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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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