Vocal feminization surgery is usually carried out as a part of the sex/re-assignment surgery among people Assigned Male at Birth (AMAB) who identify themselves as women. The ultimate result is to have a softer and feminine voice.
A deeper voice is often considered masculine which is not preferred by trans-women. The goal of this surgery is to make the voice box smaller and vocal cords shorter to produce a more feminine and comfortable speaking voice for transgender women.
Gender reassignment surgery and facial feminization surgery can be successful in providing transgender women with the desired outward appearance. But, when it comes to the pitch of the voice, they do very little to make it sound feminine. To achieve the desired result, surgery and therapy are the way to go.
Who is it for?
Generally, this is mostly for transgender women who want to look and sound like the way that they feel. Being misgendered can be very sensitive and offensive for transgender women for which they seek extensive surgery even if a trans-woman looks feminine from the outward appearance they might still be mistaken for their gender assigned at birth due to their voice, especially while talking on the phone.
This procedure aims to produce, for trans-women, a more feminine voice to resonate with their outward appearance to match the way they feel inside.
- Do not smoke before the surgery
- Drink plenty of water
- If under medication, consult your surgeon
- Arrange for someone to drive you home after the procedure
- If you are going to be placed under general anesthesia, you will be asked to not drink or eat anything at least 6 hours before the surgery.
- If any doubts exist clear them all from your surgeon.
What is the procedure?
The Feminization Laryngoplasty is aimed to make the genetic male’s voice box smaller and shorten the vocal cords in an attempt to raise the comfortable speaking pitch of the patient. The Thyrohyoid elevation will attempt to shorten the pharynx to improve the sound of the higher pitches.
Results are aimed at making it as natural as possible and not to sound squeaky or forced. The procedure tries to cut off some notes from the lower range and apply some extra notes to the upper end of the range. Sometimes, some notes may also be removed from the upper ranges.
This process may remove Adam’s apple in the process, so a separate tracheal shave procedure may be avoided.
This surgery is ideal for patients who are consistently interpreted as male causing them embarrassment and uneasiness. It is also ideal for patients who were not able to achieve their desired results even after undergoing speech therapy and training.
Even if the patient has previously undergone CricothyroidApproximation (CTA), this procedure can still be pursued. In fact, even if the CTA had failed, this procedure may still work. Complications arising from a previous trachea shave may also be corrected by this procedure.
Even though this procedure is dominantly pursued by genetically born men undergoing sex reassignment surgery, it may be pursued by cis-gender women or intersex people who have a lower voice and seek to change it into a more feminine sound according to their desire.
Risks and Complications
It is to be noted that this surgery does not meet the requirements of everyone. It carries some significant risks.
- Some patients have recorded significant improvement whereas some have produced no or minimal change.
- It can also sometimes produce results where the voice may sound squeaky and artificial.
- Sometimes, it can also lower the volume of the voice. It is difficult to determine before a procedure, how exactly the voice is going to sound.
- It is common to have infections following a vocal feminization surgery. It can range from prolonged infections to mild-redness which may require the infected area to be removed surgically.
- In serious cases where the throat experiences too much swelling, the patient may require a tracheotomy to help them breathe for some days.
- Infections and inflammations may also lead to the formation of granulomas inside the patient’s voice box. They might not be able to be cough out, requiring the surgeon to inject steroids to make them fall off.
This surgery is not an easy one and requires experienced hands. It is important to look for a qualified surgeon with an impressive track record.
After the Procedure
- After the procedure, complete rest of your voice is recommended. This is the most crucial and difficult part. Patients are asked to not even whisper. And for months following that, you will be allowed to utter only a few words.
- It is also advised to avoid turning your head at all times. During the first week, even fully opening your mouth is to be avoided as much as possible.
- It is advised to seek a full month leave of absence if the patient is employed or in school.
- The healing procedure is not necessarily painful but can be very stressful and difficult. Not knowing how the final voice will sound after the procedure for more than a month may further add to the anxiety.
Voice therapy is recommended both before and after surgery. This is a less invasive procedure, and many trans-women prefer vocal training instead of invasive surgery.
It is also to be kept in mind that vocal feminization surgery doesn’t guarantee success and has some significant dangers.
Other procedures are also available such as:
- Cricothyroid approximation (CTA)
- Anterior Glottal Web Formation or Anterior Commissure Advancement
- Laser-assisted voice adjustment (LAVA)
- Laser Reduction Glottoplasty (LRG)
Research properly and decide which procedure will suit your needs better. But do keep in mind that no vocal feminization procedures guarantee success and will depend on the techniques of the doctor.
Is the surgery safe?
A: The surgery is mostly safe with experienced hands, but complications are to be expected.
How long is the recovery time?
A: varies from patients but generally 1-2 months.
What results can be expected?
A: Generally the results have been satisfactory. However, some patients have noticed little or no change.
Can I practice vocal therapy?
A: Yes, it is recommended both before and after surgery. But after surgery, you may take vocal therapy only after full recovery.
Is it covered under health insurance?
A: Depends on where you are from. Generally, it is not covered by most clinics.