VR-based speaking practice increases willingness to communicate in gender-affirming voice training
How this was rated
Pilot RCT (n=11) in gender-affirming voice training. Randomized design is a strength; sample size makes this a feasibility signal rather than a firm effect estimate.
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The first RCT using Therapy withVR for gender-affirming voice training found that practicing in virtual speaking situations led to broader gains in willingness to communicate with strangers compared to traditional in-person role-play.
A small pilot RCT suggesting that VR-based gender-affirming voice practice may produce broader gains in willingness to communicate than traditional role-play alone; sample size makes this a feasibility signal rather than a definitive effect.
Key findings
- The VR group showed broader gains in willingness to communicate, especially with strangers (pre 31.6 to post 43.0)
- Between-groups effect size of d = 0.76 for pitch elevation during reading favored the VR group
- Between-groups effect size of d = 0.68 for willingness to communicate with strangers favored VR
- Both groups showed slight improvements in voice-related quality of life
Background
Gender-affirming voice training helps trans women develop a speaking voice that aligns with their gender identity. A key challenge is generalization - being able to use a new voice confidently and consistently in everyday life, not just in the therapy room. Many individuals experience anxiety about speaking in public with their voice, which can lead to avoidance of social situations.
Leyns and colleagues explored whether VR-based speaking situations could help bridge this gap, providing a safe and controllable space to practice using one’s voice in realistic social contexts.
What the researchers did
Eleven trans women who had previously received gender-affirming voice training at Ghent University Hospital were randomly assigned to a VR group (n = 6) or a traditional training group (n = 5). Both groups completed four weekly 30-minute sessions with a speech-language pathologist focused on pitch elevation and generalization.
The VR group practiced speaking in virtual scenarios - a cafe conversation and a job interview - delivered through Therapy withVR on a Meta Quest 2 headset. The clinician controlled the scenarios in real time from a laptop, adjusting avatar expressions, gestures, and background noise to gradually increase difficulty. The traditional group performed comparable role-play activities in person.
What they found
Both groups showed slight improvements in voice-related quality of life, though neither reached the threshold for clinically meaningful change on the Trans Woman Voice Questionnaire. The most notable difference was in willingness to communicate: the VR group showed broader gains, particularly with strangers (rising from 31.6 to 43.0), while the traditional group’s scores remained essentially unchanged.
Both groups increased their median speaking pitch, but the VR group showed a larger effect during reading (within-group d = 0.57 vs. 0.12 for the traditional group), with a between-groups effect size of d = 0.76 favoring VR.
Why this matters
This is the first randomized controlled trial using VR for gender-affirming voice training. While the small sample means results should be interpreted cautiously, the pattern is encouraging: VR-based practice appears to particularly support the social confidence dimension of voice work, helping individuals feel more willing to use their voice with unfamiliar people and in public settings.
For clinicians, the practical advantage is clear - VR allows you to create the kinds of speaking situations (a busy cafe, a job interview) that are impossible to arrange reliably in a therapy room, with full control over difficulty and the ability to de-escalate instantly if someone becomes overwhelmed.
Limitations
The sample of 11 participants precluded inferential statistics. Prior VR experience was not assessed. Technical interruptions (software crashes, non-responsive avatars) disrupted some sessions. Only four sessions were conducted, which may be insufficient to produce meaningful changes on self-report measures. No long-term follow-up was included.
Implications for practice
VR offers clinicians a practical way to create diverse speaking situations that are difficult to replicate in a therapy room, with adjustable difficulty. The trend toward increased willingness to communicate with strangers is clinically relevant, as social avoidance due to voice-gender incongruence is a common barrier. VR may serve as a bridge between clinical work and real-world speaking confidence, particularly when in-person practice is impractical or poses safety concerns.
Where this connects to Therapy withVR
The study above is independent research and does not endorse any product. The notes below are commentary from withVR on how the themes in this research relate to features of Therapy withVR. The research findings are not claims about Therapy withVR.
Multiple Speaking Environments
This study showed VR helps people generalize vocal changes - Therapy withVR's 12 environments let individuals practice their voice across cafes, shops, meetings, and more.
Avatar Speech and Interaction
Practice responding to avatars in realistic social exchanges, building the confidence to use one's authentic voice with strangers - the key outcome this study measured.
Sound System
Add realistic background noise (ambient chatter, coffee machines, traffic) to simulate the challenging listening conditions where vocal confidence matters most.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{leyns2025,
author = {Leyns, C. and Bosschem, L. and Papeleu, T. and Sabbe, L. and Walkom, G. and D'haeseleer, E.},
title = {Virtual Reality as a Tool in Gender-Affirming Voice Training: A Pilot Study},
journal = {Journal of Voice},
year = {2025},
doi = {10.1016/j.jvoice.2025.06.034},
url = {https://withvr.app/evidence/studies/leyns-2025}
}TY - JOUR
AU - Leyns, C.
AU - Bosschem, L.
AU - Papeleu, T.
AU - Sabbe, L.
AU - Walkom, G.
AU - D'haeseleer, E.
TI - Virtual Reality as a Tool in Gender-Affirming Voice Training: A Pilot Study
JO - Journal of Voice
PY - 2025
DO - 10.1016/j.jvoice.2025.06.034
UR - https://withvr.app/evidence/studies/leyns-2025
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
Conflict-of-interest declaration from the published paper: 'Gareth Walkom is the developer of the Therapy withVR app, owner of withVR, and co-author of this study. He was consulted during the data collection whenever a problem occurred in the software system. However, he did not influence the interpretation of the results during paper writing.' This study should be read with that disclosure in mind. The study itself was conducted at Ghent University Hospital and approved by the Ethics Committee of the Ghent University Hospital (B6702023000615). Inclusion in this Evidence Hub is editorially independent of the commercial side of withVR BV; this summary was prepared from the published paper, and the certainty rating reflects the study's design and sample size, not the relationship to the platform.