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Voice Feminization Surgery: Considerations

Are you having problems sounding the way you want? Do you wish you could sound more feminine but don’t know how or where to start? Do you sometimes wish there was a magical surgery for voice feminization? Our voice is a unique part of our identity that most people think about subconsciously. Sometimes there are awkward moments when someone misgenders you on the phone, but you might be gendered correctly in-person because of your appearance. Some of us have been there and have found ways to divert these awkward moments.

voice feminization

If you are considering changing your voice to sound more feminine, there are some options you can choose from. You will find that each method will have its pros and cons. In this post, we will talk about voice feminization surgery, how it works, and some things people consider when deciding on voice training vs surgery, or both!

What is Voice Feminization Surgery?

Voice Feminization surgery is a surgical procedure that is somewhat invasive, usually requiring general anesthesia. You may notice that this surgery also has a lengthy recovery period. It’s common to go on total vocal rest, or not using your voice at all, for a month! The way that these procedures work is by changing the way in which the vocal folds vibrate to produce a fundamental frequency (F0). Therefore, even before or after the surgery is performed, your speech language pathologists will want to work with the transgender person to change their speaking habits. Altering the voice to have a higher pitch is just one aspect of how a feminine voice sounds.

voice feminization surgery

Procedure Types

Every surgery is performed with the technique the surgeon is familiar with. The three most common techniques include:

  • VFRAC,
  • Wendler Glottoplasty, and
  • the Dr. Toby Meyer technique

The VFRAC Technique

VFRAC stands for Voice Feminization Retrodisplacement of the Anterior Commissure. It is said to be the safest surgical technique in making the voice sound more feminine. Traditionally, most surgeries using the Wendler Glottoplasty technique often leaves someone’s voice sounding breathy, which can sometimes cause problems for singers.

According to a post on Professional Voice, vocal feminization surgery is primarily intended to change the patient’s speaking voice.This procedure is done using an endoscope, which is a thin tube that goes through a small incision on the neck. At the end of this tube is a camera and light so that the surgeon can see the structures underneath. Your surgeon then feeds micro surgical instruments through the endoscope to remove parts of the vocal folds, and ties permanent threads or place titanium clips to sew or clamp the shortened vocal fold in place. Your surgeon will use this unique method of suturing to allow the thinning of the vocal folds to take place over a period of time. With thinner vocal folds, your average pitch will increase over time.

The Wendler Glottoplasty Technique

As previously mentioned, the Wendler Glottoplasty technique can sometimes result in a voice with a lower quality, usually described as breathy or weak. The procedure is done somewhat differently, as no incision is made. Instead, the vocal folds are accessed through the mouth, and lasers are used to burn away the excess tissue holding approximately one third of the vocal folds. Long instruments are then used to sew that one third of the vocal folds together, so that the remaining two thirds can function as the new voice. Sometimes this procedure is known as laser reduction glottoplasty.

Your doctor will advise you to rest your voice for a week or two, so you don’t risk causing any complications during the critical period of recovery. Usually, vocal folds heal within six to eight weeks. Some people may decide to have a tracheal shave (where the Adam’s apple is made less visible by removing excess cartilage) before or during the procedure, as well.

voice feminization surgery

Dr. Toby Meyer’s Technique

Dr. Toby Meyer is a plastic and reconstructive surgeon located in Beverly Hills, California. He has been performing many trans-affirming surgical procedures for a little over forty years, including facial feminization surgery, tracheal shave, and voice feminization surgery.

While he is tight-lipped about how his technique works, he describes it as being one that he developed himself, using an incision on the neck that is so thin that it only requires local anesthesia. His success rate is about 90%, with the remaining 10% reporting underwhelming or no vocal changes.

Other Techniques

  • The Cricothyroid Approximation Technique: This procedure involves manipulating the cricoid and thyroid cartilage to lengthen and put more tension on the vocal folds. This is done using plates or clips to bring them together to raise the fundamental pitch.
  • Laser-assisted Voice Adjustment (LAVA): similar to the Wendler Glottoplasty technique, this procedure involves using a microlaryngoscope and burning and vaporizing small portions of the vocal folds, so that as it heals and scars, it will develop stiffness, which will raise the fundamental frequency.

