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Voice Feminization Surgery

Introduction

Having a masculine-sounding voice can be a major source of gender dysphoria for many transgender women, as well as some transfeminine nonbinary people. Unfortunately, GAHT does not do anything to affect a voice that has already dropped. Some transgender women are lucky enough to have access to puberty blockers at a young age, largely preventing the voice from dropping. For a woman unable to achieve a feminine voice through voice training, vocal feminization surgery is an option that is available to promote gender euphoria.

A major benefit of voice feminization surgery (as opposed to simply voice training) is that there is no continued concious effort to maintain your preferred voice, even when exhausted. That being said, most people will voice train prior to having voice surgery; both to try a less invasive route to gender affirmation, and as a method of strengthening the vocal cords before surgery.

Note that while there are some cisgender women who seek out voice feminization surgeries, this page will be discussing these surgeries in the context of how they serve as gender-affirming care for transgender women.

General Information

Voice feminization surgeries permanently raise the pitch of the patient's voice. These are surgeries outpatient procedures done by a laryngologist while the patient us under general anesthesia. The main effec that these surgeries have on transgender women is increased happiness, self-confidence, and willingess to speak up in conversation more often.

The vocal cords (also known as vocal folds) are soft bands of tissue located in the larynx. These cords are shortened, thinned, or tightened during voice feminization surgery. It is important to work with your surgical care team to figure out if you have any preexisting voice disorders that could negatively impact surgical results.

In the United States, the cost of vocal surgery can range from $5,500-$9000+ and are not covered by insurance.

It is advised to work with a speech-language pathologist (SLP) prior to surgery. A SLP can help a patient with vocal function exercises and vocal hygine. Vocal function exercises typically involve expanding and contracting the vocal cords several times daily to help with their movement, which can both help strengthen the voice box and help with the recovery process. Good vocal hygine involves not smoking, drinking plenty of water, and avoiding alcohol & caffine (which dry out the vocal cords).

It is recommended not to have any surgeries that require general anesthesia within 6 months of vocal surgery, as the breathing tube involved with general anesthesia can negatively affect how the vocal cords heal. Prior to surgery, a patient will be assessed for good health, as certain conditions (such as a history of heart disease) may make a surgeon hesitant to perform surgery.

Certain types of voice feminization surgeries are not advised for women over 40. This is due to the loss of elasticity in certain tissues as you age. In the case of voice surgery, this can negatively affect healing and results. Talk about your options with your doctor.

After surgery, voice rest (not speaking) is required for 5-14 days, and recommended for 30 days. You can use your voice as usualy for roughly 6 months post-op, avoiding yelling and singing. It is recommended to eat soft foods (avoid anything spicy or scratchy) and drink liquids after surgery. Post-op pain (such as a sore throat or temporary roughness of the voice prior to full healing of inflammation) is typically managed with acetaminophen and ibuprofen. A cool compress should be used to sooth the throat after surgery.

Following up with the laryngologist and SLP care team is important, in case any additional minor procedures are required. Most patients typically follow up with their laryngologist 3 weeks after surgery. The final follow-up appointment with the laryngologist is typically 6 months post-op, provided that the patient is healing well.

After having voice feminization surgery, the effort required to maintain a feminine voice is practically gone (after follow up appointments with a speech therapist, of course). There is no longer the risk of accidentially slipping into a deeper voice. For the people who seek out this surgery, this causes immense happiness and joy in day to day life.

Stroboscopy

A stroboscopy is a medical examination of the vocal cords. This is a simple assesment done in a doctor's office. The physician sprays the patient's throat and nose with a numbing spray. The patient then leans forward and holds her tongue with gauze. The doctor inserts an endoscope into the patient's mouth. The endoscope is equipped with not only a camera, but a strobe light that helps the doctor view the movement of the vocal cords in slow motion. The patient is prompted to make certain vocal sounds, so that the doctor can observe how the patient's vocal cords function.

Please note that a strobe light is a very bright light that flashes very quickly. If you have the option at looking at the monitor during this exam, and you have photosensitive epilepsy, I would advise that you do not look at the screen. Make sure that your physician is aware of your condition, and please keep yourself safe at all stages of seeking out gender affirming care. Prioritize your own health and happiness.

