Transgender Voice Surgery

Transgender Voice Surgery

There are several types of voice feminization techniques, Crico-Thyroid Approximation (CTA), Laser Assisted Voice Adjustment (LAVA), Vocal Cord Shortening (Anterior Web Creation), Thyroid Cartilage and Vocal Cord Reduction and Laryngoplasty. All procedures are designed to make a genetic Male’s voice box smaller and vocal cords shorter in an attempt to raise the comfortable speaking pitch.

Voice Feminization SurgeryThe characteristic pitch or fundamental frequency (F0) of the male voice ranges from about 100 to 150 Hz; for the female voice, F0 ranges from 170 to 220 Hz. By reducing the voice box, these procedures can increase the pitch of the voice.

Another distinctive characteristic of the voice is resonance. The timbre or resonance of the male voice is deeper than females, this is due to the greater length of the male upper airway.

Currently there is no procedure to help modify the resonant character of the voice, however altering the fundamental frequency is the more important factor.


CRT Crico-Thyroid Approximation

The most common formed operation to increase the F0 is CRT. In this technique, the thyroid cartilage (Adam’s apple) is pushed against the cricoid cartilage that lies below it. The two cartilages are then sutured together with nylon sutures, usually placed over bolsters

The approximation of the thyroid and cricoid cartilages increases the tension of the vocal cords by stretching them. This raises the pitch at which the cords will vibrate.

CTA is performed through a small incision in the neck. The incision is placed within a natural skin fold so the resulting scar will either be invisible or at least easily concealed. Either local or general anesthesia can be used and because there is no actually surgery on the vocal cords themselves, patients can have the procedure reversed if unsatisfied.


This minimally invasive technique involves removing the front of the voice box to make the voice box smaller. First an incision is made in a skin crease of your neck, over the Adam’s Apple.

The front of the voice box is removed making the voice box smaller.The vocal cords are then stretched and a third of them removed. A tiny metal plate maybe used to over the voice box to help maintain tension. This plate stays in place, even once everything is healed.

This procedure reduces the projection of the Adam’s Apple, making it unnecessary to have a separate “trach shave” procedure. CTA may also be performed to help correct a previous voice feminization procedure.

The surgery is performed in an outpatient setting under general anesthesia.

Laser Assisted Voice Adjustment

Laser Assisted Voice Adjustment is an endoscopic technique in which a CO2 laser is used to scar and stiffen the area surrounding the vocal cords. The surgery aims to alter the pitch of the voice by increasing the tension of the vocal cords. Surgery is performed under general anesthesia, and with this type of endoscopic procedure, there is no incision to the neck.

Vocal Cord Shortening

Vocal Cord Shortening is also known technically as Anterior Web Creation. It is another technique to increase F0 is to shorten the vibrating length of the cords by suturing them together. This creates what is called an anterior vocal web. Depending on the specific technique used, a piece of the thyroid cartilage maybe also be removed to aid the creation of the anterior vocal web.

This technique can produce long lasting results without the need for neck incisions and is done under general anesthetic.

Thyroid Cartilage & Vocal Cord Reduction

This procedure combines the open resection of a central strip of the thyroid cartilage, about 8 mm wide, along with resection of the anterior one-third of the vocal cords to reconstruct the anterior commissure (where the vocal cord meet anteriorly). This aggressive procedure has been proven to effectively increase the pitch of the voice (perhaps too much).

The results from six Thai patients showed the surgery to increse pitch by an average of 147hz. This can leave the voice sounding oddly high even by female standards.

Although the procedure requires a neck incision, previous result suggest long term effectiveness.

Best Candidate for Voice Surgery

Voice feminization surgery is for patients whose still conscious of their distinctive male voice. If voice training or speech therapy has not produced noticeable results, you may want to consider having surgery.

The typical patient will be a male who has or is undergoing transgender surgeries and wishes to change the voice pitch and potentially other qualities of the voice as well.


Before the surgery your surgeon will evaluate your larynx with a video-endoscopy.

They will then hold a PARQ (Procedures, Alternatives, Risks and Questions) conference with you.The evaluation and examination of your voice box is essential. You will also be shown important preparation and recovery guidelines which you must follow strictly.

A number of your vocal parameters will be recorded, and your vocal cords will be filmed in motion.

You will be asked about allergies you may have, and smokers will also be advised to stop around two weeks prior to the operation.

The Procedure

Your chosen procedure will likely take place in an outpatient ward and will be performed under local or general anesthesia. The duration of the operation varies depending on which technique is being used.

After the surgery and once you have recovered from the anesthesia, your surgeon will discuss with you the outcome of the surgery and remind you once again of the important guidelines during recovery.

