Voice Therapy (transgender) - Vocal Surgeries

Vocal Surgeries

While hormone replacement therapy and gender reassignment surgery can cause a more feminine outward appearance, they do little to alter the pitch or sound of the voice. The existing vocal structure can be surgically altered using procedures that include

• Cricothyroid approximation (CTA) (is the most common)
• Laryngoplasty
• Thyrohyoid approximation
• Laryngeal reduction surgery (surgical shortening of the vocal cords)
• Laser assisted voice adjustment (LAVA)

There was, until recently, limited evidence as to the efficacy of these surgeries in raising the fundamental frequency over the course of several years. However, since the late 1990s, surgeons performing CTA and other 'voice' procedures at Charing Cross hospital, (Hammersmith, London), have conducted long-term follow-up studies indicating "high" levels of patient satisfaction with both surgical and social health outcomes. All of these modes of 'voice surgery' may or may not have an effect on resonance or other vocal characteristics. Many in the transsexual community have previously been led to regard voice surgery as 'inadvisable', while others regard a socially acceptable standard of feminine speech to be indispensable (and further surgery an acceptable risk). Anecdotal evidence has suggested that (CTA) voice surgery can be expected to raise pitch above female norms in the immediate post-operative period (when sutures are used to create the adjusted 'approximation'); however the (more modern) use of titanium clips avoids this problem, maintaining a correct and even tension on the vocal folds, in the immediate and longer term. Of course, laryngeal surgery carries risks and some patients experience 'raspiness', or, much more rarely, complete loss of voice.