Pitch-lowering

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Pitch lowering surgery is an option for individuals whose gender is frequently mis-identified.
 

Pitch lowering surgery may benefit 

  • genetic males who have an unusually high voice for a male.
  • Individuals who gender identify as female, but are perceived as male.

I offered two types of surgery designed to lower pitch.

  • A thyroplasty, designed to loosen the vocal cords will lower pitch.
  • Microlaryngeal rearrangement of soft tissue can add mass to the vocal cords and loosen them, lowering the pitch

Both of these surgeries tend to reduce volume, so there are trade-offs with surgical alteration of pitch.

Caveat: Many male gender individuals who contact me actually have a normal bass voice, but lack appropriate resonance. Resonance is better dealt with through training and voice therapy rather than with surgery because the actual impediment is the throat (pharynx) rather than the vocal cords. That is, the diameter and height of the throat need to match the pitch in order to resonate and amplify the deep tones. 

If you actually have a higher than normal pitch for a male, then a good self-evaluation is that you are inappropriately identified as a female on the telephone, then surgery might offer you benefit.

Transgender males who have undergone more than one year of testosterone therapy and yet are still perceived as female based on their voice, may benefit from these surgeries.

With practice, some individuals are able to lower their speaking pitch and improve their resonance. While I wouldn't recommend it, even cigarette smoking creates edema (swelling) in the vocal cords and lowers the pitch.

Presurgery

Before the surgery/procedure, a PARQ conference is held with you. This is an acronym for Procedures, Alternatives, Risks and Questions. It means that your surgeon has discussed with you in full detail the reasons for the procedure, the alternative treatments to the procedure, the risks of the procedure and that you have been given ample time to ask questions and are satisfied with those reasons and answers. In addition, an evaluation and examination of your voice box is essential. This involves a skilled examiner listening to and measuring a number of characteristics of your voice. A visual inspection of your voice box is also performed. This takes about an hour.

Risks

The general risks of surgery are discussed here. There are some specific risks which may include not getting exactly the pitch you want (insufficient lowering). There will typically be some reduction in overall vocal range and vocal volume.

Procedure

The thyroplasty surgery is performed in an outpatient setting under general anesthesia or sedation. After you are asleep, a one to two inch incision is placed parallel to, or in a skin crease of your neck over the Adam’s apple. The thyroid cartilage is cut on each side and the vocal cords are allowed to loosen.

The microlaryngeal Pitch reduction surgery is performed in an outpatient setting under general anesthesia. I use a laser to incise some of the laryngeal tissue near the vocal cords and I transfer the bulk to near the vibrating edge of the vocal cords, increasing their mass. The vocal cords may also be loosened with some cuts. These changes in tension and mass can lower the comfortable speaking pitch.

Recovery

Your voice will likely be changed immediately, though the final pitch may not be settled for 1-2 months. Initially there may be some swelling that makes the voice quite low and but this changes as the swelling goes down.

Instructions during healing

Relative voice rest is helpful for one week after the procedure. Aerobic activity may be resumed after two weeks. No weight lifting for one month. After the thyroplasty, there will be a single suture in the skin to be removed one week after surgery.

Benefits

Lowered day-to-day speaking pitch.