Depending on the specific technique of voice feminization and the outcome of your surgery, you may be asked to stay in hospital, however in most cases and overnight stay will not be necessary.

Post Operative Voice Feminization

Recovery Period

After one or two days you will be required to go for a post-operative exam, you will also be advised to stay in the area for up to a week so the doctor can monitor your progress.

Complete voice rest is mandatory for one to two weeks after the procedure (all forms of verbal communication are not allowed, including whispering), until your body’s own scar tissue helps support the procedure. You should also refrain from strenuous activities for a at least three weeks.

In the initial post-surgery weeks, it is possible that your voice may sound lower than before surgery. This is perfectly normal may happen because the surgery opens the voice box and/or creates a lot of swelling.

Your voice will often seem quite soft, tight or requiring effort to use. It will likely get worse before it gets better

There will be initial pain or discomfort from the procedure. patients have describe symptoms such as a sore throat sensation and difficulty swallowing.

Other symptoms which are considered normal include swelling and bruising, discomfort and pain, crusting along the incision line(if any), numbness and visible scars.

You may gradually begin speaking after two weeks, but this should remain absolute minimum for the third week. There is a possibility that your voice may drop in pitch or become horse if you try to talk too much.

After three week you may begin aerobic activity and finally after the 6th week, your voice will begin to approach its new pitch.

Voice Surgery Risks

As with any surgical procedure, voice feminization carries significant risks, these include:

  • Allergic Reaction From Anesthesia
  • Hematoma Inflammation and infection
  • Thick, wide or depressed scars
  • Wound separation or delayed healing
  • Sensitivity or allergy to dressings or tape
  • Injury to blood vessels, nerves or muscles
Complications that may arise are similar amongst the different types of voice feminization, however each technique carries its own risks, these will be discussed during your PAQR conference.


  1. Lazaros says

    Hi i would like to know if the adams apple can be made to look like a female also does this increase the voice as a by product of the opp . Also the cost of this work , im asking for a friend as she is a little shy about operations so im asking for her . while im here breast enhancement the cost on that . one last thing she is adamant about about increasing her buttox by injections whats all this about please can this be done . THANK YOU

  2. Sathie Reddy says

    hi please can you let me know the price of the voice surgey..I had my adams apple removed and I feel my voice is alot more deep….Please get into contact with [email protected]


  3. zara says

    can this surgery be performed on a genetic female with a low-pitched voice?

  4. Hoang_Vietnam says

    I’m twenty five years old and I’m male. However, my voice is like voice of woman. This makes me feel confused when communicating with other people. Do you can alter my voice by surgery. I would have the voice of man.

    • jeff says

      hey man we have the same condition and its called puberphonia. I’m no longer responding on speech therapy and looking for a potential voice surgery like this.I’m a man but sounds like a girl. Do you get one already please reply here [email protected] thanks.

  5. fiorela says

    im very  interesting in  this  surgery  with  laser ,  because  i  dont  want  more  scars  in  my  neck  ,i  alredy  have  2 ,  so  please  if  you  can  reply me  with  the  price  , and  more  information  ,  i  live  in  NY  so  i  can  not  go  there  just  to  ask  the b price  ,   so  please  give  me  all  the  information  ,   before  i  go  there  ,or  you  can  call  me  …thank  you.

  6. Brenda Francis says

    Hi I am a post op transgender person and am very interested in your voice surgery.

    I was in Chonburi early this year visiting Dr Suporn for SRS.

    I intend to visit him again later next year for other surgery and would like to include you in my visit.

    What would be an aproximate cost for larangoplasty in Thai baht and what is your aproximate waiting time for a booking ?

    Thank you Brenda Francis

  7. Sashi says

    Iam about to transition to female however most surgeons do not perform vocal chord alteration in what forms there may be ….!
    My question is, which top Thai surgeon could you recommend for this type of surgery and is Dr Suporn the best surgeon to go with for Gender Reassignment as well as Facial Feminisation?
    Thanks……. I need all the help I can get!!!

  8. rh says

    I  do not think it makes sense that men and women are listed with vocal ranges that do not overlap.  My voice is higher than my husband’s voice, by a good bit.  I get mistaken for a man on the phone, but in person men do like a sultry voice.  My husband never gets mistaken for a woman on the phone though.
    I would think that voice training might work out for all but the lowest voiced men who have a change/want to live as a woman.  Lots of women have low voices and men like it.
    I also think that people who have not had the change surgery yet should wait and see.  I have vocal cord problems (why I found this site) so be careful about messing with them.

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