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Vocal Feminization: Surgery
Experimental and risky
There are several surgical methods of vocal cord alterations being performed.
I do not recommend existing voice surgery techniques based on results I've heard. To date, I have met or spoken to 14 people in person who have had vocal cord surgery. Of these, 12 have what I consider poor results. Two have acceptable results, and of these two, one has very good results.
One woman I know sounds like slightly deeper version Minnie Mouse, or maybe Michael Jackson. On the other end of the spectrum are two women who sound like a hoarse Bea Arthur, or Marge Simpson's sisters Selma and Patty. Most don't sound much different than before surgery.
JulieAnne is an ENT (ear, nose and, throat) surgeon who writes:
A reader sent this comment in June 2005:
I do not believe this surgery has an acceptable success rate given the costs, risks, and the permanence of poor results I've heard.
This surgery is not a quick fix for a non-passing voice. You will not go from male to female from this procedure. It must be combined with voice therapy pre-surgically and post-surgically in order to optimize the results. Even then, it's likely that your voice will sound unnaturally high and thin in most cases. On the other hand, your voice can sound raspy like a bad smoker.
Voice surgery can only raise pitch and does little to nothing to your resonance. As I and others discuss, resonance is the key to feminizing your voice.
It's cheaper, easier, and less risky to practice. This allows you to maintain your range, and practicing is 100% reversible. Plus, you'll need to practice anyway, even if you do get surgery.
Don't take my word...
If you are still considering this surgery, I suggest you personally speak with at least three women who have done it. That should be enough to change your mind.
Patient first-hand experiences
The following posts were culled from various transgender newsgroups.
Melissa wrote a detailed article on her voice surgery experiences.
My Voice Surgery Experience
Now that I'm feeling better and starting to be able to hear the results of my voice surgery more clearly, I'd like to tell the story and recommend the doctor, surgical center and voice therapist to any of you who might be interested in voice surgery. These are all very good people! I'll include the details and phone numbers at the end of this article.
As most of you know, who have ever been around many M-F Transsexuals or talked to them on the phone, the voice is one of the greatest obstacles we all face. Someone can be the nicest looking woman in the world and if people hear a male voice, or even one that doesn't sound quite like a woman, it's all over and they get to be called "sir" no matter what they look like!
I've heard a very small minority who have managed to do an excellent job with solving this problem but in most of the cases I've heard, it hasn't worked out very well with practice and speech help alone.
Computers are a wonderful tool. Here's an example of what can be done with a fax modem:
I read an article a few years ago about the voice surgery done by Dr. Meyer, a plastic surgeon in Beverly Hills. But I knew there was no way I could afford $6000 for that, plus the trip out there! As much money as I was able to save for transition, before being discovered and eventually getting fired, it was still just not in the budget.
So last year, I started a long search locally. I got the fax numbers of almost all the local plastic surgeons and faxed them that article and a letter inquiring as to whether they could do that type of surgery. I was turned down by all. But some of them did tell me this was not the type of surgery a plastic surgeon would normally do and suggested checking with Otolaryngologists ( ENT's; Ear Nose & Throat doctors ) So I made a list of almost all the ENT's fax numbers in this area and did the same with them. Almost all of them sent back letters declining and said that they didn't know anyone in this area who had ever done such surgery. But one day I received a letter back from a doctor Michael Tralla, who said he might be able to help, and to please call him & talk. I did and he said that he would try to find out more about what this Dr. Meyer was doing to see if it could be done. He would call him. I asked what would make Dr. Meyer necessarily tell him what he was doing and how. He said that all doctors are bound, by the codes of medical ethics, to help each other, even to the point of inviting others to observe their work and showing them how it is done. If Dr. Meyer did not cooperate, he would be considered a pariah in the medical community. I had doubts but wished him luck with it. He said to get back with him in 3-4 weeks.
After about a month had gone by, I contacted him again and asked how it had worked out with Dr. Meyer. It turned out that a Beverly Hills plastic surgeon does not have to worry much about being considered a pariah among his medical peers. He had apparently stonewalled on the cooperation, which I suspected he might from the beginning.
But Dr. Tralla said he still thought he could help me and to make an appointment to see him. He examined my sinuses and throat and put an optical probe down through my nose to look at my vocal cords. He told me that he felt that he had figured out what Dr. Meyer had been doing and that it was not such an uncommon procedure among ENT's. ( Reconstructive Laryngoplasty ) He had done similar procedures successfully with other people before, for other problems, and had even given a woman back her voice who had lost it earlier due to disease. It was a matter of adjusting the structure of the area around the vocal cords and the pitch could be changed. He said he could not absolutely guarantee me success but that he would guarantee me no harm to my voice, and that it could be reversed if I later changed my mind. ( No way! But it was certainly an ethical guarantee to make. ) This was also the time to talk about whether I would need a tracheal shave to take care of my Adam's Apple. I suspected I didn't because mine is smaller than those of some women I've seen and Dr. Tralla confirmed this. But it's a good idea to discuss this early on because it might harm the results to attempt it after the voice adjustment.
