What is voice feminisation surgery?
The pitch of your voice is related to the length, bulk and tension of your vocal cords – the longer, bulkier and looser they are, the deeper your voice.
A person who is assigned male at birth develops a larger voice box with longer vocal cords during puberty. In addition, higher levels of testosterone make the muscle bulk within the vocal cords relatively larger in males than females. These changes lead to lower vocal pitch.
Voice feminisation surgery is used to raise the pitch of your voice (make it sound higher) by changing the length, size or tightness of your vocal cords so that your voice sounds more female and less male.
Why might you want to have voice feminisation surgery?
The pitch of your voice can affect how you are perceived in regard to your gender.
You may wish to have voice feminisation surgery if you have a low-pitched voice because you:
- Are a transgender woman
- Have a disorder of sex differentiation
- Cisgender woman with naturally deep voice
- You are receiving androgen (male sex hormone) therapy
- Have ovarian cancer that causes high androgen levels
What does voice feminisation surgery involve?
At OneWelbeck, we offer three types of voice feminisation surgery; glottoplasty, vocal fold muscle reduction (VFMR) and cricothyroid approximation (CTA), as well as gender-affirming Adam’s apple reduction procedure called laryngeal shave (Some times referred to as tracheal shave).
The aim of glottoplasty is to reduce the length of the vibrating segment of the cords that are involved in speech, to create a higher-pitched voice. This is the most commonly performed type of voice feminisation surgery.
The procedure is performed under general anaesthetic via the mouth with no external incisions. Using an endoscope, a CO2 laser is guided through the throat to the vocal cords. Here, the lining of the front part of the cords is removed by the laser and the two sides are sutured together to shorten the length of the vocal cords.
Vocal fold muscle reduction (VFMR)
Vocal Fold Muscle Reduction (VFMR) is a new technique aimed at reducing the bulk of the vocal folds. As with glottoplasty, this is an endoscopic surgery using CO2 laser which is applied along the full length of each of the vocal cords. The laser decreases the mass of vocal fold while resulting scar causes the cords to tighten, this in turn increases the pitch of the voice.
VFMR is suitable option where a smaller pitch increase is desired or in professional voice users who don’t wish to risk the reduction of vocal volume and projection. VFMR can also be preformed as a second line surgery to further enhance the pitch after glottoplasty.
Cricothyroid approximation (CTA)
Cricothyroid approximation (CTA) increases the tension of the vocal cords to achieve a higher pitch.
The procedure involves making a small incision in the neck to then bring the cricoid and thyroid cartilage of the voice box together. This procedure is also performed under general anaesthetic. This type of voice feminisation surgery is generally only considered in special cicumstances where endoscopic surgery is not possible or as second line procedure after glottoplasty to further enhance the pitch elevation.
Laryngeal shave can be performed as a standalone procedure or can be combined with voice feminisation procedures.. This is agender-affirming procedure that’s done to reduce the size and prominence of the Adam’s apple to give the neck a more feminine contour.
How should you prepare for voice feminisation surgery?
Pitch is only one aspect that determines whether your voice is perceived to be masculine or feminine. Intonation, resonance, vocal quality and articulation are all important aspects too. Language, loudness and non-verbal communication also play a part in the social perception of a person as a female.
It’s therefore important to know that surgery must be supplemented by dedicated specialist speech therapy in order to achieve the desired voice outcome.
Before having surgery you may wish to work with a speech-language pathologist on vocal function exercises and vocal hygiene.
Vocal exercises work to expand and contract your vocal cords so that they move more easily. This can help in your recovery process post-surgery. Maintaining good vocal hygiene (staying hydrated, stopping smoking and avoiding caffeine and alcohol) can help you keep your vocal cords as healthy as possible before surgery so that you have the best chance of your procedure being successful.
Recovering from voice feminisation surgery
It will take several weeks for your voice box to heal fully after voice feminisation surgery. Your consultant will talk you through any aftercare you need to follow.
Continuing with speech therapy after your procedure is essential for a satisfactory outcomes it can help you adapt to your new voice. Your consultant can advise you on when it is safe to resume.
What are the risks of voice feminisation surgery?
As with any procedure, voice feminisation surgery does carry some risks. Your consultant will discuss all of these with you before any procedure takes place.