What is Voice Feminization Surgery

Changing the voice is something very important for trans people. For ftm people voice changing starts with hormone therapy. Hence testosterone is a male hormone, it caused a physical change in the vocal folds. Hormone therapy is a good approach for male transgenders but for mtf it is not useful because anti-androgens and estrogens will not alter the voice.

So, voice feminization surgery might be good approach for trans women. Voice feminization surgery is a procedure that changes the pitch of the voice or make the sound higher or lower. It also will alter the size and length of the vocal folds.

• Anterior glottal web formation: this procedure is the most common type of voice feminization surgery. It reduces the lengths of vocal folds.
• Cricothyroid approximation (CTA):  this procedure enlarges the tightness of the vocal folds.
• Laser reduction glottoplasty (LRG): it reduces the mass or size of vocal folds.

The purpose of voice feminization surgery is to raise the overall vocal timbre, thereby creating a more feminine quality. As mentioned before, the most common types of voice femininization surgery are Anterior Glottal Web Formation, and Cricothyroid Approximation (CTA).

This surgery includes several steps which are as follows:

Primarily, just like the other surgeries the patient will receive general anesthesia. Then the surgeon may utilize a laryngoscope (an instrument for examining the larynx, or for inserting a tube through it) in order to access the patient’s vocal bands. But some procedures may need some incisions on the outside of the throat. The process of the surgery generally depends on the type of the surgery. In Anterior Glottal Web Formation, a web is created between the vocal folds in order to shorten their length. The goal of this procedure is to create the low-sounding pitch which is related to the masculine voice. So as a result, the timbre of the voice sounds more feminine.

In Cricothyroid Approximation (CTA) surgery the cricoid cartilage is attached to the thyroid cartilage, extending the vocal cords. The result of this surgery is similar to Anterior Glottal Web Formation. It heightens the sound and reduce the ability to create low pitch.

As mentioned, there is another approach to change the voice which is Laser reduction glottoplasty (LRG). In this procedure the outmost tissue of the vocal folds will be destroyed with light laser energy.

Voice feminization surgery is done with only 1% of trans women. Most of the transgender woman (14%) prefer to have the non-surgical feminization therapy.

In some cases, before the voice feminization surgery, some therapies are needed. These therapies are as follows :

Vocal function exercises

Expanding and contracting your vocal cords several times each day helps them move more easily. Exercises also strengthen the muscles in your voice box. This can help your recovery process.

Vocal hygiene

Good vocal hygiene means keeping your voice as healthy as possible, especially before surgery. Your speech-language pathologist may ask you to drink plenty of water and stop smoking. They might also want you to avoid alcohol and caffeine, both of which can dry out your vocal folds.

Risk factors of voice feminization surgery are as follows:

• Dysphonia may happen which means difficulty speaking.
• Edema may happen.
• Hoarseness may happen
• The pitch may not increase enough which causes low voice.
• There might be scars in the Adam’s Apple or on the outside of the throat.
• The pitch may increase too much which causes abnormal high voice.
• It may enlarge the Adam’s Apple
• It may cause vocal fold dysfunction.
• Vocal fold paralysis and vocal fold lesions are the other risks of voice feminization surgery.

At the beginning, for the first days after surgery actions which are associated to larynx like talking, singing, laughing and coughing might be difficult for the patients and they should circumvent these actions. But they can use nonverbal actions like messaging or texting in order to communicate with others.

But it doesn’t last forever and the health care provider will let the patients know about the duration of the recovery and when the patients can use their voice again and continue their voice therapy. The result of the surgery might be different depending on the type of the surgery. As it was mentioned before, after the surgery, voice therapy might be resumed because there are more layers than pitch that feminize the voice. Other important factors, such as bright tone, subtle nasalization, and crisp diction will be achieved by changing your speech patterns with voice training.

Voice feminization surgery is not appropriate for all trans women. Each person has its own way to be treated.