Surgical Options
For biological males who seek to sound more female, surgery is an option. Generally concurrent with speech therapy, there are several procedures that can be used to achieve a more feminine, higher-pitched voice. Results vary by procedure and individual but can even lead to one desired outcome of being identified as female on the phone.
As with any surgery, there are risks involved. If not done by a reputable surgeon, the procedure may result in "permanent, irreversible scarring" (Haben, 2009). According to Haben, at least in the state of New York, health insurance plans will not cover the cost of the surgery, which can be several thousands of dollars. Speech therapy may have to be paid for out of pocket, as well. For those considering voice feminization surgery, these costs must be weighed. Additionally, some surgeries are reversible, while others are not. Individuals should be sure to do the research to find the right surgeon and therapist for their needs.
Speech therapy is recommended both before and after surgery. In fact, it is considered by some to be an "integral part of the feminization process" (Haben, 2009). So much of speech is not what we say or how high or low our voice is; a lot of how we sound is due to inflection, word choice, and facial expression. These patterns differ greatly between men and women. A speech-language pathologist can help biological males give the impression of being female through voice, gesture, and speech patterns. Shelagh Davies in Vancouver, Canada, has developed a workshop to help individuals meet these goals. More details can be found here. Her website is: http://www.shelaghdavies.com/workshops/changing_keys.html.
As with any surgery, there are risks involved. If not done by a reputable surgeon, the procedure may result in "permanent, irreversible scarring" (Haben, 2009). According to Haben, at least in the state of New York, health insurance plans will not cover the cost of the surgery, which can be several thousands of dollars. Speech therapy may have to be paid for out of pocket, as well. For those considering voice feminization surgery, these costs must be weighed. Additionally, some surgeries are reversible, while others are not. Individuals should be sure to do the research to find the right surgeon and therapist for their needs.
Speech therapy is recommended both before and after surgery. In fact, it is considered by some to be an "integral part of the feminization process" (Haben, 2009). So much of speech is not what we say or how high or low our voice is; a lot of how we sound is due to inflection, word choice, and facial expression. These patterns differ greatly between men and women. A speech-language pathologist can help biological males give the impression of being female through voice, gesture, and speech patterns. Shelagh Davies in Vancouver, Canada, has developed a workshop to help individuals meet these goals. More details can be found here. Her website is: http://www.shelaghdavies.com/workshops/changing_keys.html.
Cricothyroidopexy (also known as Cricothyroid Approximation)
This technique approximates the cricoid and thyroid cartilages in order to achieve a higher pitched voice through an increase in vocal cord tension. This procedure is reversible and deals with external structures of the larynx only. It can be combined with reduction of the Adam’s apple. The cricoid and thyroid cartilages are effectually stitched together using a thin wire which, depending on the material, can be absorbed by the body (for example, titanium cannot be absorbed) (Thomas, 2012a). Due to the potential for inconsistent long-term results, this procedure is given only a cautious endorsement (Lawrence, 2004).
Cricothyroidopexy is usually done under general anesthesia, primarily for the emotional comfort of the patient. Anesthesia is especially helpful in older patients when a more involved surgery is required to achieve the desired effect (Thomas, 2012a).
In the study by Berghaus, Neumann, & Welzel (2002), patients were closely evaluated and monitored pre- and post-operatively. The average change in pitch was 2-3 semitones, and timbre was generally perceived as female.
Here is a sample of a post-operative patient:
Cricothyroidopexy is usually done under general anesthesia, primarily for the emotional comfort of the patient. Anesthesia is especially helpful in older patients when a more involved surgery is required to achieve the desired effect (Thomas, 2012a).
In the study by Berghaus, Neumann, & Welzel (2002), patients were closely evaluated and monitored pre- and post-operatively. The average change in pitch was 2-3 semitones, and timbre was generally perceived as female.
Here is a sample of a post-operative patient:
Anterior Web Creation
This is an option for people who wish to leave their vocal folds more or less intact. Rather than removing a portion of the folds, this procedure opts instead to create a web of sutures over the anterior 1/3 of the folds. This shortens the vibrating length of the vocal folds, which in turn increases the pitch of the voice (Lawrence, 2004).
The surgery can be performed two ways: either through an incision in the anterior of the neck, or endoscopically. Some doctors prefer to strip the outer layer of tissue on the folds, allowing them to fuse more securely. Some will also remove a portion of the thyroid cartilage (Lawrence, 2004).
Results of the procedure are mixed; while there is the potential for a breathy-sounding voice post-surgery, some individuals were found to have an increase in pitch of one full octave.
The surgery can be performed two ways: either through an incision in the anterior of the neck, or endoscopically. Some doctors prefer to strip the outer layer of tissue on the folds, allowing them to fuse more securely. Some will also remove a portion of the thyroid cartilage (Lawrence, 2004).
Results of the procedure are mixed; while there is the potential for a breathy-sounding voice post-surgery, some individuals were found to have an increase in pitch of one full octave.
Vocal Fold Thinning
In this procedure, a laser is used to shave off a tiny portion of the thyroarytenoid muscle that runs parallel to the vocal cord. By reducing the mass of the folds, they are then free to vibrate at a higher frequency (Lawrence, 2004). Additionally, this procedure is thought to increase the tension of the vocal fold (Thomas, 2012c). Both of these factors increase the pitch perceived by the listener.
Laryngoplasty
In this procedure, the surgeon cuts into the interior of the larynx and removes the anterior 1/3 of the vocal cords. He then refastens them with a metal plate to the cricoid cartilage. The pitch of the voice is raised due to the shorter vibrating length of the vocal folds. Along with the removal of a portion of the vocal folds, some surgeons also favor the technique of removing a portion of the thyroid cartilage. This helps reduce the appearance of the Adam's apple, while at the same time providing a new attachment point for the shorter vocal folds. This procedure is highly invasive and irreversible (Thomas, 2012b). Below is an image of another technique for achieving this result. While there is the risk of over-correction (vocal cords shortened too much), the long-term benefits and cosmetic advantages are significant (Lawrence, 2004).
Thyrohyoid Elevation
This raises the larynx, which decreases the resonance space in the throat. This in turn causes higher pitches to be heard more strongly. Sutures are passed between the hyoid bone and the thyroid cartilage, raising the larynx. Because the distance between the hyoid and the thyroid is different for everyone, in some cases, a portion of the thyroid cartilage is removed to leave an appropriate gap. This procedure can also be done in conjunction with laryngoplasty (Thomas, 2012d).