Voice feminization surgery

To tell you more about the procedure of the voice feminization surgery, you need to understand the  vocal instrument, why you sound like you sound, and how surgery can affect your voice.

The sound source of your voice are your vocal folds. These will turn your air (power) into sound by vibrating. The vibrating frequency of the vocal folds will affect your pitch.

After the sound is produced, the sound will resonate into the pharynx, nasal structures and mouth. This will affect the timbre of your sound.

The increase of testosterone levels in boys during adolescence, the cartilages of the voice box will grow. The mass of muscles will increase. Your vocal folds (which are muscles) will also become thicker. This is why there is a voice change and why your voice will deepen as you are going through puberty. Because as I’ve said before, the vibrating frequency of your vocal folds will affect your pitch, so more vocal mass means a slower vibrating frequency.

That’s why a female voice has a pitch from 145-275 Hz

and a male voice from 80-165 Hz. There is also a gender neutral range from 165-185 Hz.

The goal of a voice feminization surgery can be two aspects:

– Shorten the vocal folds (Wendler Glottoplasty)

– Reduce vocal mass (LAVA)

Under general anesthesia, a metal tube (laryngoscope) is placed through the mouth to lift the tongue out of the way and visualize the vocal cords directly. By using a laser, 1/3th of the vibrating portion of the vocal cords is removed from the anterior part of the vocal folds.

After this comes the most complex part of the voice feminization surgery where  the 1/3th is sewed together with sutures, this is done with long instruments that reach from the outside. This is why it’s very important you have a skilled surgeon to do this.

If there is not enough result after the Glottoplasty and post op voice therapy, the surgeon can still perform a LAVA procedure. During this procedure, the vocal mass will be reduced with the laser.

15 days of full vocal rest is required.

After this there will be a period of relative vocal rest with strict personal instructions from the voice therapist. Voice therapy is obligated to create a good vocal fold closure, stretch and symmetry.

– No external incision, the procedure is done via the mouth

– Crico-thyroid muscle is untouched, so you can still train your voice flexibility (good for singing!)

– Less good general voice quality: breathiness, hoarseness

– It can take a long period of training before your voice will be back to normal.

How long? This depends on the state where your vocal folds are in before the surgery.

– Voice feminization surgery only focusses on pitch and due to Leung et al. (2018) Speaking fundamental frequency contributes to 41.6% of the variance in gender perception. So if we would only work on pitch, it wouldn’t be enough to be perceived as female. This is why voice therapy in is highly recommended.