Things to Consider

factors to think about when considering voice feminization surgery

Before any of these surgeries are done, the surgeon must make a full evaluation of the patient, as well as take measurements of their current vocal structure. Some of these evaluation techniques may feel somewhat uncomfortable, as videostroboscopy, for instance, requires a small microscope to be inserted into the mouth or through the nose while awake. They will usually numb the inner lining of your throat or nasal airways before that happens, so the most you would feel is an urge to cough.

As with any other medical procedure, there may be costs that are not covered by insurance, such as travel and boarding whilst recovering. There is also the risk of using local or general anesthesia, which increases with certain risk factors, such as high blood pressure, obesity, etc. There’s usually a four-to-six-week recovery period after undergoing surgery. Furthermore, the final voice may take as long as 2 years to achieve post-surgery, between healing and post op voice therapy as is necessary.

Many insurance companies would consider voice feminization surgery as an elective procedure and not medically necessary, unless they are able to get a letter from a doctor or psychiatrist who is able to properly diagnose gender dysphoria, according to the definition provided by the Diagnostic and Statistical Manual on Mental Health Disorders, Fifth Edition. Getting trans-affirming care can be pretty difficult if you have a doctor who is not as experienced. One possibility is using an online telehealth service called Plume, which can supply you with supporting letters and documentation.

While costs vary and are ever-changing, the prices we found for voice feminization surgery are $8000-$15000, varying by surgeon, location, and technique -, and that does not include other costs like airfare, room and board, and time off work.

Perhaps the most important thing to consider is that, once the surgery is performed, it is almost entirely irreversible. Risks of the surgery include damaging or losing the voice, which may require further operations, or it may even be permanent. The ability to sing or yell post op is also highly questionable, even after making a full recovery.

voice feminization is achievable without surgery

Many transgender people are able to retrain their voice to a sound they are happy with through voice training alone, spending a fraction of the cost and not having to face the risks of surgery. Should you decide that you’d like to try voice training, our instructors are happy to work with you on your voice feminization goals.

Disclaimer

We are not licensed medical professionals. The content supplied here is for general information and educational purposes only. Nothing in this article is meant to be nor should be construed as medical advice. Any requests for medical advice should be directed to a qualified physician. We encourage our readers to do their own research.

Sources

https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/our-services/transgender-voice-feminization1

Wendler Glottoplasty

https://us.yesonvc.com/page/2_4_1.php

https://www.uhb.nhs.uk/Downloads/pdf/PiAdviceVocalFoldSurgery.pdf

https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria#:~:text=Gender%20dysphoria%3A%20A%20concept%20designated,and%2For%20secondary%20sex%20characteristics.

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Transgender Voice Therapy vs. Trans Voice Training

Different Schools of Thought

When you hear the terms trans voice therapy or transgender voice therapy, this often implies a medical approach rather than a general or musical one. We will be comparing the pros and cons of trans voice therapy and transgender voice training approaches, so that you can decide which school of thought you feel is best for you.

transgender voice therapy
Transgender female with arms folded and tattoo with friend, standing outdoors, smiling

Trans Voice Therapy

Transgender voice therapy is the term often used by speech language pathologists and medical professionals. It implies a mechanical, medical approach. These professionals come from a background of treating swallowing disorders, unhealthy voice habits, and voice damage.

Advantages

   You will find a few advantages to this approach, that may make it the better choice for some. First, speech language pathologists are able to accept insurance in some cases for offering trans voice therapy. Within this school of thought, gender dysphoria (with respect to the voice) is a medical condition, and can then be treated medically for insurance eligibility.

    Another advantage of a medical providers is that they record progress in an objective way. This can be helpful for measuring progress of transgender voice therapy. You will have concrete data, and can understand the progress you are making. Some objective ways of measuring the voice include:

  1. Frequency: the number of times the vocal folds vibrate in a set amount of time. Frequency is typically measured in vibrations per second, or Hertz (Hz).
  2. Harmonics: frequencies that are multiples of the frequency that your vocal folds produce. This influences what quality we perceive a person’s voice to have.
  3. Volume: how loud or quiet a voice is, measured in decibels.
Disadvantages

    You will notice that while a medical approach to transgender voice training offers advantages, it can have its downsides as well.