Dr. Tralla said he would be able to do the surgery for $2000. It did not turn out to be an office procedure, so this did not include the costs of the place to do it and a surgical assistant to help him. The surgery was to be done with me awake under a local anesthetic ( I had to be awake to talk so my voice could be adjusted properly ) so there was no additional fee for an anesthesiologist. Instead of using a hospital for day surgery and incurring all the extra expenses associated with that, I contacted Lakewood Surgical Center and because they said my insurance would probably not pay for this procedure ( I'm going to submit the bills and fight them if they won't! ) , I got a price in advance for how much I'd have to pay them; $438. The surgical assistant's fee was 12% of Dr. Tralla's fee, or $240. That brought the total to $2678. Still quite a bit less than Beverly Hills, even if I had lived in California!
We scheduled the surgery for 7:30 AM on January 17th. I was told to be there an hour early for prep. The people at Lakewood Surgical Center were super nice to me from the start. The only kink we ran into was over my blood pressure medicine. I usually take it around 10:00 AM and PM each day and after food because otherwise it can cause a sore colon. The surgery was only supposed to last an hour, to an hour and a half maximum. So they told me I could wait and take it after the surgery. Unfortunately that didn't work out too well and caused them a little scare.
In the prep. room they started an IV in the back of my hand about 15 minutes before the surgery was to begin. This proved to be a more difficult task than ever before. I used to have great big excellent veins for such purposes but it looks like 2 1/2 years on Estinyl must have changed that. My skin has become softer and smoother and the big veins have all but disappeared. It took the nurse about 10 minutes to find a good enough place to stick me. I have to give her a lot of credit for only having to do it once, despite this!
Then they wheeled me into the operating room. They must have put some good stuff in that IV because my anxiety level was very low. I was also extremely happy that this was finally getting done because I considered it one of my last prerequisites to going full time as a woman. I was smiling all over the place and if the doctor hadn't known why, he might have thought I was crazy.
They got me all strapped down to the table and, like I said, the drugs must have been pretty good because I don't even remember the local anesthetic he did as hurting! In fact I don't remember the local at all. < smile > They began the surgery and started opening up a hole in my throat and separating the tissue and muscles so they could get into the area they needed to. The procedure wound up taking longer because of some complications. It turns out that as a person gets older, the wind pipe begins to harden or calcify. Dr. Tralla needed to put some sutures into place there, to hold his work in place so it could heal. But he couldn't get sutures in because the cartilage had calcified. So he had to break out the drill and drill some holes for the sutures. Another problem was that because of my size, they had to bend my head back at a more extreme angle than usual and hold it there to reach the area they needed to reach. It was difficult to get my head back far enough and it had to be pushed back by pressure on the bottom of my jaw. ( It felt like somebody's elbow! )
So there I was with my head pushed back and Dr. Tralla drilling holes in my wind pipe and it slowly started to hurt. It wasn't supposed to hurt and hadn't before that, but some pain started from about where he was drilling the holes on the left side and crept up under my jaw and over into my ear on that side. It was also taking longer than expected and the blood pressure monitor said that mine was starting to go up, probably because of the pain. I started to complain about the pain and get a little nervous. I broke out in a major sweat from it. It wasn't really serious pain, just enough to cause me to sweat a lot and moan a little. It was a little scary but I certainly didn't want them to stop the surgery so I knew I had to just hang in there. But the blood pressure started to go too high so they had to get some liquid medicine under my tongue to bring it back down. When he began drilling on the other side the same pain started creeping over there and after awhile it was really hurting. This pain went away as soon as the surgery was over, but because of the complications the surgery wound up taking 3 hours altogether.
About two thirds of the way through, Dr. Tralla reached the point of being able to adjust my voice and it was like a miracle! He asked me to count up and as I did, my voice started changing in pitch! It was so great to hear! When it got to a certain pitch, they said OK and stopped it there. Everyone I have talked to since agrees that in my case, they managed to raise the pitch about an octave, which was perfect! We've done some comparisons since the surgery and my pitch range now closely matches Jennifer's ( my wife ) and Linda's ( my therapist )! In fact I think I can even go about one note above Linda's!
Of course I still need voice therapy to learn how to modulate that pitch and speak like a woman does, but no matter how I tried ( over a couple of years! ) I could not get it right before and now it's only a matter of some work and practice. No problemo!
After the surgery was done and they wrapped it up and were ready to wheel me to the recovery area, someone commented that I had really been through a ringer. I agreed. Then someone said that; "now at least the voice matches the face". I got all watery hearing that and as they wheeled me out of the operating room, the realization of what had just been done struck me and got really moved and cried a little bit from the overwhelming happiness and relief !
