Feminization Laryngoplasty is a surgery designed for male-to-female transgender patients to raise the comfortable speaking pitch by remodeling the larynx. This page covers the anatomical background, surgical rationale, and reference materials.
Background
Once exposed to testosterone — typically during puberty — the thyroid cartilage enlarges, increasing the internal opening of the larynx and creating the visible protrusion of the Adam’s apple. The vocal cords elongate and thicken, lowering the comfortable speaking pitch and lowest vocal pitch, and usually reducing the upper vocal range. The relaxed laryngeal position drops lower in the neck, increasing the internal length of the pharyngeal chamber; a longer chamber selectively amplifies the lower notes.
In individuals identifying as female gender, speech therapy or self-practice may result in a desirable speaking pitch, masking these testosterone-induced changes. These techniques utilize active compensatory muscle contraction and require ongoing effort. Some individuals develop a habitual contraction — to the point of requiring conscious effort to produce their male voice — while others develop ongoing fatigue from maintaining female pitch through tonic muscle contraction, and some are rather unable to accomplish this task. Even when successful, some remain fearful of any momentary lapse in a sensitive situation. The ideal outcome of surgery would be comfortable feminine speech without having to think about contracting muscles before every phonation.
Surgical Rationale
Somyos Kunachak proposed an open laryngoplasty to alter pitch (Kunachak S, Prakunhungsit S, Sujjalak K. Thyroid cartilage and vocal fold reduction: a new phonosurgical method for male-to-female transsexuals. Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1082–6). This procedure reduced the size of the larynx to a more female dimension in cross section and shortened the length of the vibratory vocal fold. Based primarily on this article, the procedure that developed into Feminization Laryngoplasty — or as the first patient called it, “FemLar” — was undertaken.
The procedure remodels the larynx to make it smaller and the vocal cords shorter, raising the comfortable speaking pitch. A thyrohyoid elevation is almost always added to shorten the pharynx and improve resonance at higher pitches. In general, the procedure cuts off the lower range and sometimes adds notes at the upper end — and sometimes removes some from the upper end.
As pitch elevation in both males and females involves changes in diameter and length of the throat during speech, surgical reduction of the diameter or length of the pharynx may change vocal resonance. Surgically elevating the voice box is an attempt to accomplish this. See the thyrohyoid elevation procedure for further information.
Lecture
A full lecture on Feminization Laryngoplasty is available on YouTube:
Handout
This work by James P. Thomas, MD is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.