    Firstly, you may feel like a transgender voice therapy approach seems too boring and/or intimidating. You may have difficulty progressing and feel discouraged by how complicated it can seem.

    You will likely notice that the cost of working with a speech language pathologist is often markedly higher, and not affordable out of pocket for many. In our case, it is not unusual for a speech language pathologist to charge double our rates if someone is paying out of pocket.

What will you find most concerning? You will find many medical professionals that offer transgender voice therapy without having knowledge, experience, or connection with the transgender community. Unfortunately, you will find that this can be true of vocal coaches. However, we have heard many more stories of speech therapists offering trans voice therapy as a first-time experiment on clients. We are hopeful that more speech language pathologists in the future will demonstrate better trans affirming practices and/or belong to the transgender community.

transgender voice therapy

Trans Voice Training

Transgender voice training is the term often used by voice coaches and teachers. It implies a more musical and/or multidisciplinary approach. These professionals typically have a background in education, acting, and/or music.

Advantages

    We have the advantage of using classical voice technique in our training. They are backed by centuries of teaching traditions and research, which makes them tried and true for vocal control and health.

    Additionally, we often have a multidisciplinary approach. Your coach can use speech therapy ideas, classical singing, acting, Alexander Technique, and even exercise science to build an effective plan.

Elements

    While we use objective measurements of the voice for voice training, we also have success using subjective markers. We as voice coaches use these, which include:

  1. Pitch: how high or low a voice is understood to be. You can likely describe or understand pitch easier than frequency.
  2. Resonance: the quality of a voice. You’ll learn that this is how we hear, and how we understand harmonics. Voices can be dark or bright, or booming or steely. You can feel resonance in different parts of the body. For example, you’ll feel it in the chest for a masculine voice, and more in the cheeks for a feminine voice. This allows clients to discover feelings that they can easily replicate to achieve their desired sound.
  3. Pitch fluctuations: how much a voice’s pitch changes as it speaks or sings. You will learn a more sing song pattern for a feminine voice, or monotone for a masculine voice.

    It is also more common for a vocal coach to be transgender themselves. Here at TruVoice, about half of our staff is transgender, which allows our clients and coworkers to benefit from lived experience. This can include understanding common struggles, knowing how a certain voice quality feels, or even just feeling like your coach is relatable.

Disadvantages

    If you are looking to use insurance for voice training, then a voice coach may not be your best choice. You will most likely not find a voice coach that can accept insurance. However, you will also notice that out of pocket cost for a session with a vocal coach is often much cheaper. Here at TruVoice, we offer discounts for clients that struggle to afford sessions – our hope is to work with as many people as we can.

    Lastly, we cannot treat any medical conditions related to the voice. Whether it’s voice disorders, vocal damage, or other health problems, you will have to see a medical professional.

trans voice therapy

To Recap

While both of these approaches may be used for transgender voice feminization, masculinization, or androgynous voice, the means by which the client’s goals are achieved will differ. This is largely influenced by the background and training of the professional.

A speech language pathologist may work more on helping the client with fine motor skills to adjust the vocal tract and use objective measurement and medical knowledge to alter a client’s voice quality. They will sometimes have a much broader understanding of speech acoustics.

Voice coaches and teachers will most likely work on these techniques. However, we will mostly help the student explore their voice range in a musical way to reach their full potential. We still then have the ability to use other disciplines, and change our strategy as needed. There may be some overlaps, and some speech therapists may use something called melodic intonation therapy. Instructors will mainly address the subjective markers of someone’s voice, and change these elements to make it sound more feminine, androgynous, or masculine.

Bottom Line

Since transgender voice training tends to be less expensive, we hope that you will consider that first. Should you want greater results or need treatment for a voice disorder, you can always go for speech therapy. If you connect with a certain approach better, that will also affect your progress.

Should you wish to try voice training with a coach, you can book a lesson with us by clicking the button below. Unlock Your TruVoice!