Assessing vocal gender incongruence in singing contexts: Creation of the SInG Scale

Background: Singing-related gender incongruence can be a significant source of distress for transgender and nonbinary (TGD) individuals, yet existing measures of gender dysphoria do not capture this domain. This study developed and validated a self-report measure of singing-related gender incongruence. Methods: Participants include 147 transgender and nonbinary individuals (32 transgender men, 25 transgender women, and 90 nonbinary individuals) as well as a cisgender comparison sample to examine known-group validity. Participants completed items assessing psychological, social, and physical aspects of their experiences with singing voice. Results: Exploratory factor analysis revealed a four-factor solution encompassing Misgendering, Anxiety, Effort, and Satisfaction. The Misgendering factor in particular brought together items that previously spanned social and psychological domains, highlighting the central role of both internal experiences and external perceptions in shaping voice-related distress. The final scale demonstrated strong internal consistency and interpretability across factors. Conclusions: These findings provide preliminary psychometric support for a multidimensional measure of singing-related gender incongruence, based in part on correlations with author-derived single-item indicators of speech and singing-related incongruence, offering researchers and clinicians an initial tool to better understand and address this underexplored aspect of gender dysphoria.