced by the social support other group members provided. But how can you measure the effects of singing?
To get this data, Zumbansen drew on a range of tools, from self-assessment surveys to specialized speech and language assessment tools. For example, participants with chronic respiratory conditions underwent tests of their “maximum phonation time — in other words, you ask them to make an ‘ah’ sound and hold it for as long as they can,” she says. In another test, participants read a passage as the researcher counted how many times they stopped to breathe per minute.
Tools to measure the effects on trans women included surveys to gauge their self-perceived “voice handicap,” as well as acoustic assessments “to determine the lowest and highest note they could reach,” Zumbansen explains.
Tests were run on both the participants and a control group at the beginning and end of the study period. Zumbansen says the preliminary results are promising: compared to the control group, the participants showed improvements in their levels of psychological distress and mental health–related quality of life. Trans participants saw a drop in their self-perceived voice handicap, and all of them reported discovering at the end of the program that their voices could do more than they’d thought. People with long COVID, for their part, reported less shortness of breath and a better understanding of their breathing.
These are some of the many positive trends uncovered about the benefits these singing programs can bring. However, the small sample size in the study means the results aren’t statistically significant. That’s why the partnership with the Opéra de Montréal has been renewed to replicate the study in 2025. The combined results will be presented in May at the Music and Health Research Institute annual conference.