The doctor ordered an EKG before getting dressed again, to make sure in my case that the pain experience hadn't been caused by a heart problem and the blood pressure. It came out normal. And the nurse who ran it gave me a copy and showed me that she had put "female" on the EKG print-out because that's the way she thought of me. I got all watery again!
Why couldn't everyone in the world be as nice and accepting as these people?!
We figured later that the pain had been caused by a combination of the drilling and having my head pushed back so far so tightly. Probably just pulling on some nerves made them sore. It went away as soon as the surgery was over and they let me relax and tilt my head back down again.
Over all, the people at Lakewood Surgical Center were super nice to me, as was Dr. Tralla. He's a really sincere, kind guy!
Last week ( February 13th ) I began seeing a voice therapist, Kathy Maes, who works with the Denver Center for the Performing Arts and is a really good teacher. She showed me some exercises and I experienced a marked improvement just from that one lesson so far. Now it's only a matter of some time and work.
Voice surgery follow-ups
Some of you may remember my posting before about the voice surgery I had back in January ( ¬95 ). To the best of my understanding, it was the same kind done by that Dr. Meyer in Beverly Hills but I had it done for a lot less ( around $2700 instead of around $10k ) by Dr. Tralla here in Denver. This is a follow up and a request for additional information from others of you out there who may have had other options like this done.
One problem I had was that I was Dr. Tralla's first try at this. I was about to go full time, I'm 6' tall and large boned, had a pretty deep voice before, and *desperately* needed something done! So he had no experience with how far to go with it and he seemed concerned about the possibility that a TS might change their mind later and wanted to be conservative about how much he changed it.
" You can't always get what you want. But if you try sometime, you get what you need." - The Rolling Stones
The surgery did give me what I need to sound fairly convincing in public, with the visual clues added, which is *much* better than I started out with. Before, my voice would have given me away instantly. But on the phone I still get called "sir" most of the time, which is very annoying and I have to keep correcting people. ( "I'm not sir, I'm ma'am") One funny incident happened this summer when I had called a guy one of the neighbors recommended, to cut down a tree in our front yard. He came to the door the next day to give me an estimate and took one look at me when I opened the door and said; "I talked to your husband on the phone yesterday about cutting down the tree". So in public, I'm doing a fairly convincing job. Jennifer & I have been married 11+ years now and so far since I've been full time, there's been one time when someone asked me if we were sisters, and another time when someone asked me if she was my daughter. :-)
As far as with the surgery, one of the problems I experienced was that because of my age ( 47 ) the wind pipe has calcified and hardened like it does when people get older. So it was hard for the Dr. to get the sutures into it right. ( I mentioned this in my original article ) After he did the adjustments, it sounded pretty good for awhile ( maybe 1 month ) but then dropped down in pitch about half of what we'd gained from the surgery. ( Why does life always seem like that?! 2 steps forward, one step back! ) He said it was apparently from the scar tissue stretching later. These are the things we learn from experience and the problems associated with being the first on your block.
Dr. Tralla just got back from a convention in New Orleans and told me that apparently none of the other ENT's have a clue about how to solve this kind of problem either. Very few doctors in the country are doing this kind of thing at all! At least with an ENT like him, he's done similar types of things on other people for other problems.
He said there are basically 2 options he could try to get me the results I want with. One is injecting cortisone into my vocal cords, which will have some results and should shrink the muscle tissue and raise the pitch some. It's the lowest cost try for under about $1k. ( is that kind of thing permanent? )
The other would be laser surgery to thin the cords, which he says will not only surely raise the pitch more but also give a breathier quality, which would really help me because of my size and formerly deep voice. That's around $2k.
I had the laser thinning done by Dr. Tralla in December 1995. He also injected some cortisone into the vocal cords but I don't know how much that really helped. The thinning helped raise the pitch and make my voice sound breathier like he suggested it might. It was worth doing. I feel like it's reached the point of diminishing returns now where I have what I need but not absolutely what I wanted. By working and practicing, I've gotten to the point where a don't get sirred that much on the phone much any more. Also changing my first name from Robin to Melissa will also help that, giving further clues to people on the other end who can't see me. I don't know what the other surgeons doing these procedures are getting, to compare them to Dr. Tralla but I think he's a kind and competent doctor for doing this. I probably would have had better results if I hadn't been so big to begin with.
I have a wav sound file of my voice before these 2 surgeries and can make another one of after, if anyone's interested in comparing. The differences are quite remarkable when compared directly like that. I'm not sure if this newsgroup allows posting of files though. Let me know.
