Before surgery

  1. I listen to the reasoning for gender transition or wanting to have a more feminine voice.
  2. I record the following:
    1. Reading of a standardized passage (Man’s First Boat), documenting what I call the Comfortable speaking pitch.
      1. I typically record this passage at the attempted best female voice.
      2. I record the passsage again at the most relaxed, and typically male voice.
      3. It doesn't hurt to have recorded some spontaneous conversational speech in the recording as well.
    2. Maximum phonation time (at the comfortable speaking pitch)
    3. Vocal pitch range
      1. Record the lowest note that can be produced
      2. Record the highest note that can be produced
    4. Maximum volume - essentially a yell
    5. Vegetative sounds are recorded.
      1. A cough
      2. A Throat clearing
    6. Minimum volume
      1. I record soft singing of "Happy Birthday to You" at low, medium and high pitch.
  3. The vocal cords are then visualized and video recorded with flexible laryngoscopy including stroboscopy at a variety of pitches and volumes.

At Surgery

Location: All surgeries have been performed in a Medicare certified, outpatient surgical center. The procedure is typically two hours long. 

Anesthesia: The procedure is performed under general endotracheal anesthesia using a 6-0 endotracheal tube. (It is not a particularly painful surgery and I performed the first one under local anesthesia. However, I did not like that the patient was trying to talk while I was trying to suture the vocal cords. I worried that I was going to tear them.)

Antibiotics: I use two perioperative antibiotics at the time of surgery: 

  • clindamycin - 600 mg
  • cefotaxime or levofloxacin.
  • I also irrigate with normal saline containing 100,000 units per liter of bacitracin prior to incision closure.
  • I give 7 days of post-operative oral therapy with either cefuroxime or levofloxacin.

Steroids: 10 mg of dexamethasone are given intravenously at the beginning of surgery. Oral prednisone or methylprednisolone are given in selected cases if significant swelling develops postoperatively.

Technique: 

(All photos are taken from the perspective of the anesthetist at the head of the table. So you are looking over the chin at the neck.)

An approximately 5 cm incision is placed in or parallel to a skin crease directly in the midline