Feminization Laryngoplasty is designed for patients whose voice pitch is consistently interpreted as male despite concerted efforts at pitch modification — speech therapy, training, or previous procedures such as cricothyroid approximation.
The procedure remodels the genetic male’s voice box to make it smaller and the vocal cords shorter, in an attempt to raise the comfortable speaking pitch. A thyrohyoid elevation is almost always added at the same time to shorten the pharynx and improve resonance at higher pitches. In general the procedure cuts off the lower range and sometimes adds a few notes on the upper end, and sometimes removes some notes from the upper end.
The typical candidate is a male who has undergone, is undergoing, or may yet undergo transgender surgeries and wishes to change voice pitch and potentially other qualities of the voice. However, genetic females and intersex individuals have had the procedure as well. A previous voice surgery such as a cricothyroid approximation does not preclude this procedure — in fact, Feminization Laryngoplasty may succeed where CTA has failed. It is also an effective way of correcting the complication of a trach shave where pitch was inadvertently lowered.
This surgery doesn’t work or meet the needs of everyone. It carries significant risks and there is a range of results — from outstanding pitch elevation to minimal change and including patients who experienced complications. All examples, not just the successes, are represented in the case results.
As pitch elevation 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 pharynx that would change vocal resonance. Surgically elevating the voice box is an attempt to accomplish this. See the thyrohyoid elevation procedure for further information.
Outcomes
Feminization Laryngoplasty has been performed on 130 individuals (as of November 2015). Of 81 patients for whom both before and after recordings are available, the mean pitch elevation is six semitones with a standard deviation of 3 semitones. The lowest pitch is up seven semitones (s.d. = four semitones) and the highest pitch is down three semitones (s.d. = seven semitones).
Eighteen of the first 40 cases were revised. Six of the second 40 cases were revised. Revisions are performed when the resulting comfortable speaking pitch is not adequate. Office laser procedures are used for fine-tuning. When the outcome has been good, the quality of voice is significantly better than the quality of cricothyroid approximation. When a complication has occurred, the outcome has been poor — but if the result was a rough voice with no previous pitch surgery, revision has generally been able to improve it.
In summary, this procedure offers more potential gain and a more nearly feminine voice than cricothyroid approximation, and more potential risks. There are a number of variables still being optimized; these are discussed with prospective patients.
This work by James P. Thomas, MD is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.