Voice Pitch Surgery
Voice pitch surgery permanently changes the pitch of the voice. Some surgeries are done endoscopically (through the mouth) and some are done through a small incision in the neck, and all are performed on an outpatient basis. It is important to note that voice therapy is critical to voice rehabilitation following these surgeries.
Types of Gender-Affirming Voice Surgery
Operations to alter the pitch of the voice can greatly contribute to gender affirmation. Operations are generally not performed to lower the pitch of the voice in female to male transgender individuals.
Operations that increase pitch are:
Laser-assisted voice alteration (LAVA): This is an operation performed with the patient asleep under general anesthesia. It is performed through the mouth with an endoscope and a laser to remove some of each vocal cord muscle, making each vocal fold smaller, increasing the pitch modestly. This is not a stand-alone surgery and is not reversible.
Wendler glottoplasty: This operation is also performed with the patient under general anesthesia. It is also performed through the mouth with an endoscope and a laser to fuse the front parts of the vocal folds together to form a small web. This fusion shortens the vocal folds increasing the pitch. Often the pitch increase is enough to achieve a standard female speaking pitch without other procedures. This operation is not reversible but can be revised or tuned.
Cricothyroid approximation: This operation, also called a Type IV thyroplasty, is performed with a patient under very light sedation and with local anesthesia to the front of the neck. A small incision is made to access the front of the larynx ("voice box"). Sutures are placed to bring one laryngeal cartilage closer to the other. This action tenses the vocal folds, thereby increasing the pitch. This operation is the most reversible of those described here.
Thyrohyoid elevation: This operation is often performed under general anesthesia and is designed to alter the resonance of the voice by shortening the vocal tract. The vocal tract is the space that sound occupies as it travels from the vocal cords out of the mouth and nose. The top structures of the larynx are brought more closely together with sutures to shorten the vocal tract. This shortening produces a more female-shaped vocal tract which helps to produce a resonance of speech that is more classically female. This operation is not easily reversible.
Frequently Asked Questions
What happens if I don’t like the result after surgery?
The operations can be revised to better tune the voice, however, returning to the patient’s previous pitch and voice quality is difficult.
How long is the scar in the front of my neck?
This surgery produces a scar that measures 4 cm or just over 1.5 inches.
Do I really have to do voice therapy before surgery?
Definitely. Voice therapy alone is enough for most patients to achieve their desired pitch and voice characteristics.
Will my insurance cover this surgery?
The best way to learn about coverage of gender-affirming care is to speak with your insurance provider to understand your benefits, if any, and exactly what your coverage will be.
Beyond changing the pitch, are there other voice effects after an operation?
Yes. Sometimes the voice will sound rougher and may require more effort to produce.