April 8th 1997: I've learned how to use my voice much better now and get called "ma'am" about 90% of the time now on the phone. Changing the first name to Melissa definitely helped on the phone too and people have to be real dim to call me "sir" on the phone with both combined. I often hang up and refuse to do business with sales people who call & want to sell me something but persist in doing that even after they're told. I'd definitely recommend changing to a distinctly, unmistakably female sounding name for that reason.
Has anyone else had voice surgery with Dr. Meltzer and Dr. Cohen in Portland? I had the surgery 9 days ago and I still have quite a bit of swelling. It looks as if I swallowed a golf ball and it got stuck in my throat. It's not really sore anymore though. Tomorrow is my official day to begin speaking again. However, I did try some brief and gentle testing of my vocal range today and there appears to be no improvement in the range or speaking pitch. Also, my voice is hoarse and weak. Presumably, all of this will improve in the coming weeks.
My situation is complicated by the fact that my vocal chords had become partly detached (due to a trach shave I had 1 1/2 yrs ago) and they had to be re-attached by the doctors using pins. I guess I'm being impatient but I'm wondering how long after surgery have others gotten their voice back to normal, and how much improvement did you observe?
I had the conventional type of voice surgery done in April 1996 by Dr Pincus in Marina Del Rey, CA. This procedure "tilted" the voice box, stretching the vocal cords and making it easier to speak in the upper ranges of their ability. This is the same method being used by Dr Menard and Dr Toby Meltzer (srs surgeons).
Dr Pincus has since added the laser to this surgery...after he stretches the vocal cords, he hits the cords with the laser and sutures two of them together where they attach to the side of the voice box....shortening both of them and increasing the tension on them.
I wouldn't do this surgery unless it included the laser. My results were pretty typical...not that much improvement.
This does cost about $5000...so I would give Dr Pincus a call in Marina Del Rey and talk to him about it.
Pitch-Raising Surgery in Fourteen Male-to-Female Transsexuals
Teri is the only person I've heard who I thought had excellent results. I did not hear her voice before surgery.
I do not recommend surgery except as a last resort. To help you avoid the risk and expense of surgery, I now offer a video program for Finding Your Female Voice as well as personalized voice consultations.
Papers and presentations
Brown M, Perry A, Cheesman AD, Pring T (2000). Pitch change in male-to-female transsexuals: Has phonosurgery a role to play? International Journal of Language and Communication Disorders, 35, 129-136.
de Jong, F (2003, September). Surgical raise of vocal pitch in male to female transsexuals. Paper presented at the XVIII Biennial Symposium of the Harry Benjamin International Gender Dysphoria Association, Gent, Belgium.
Donald PJ (1982). Voice change surgery in the transsexual. Head and Neck Surgery, 13, 246-250.
Gross M (1999). Pitch-raising surgery in male-to-female transsexuals. Journal of Voice, 4, 433-437.
Isshiki N, Taira T, Tanabe M. (1983). Surgical alteration of the vocal pitch. Journal of Otolaryngology, 12, 335-340.
Kunachak S, Prakunhungsit S, Sujjala K (2000) Thyroid cartilage and vocal fold reduction: a new phonosurgical method for male-to-female transsexuals. Annals of Otology, Rhinology, and Laryngology, 109, 1082-1085.
HF Mahieu, HK Schutte New surgical techniques for voice improvement. European Archives of Oto-Rhino-Laryngology, 1989
HF Mahieu, T Norbart, F Snel - Laryngeal framework surgery for voice improvement. Rev Laryngol Otol Rhinol (Bord), 1996
Neumann K, Welzel C, Berghaus A (2002). Cricothyroidopexy in Male-to-female-Transsexuals – Modification of Thyroplasty Type IV. International Journal of Transgenderism, 6(3). Retrieved December 30, 2003 from http://www.symposion.com/ijt/ijtvo06no03_03.htm
Oates J, Dacakis G (1983). Speech pathology considerations in the management of transsexualism: A review. British Journal of Disorders of Communication, 18, 139-151.
Pincus SJ (1997). Voice surgery. Paper presented at the Second International Congress on Sex and Gender Issues, Philadelphia.
Sataloff RT, Spiegel JR, Carrol LM, Heuer RJ (1992). Male soprano voice: A rare complication of thyroidectomy. Laryngoscope, 102, 90-93.
Wagner I, Fugain ., Monneron-Girard L, Cordier B, Chabolle F. (2003). Pitch-raising surgery in fourteen male-to-female transsexuals. Laryngoscope, 113, 1157-1165.
Wolfe V, Ratusnik D, Smith F, Northrop G (1990). Intonation and fundamental frequency in male-to-female transsexuals. Journal of Speech and Hearing Disorders, 55, 43-50.
CY Yang, AD Palmer, KD Murray, TR Meltzer, JI … - Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: results of surgery …The Annals of otology, rhinology, and laryngology, 2002