Feminization laryngoplasty

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Feminization laryngoplasty is a surgery designed for male-to-female transgender patients.

Here is a short overview of the procedure presented at WPATH in Amsterdam in 2016

The procedure is designed to remodel the genetic male's voice box, to make it smaller and the vocal cords shorter,in an attempt to raise the comfortable speaking pitch. I almost always try to alter the resonance as well by adding in a thyrohyoid elevation at the same time, although I'm uncertain if resonance is significantly changed. The thyrohyoid elevation attempts to shorten the pharynx (the throat) to improve the resonance of the higher pitches. In general the procedure cuts off the lower range and sometimes adds a few notes on the upper end of the range, and sometimes removes some notes from the upper end.

The surgery is most optimal for patients whose voice pitch is consistently interpreted as male, despite concerted efforts at altering pitch such as speech therapy and training; for instance, a person who might be faring well in person, but is still typically perceived as male when on the telephone. The typical patient will be a male who has or is, or may yet be undergoing transgender surgeries and wishes to change the voice pitch and potentially other qualities of the voice as well. However, other genetic females or intersex individuals have had the procedure as well. Having a previous voice surgery such as a cricothyroid approximation (CTA) does not preclude performing this procedure. In fact, this procedure may work even if the CTA procedure has failed. It also is a very good way of correcting the complication of a trach shave where the pitch was inadvertently lowered (a somewhat frequent complication of aggressive reduction of the Adam's apple).

This surgery doesn’t work or meet the needs of everyone. It is new (I have been performing it for 13 years as of 2016) and carries with it some significant risks. The examples on the left side of the page include all results, from patients who had outstanding results to patients who had minimal if any change and also including patients who had complications. There is a range of results.

As pitch elevation in both males and females involves changes in the diameter and length of the throat during speech, there may be a way to surgically reduce the diameter or length of the throat (or pharynx) that would change the resonance of the voice. I have surgically elevated the voice box in an attempt to accomplish this.  See the thyrohyoid elevation procedure for further information.

If you are a potential patient, some information about the surgical process is available.

If you are a physician or you would like to read the technical details of the surgery, you may read more or download a pdf file.