Types of Surgery

The surgical method chosen will vary based on current vocal pitch, personal transition goals, the surgeon’s experience and expertise, anatomy, age, and overall health. During surgery, the surgeon may make a small incision may be made to directly access the throat or use a laryngoscope (small tube that goes directly in the mouth).

Anterior Glottal Web Formation/Wendler Glottoplasty

This surgery shortens the vocal cords to raise the voice pitch, and eliminates the ability to make lower pitches. The airway is somewhat narrowed, making this surgery less optimal for professional singers, or anyone who uses their voice on a professional level.

Several layers of tissue from the vocal cords are removed from the front of the voice box during this surgery. The laryngologist uses stitches to join the vocal cords in this area, shortening the overall length of the voice box, and shortening the vibrating length of the vocal cords. A web or band of scar tissue is created on the front of the vocal cords, and the vocal cords shorten over time as the scar tissue contracts. The medical term for this scar tissue is known as anterior commissure.

This is the most common method of voice feminization surgery. This surgery takes approximately 1 1/2 hours to perform in an operating room while the patient is under general anesthesia. This is an endoscopic procedure.

Cricothyroid Approximation/CTA

The cartilage from the top (thyroid cartilage) and bottom (cricoid cartilage) of the voice box are stitched together, increasing the tightness of the vocal cords. This tenses and lengthens the vocal cords.

This method was the first developed procedure for voice feminization surgery, though it is no longer commonly used, due to having effects that are not as long-lasting as other methods of voice feminization surgery. This operation can also twist the voice box, and make an Adam's apple more prominent.

Feminization Laryngoplasty

After the patient is alseep and under general anesthesia, a small incision is made is placed parallel to or in a skin crease of the neck above the Adam's apple. The front of the voice box is removed, making it smaller. Cartilage is removed from the thyroid and parts of the vocal cords. The voice box is lifted, and the vocal cords are shortened. A small, non-magnetic metal plate is placed over the voice box to maintain its new tension. This plate can stay in or be removed (after 4-6 weeks, once everything has healed). That being said, removing the plate requires a second surgery.

Laser Assisted Voice Adjustment/LAVA

Pieces of the vocal cords are destroyed with a carbon dioxide laser, making them smaller and tenser. LAVA may be done on its own, at the same time as Wendler Glottoplasty, or as a follow-up procedure after Wendler Glottoplasty.

This is an endoscopic procedure that is done while the patient is asleep under general anesthesia.

Laser Reduction Glottoplasty/LRG

The outermost (anterior) tissues of the vocal cords are destroyed with a carbon dioxide laser. The vocal cords are then sutured together so that they become tense.

Risks

Factors that can impact surgical results include the following; the health of your vocal cords, whether you do speech therapy before or after surgery (or both), how your postoperative recovery goes, your age and individual anatomy, type of surgery, and whether you smoke or vape.

Some potential risks and complications associated with voice surgery include the following; difficulty speaking (especially for the first 6 to 12 months), scarring on the voice box, enlarged Adam’s apple (can be addressed with a tracheal shave), cracked or chipped tooth from endoscope, scarring outside the throat (can be managed with anti-scar products), no change in pitch or too little change in pitch, voice breaks or tremors, needing a second surgery, numbness of the tongue (can be temporary or persistent), too much pitch increase (voice is unnaturally high), a voice that sounds weak or strained (especially in the upper range), or a voice that sounds hoarse, breathy, rough or raspy (dysphonia).

Rare conditions that vocal surgery can lead to include the following; abscesses in the airway, fluid buildup in your vocal cords (edema), vocal fold paralysis, vocal cord lesions, and vocal cord dysfunction.

None of these links are sponsored, nor endorsed. If you are looking to get voice feminization surgery, be sure to do as much research on your surgeon as possible (look for real reviews and images from real people on websites other than the one run by the surgical practice - they are only going to put their best work!). Do as much research on the surgery you want as possible. These links are only provided for educational and entertainment purposes. The thoughts/views/opinions/etc contained in the links below do not inherently represent that of The Transgender Dictionary. I am not a medical professional, nor do I claim to be. This website is made up of my research. Nothing more, nothing less.