Once going by the name of Michael Strong, she is now known as Michelle. Michelle wishes that her voice more nearly matched her appearance. She has spent several years of her life and many thousands of dollars changing her male birth anatomy to the anatomy she identifies with, which is female. She has had genital gender reassignment surgery. She takes female hormones. Her breasts have enlarged and she helped them further with implants. She dresses impeccably. Her facial bones have been re-contoured. However, on the telephone, she is frequently called “sir.”
Born into the Wrong Body
I also meet transgender males who were originally females. As a broad generalization, since the genetic female’s larynx still approximates a young boy’s larynx in size, cartilage softness and consequently in pitch, with masculinizing hormones (testosterone) the pitch will generally gradually drop. Effectively this new male will now go through puberty with their voice over somewhere from one month to two years of hormonal treatment.
In the other direction, a genetic male such as Michelle, who is now living in or transitioning to a female life, has the unfortunate problem of the larynx already having enlarged to create a tenor, a baritone or bass voice. On top of that, testosterone promotes calcification and hardening of the laryngeal cartilage so that it becomes bone. It will not shrink no matter how much estrogen is added to her body. Consequently, males transitioning to females generally require some surgical change to their larynx if they do not wish to or cannot full time stretch their vocal cords into falsetto when making sound.
It is possible to keep the vocal cords on a stretch full time, but very difficult. On top of that, the throat and chambers above the larynx are large and resonate and amplify the deeper pitches. In addition to tightening the cords, the transgender female must also learn to constrict her throat full time when speaking. All this is on top of learning the societal speech patterns of females.
Feminization Laryngoplasty (FemLar)
I have been pursuing a surgery, feminization laryngoplasty (FemLar) for a number of years trying to address as many of these parameters as possible. Through an incision in the neck, I shorten the length of the vocal cords, try to tighten them so that at a longer length they are effectively a bit thinner. I reduce the size of the thyroid cartilage so that it protrudes less as an Adam’s apple. I raise the larynx in the neck so that the resonating pharynx is shorter and amplifies more of the higher frequencies.
On endoscopic examination before surgery, Michelle’s vocal cords would be considered normal male vocal cords. She underwent the feminization laryngoplasty surgery and has been living contentedly as a female since. Her voice continued to change for about one year after the surgery. Some of this may have been part of the healing process including gradual reduction of swelling and a more gradual softening of scar tissue. However, I think much of the change was Michelle’s gradual learning or adaptation to the new amount of closure required of her shorter vocal cords.
It will not shrink no matter how much estrogen is added to her body.
Approaches to Raising Speaking Pitch
There are several different approaches taken to raise the pitch of the speaking voice including:
- voice therapy alone
- feminization laryngoplasty
- sewing the front of the vocal cords together (vocal cord webbing)
- lasering the vocal cords
- cricothyroid approximation (CTA)
Some people respond well to coaching and training. With therapy and practice they can produce a feminine sounding voice. Just as some people will never be able to sing well, some transgender females will never be able to produce a feminine sounding voice no matter how much they try.
Vocal cord webbing is a surgery done through the mouth where the front half of the vocal cords are sewn together. Lasers have been used to try and thin out the muscle of the vocal cord and to try and tighten the surface of the vocal cord.
Cricothyroid approximation (CTA) surgery is a simple approach that effectively tightens the CT muscle which raises the voice into falsetto, potentially giving the patient a permanent falsetto voice.
Unfortunately about one-third of patients after CTA surgery have their vocal cords stretch back out and their pitch drops back down to its previous range after a few months. It is also in the mind of the listener to judge whether a falsetto voice sounds more feminine or more like a gay male’s voice. I dislike the quality, which coupled with the one third failure rate and an uncommon complication of locking the patient into a single pitch, led me to stop performing CTA surgery.
What you learned
- For transgender males (female to male), masculinizing hormones generally lower the pitch gradually over one month to two years — effectively a second puberty for the voice.
- For transgender females (male to female), the larynx has already enlarged and its cartilage calcified; no amount of estrogen will shrink it, so surgical intervention is usually needed.
- Feminization laryngoplasty (FemLar) shortens the vocal cords, reduces the thyroid cartilage prominence, and raises the larynx to shorten the resonating pharynx — addressing pitch, resonance, and appearance together.
- Voice therapy can help some transgender females achieve a feminine-sounding voice, but not everyone can get there with therapy alone regardless of effort.
- Cricothyroid approximation (CTA) has a one-third failure rate and produces a falsetto quality that many listeners do not perceive as feminine; its uncommon risk of locking pitch led Dr. Thomas to stop performing it.