Voice Feminization: Vocal Surgery

Jahn Westbrook

I have on my current favorite inc. black, mixed leather and cotton skirt. The front side slit and bias zipper, delicious. Coordinated that with a Jennifer Lopez deep pink and coral striated cami. Tasty. The lycra in my black pantyhose make my legs shimmer. I slide into my Alfani 2 1/2 inch heel booties, and slip on my white leather inc. fitted jacket. The one with the black trim. Last check on my make up and hair, yummy. I sing with feminine confidence. I’m out the door. But…the phone rings.


“Good evening sir, this is the Repub…”

And there it was, the moment that changed my evening. Clocked on the phone. Confidence deflated to being self-conscious about my whole presentation. I still went out, but with greatly reduced enthusiasm, feeling more trepidation.

Transfemales like me have to work at getting their voice in the female range. It is a conscious effort every time I speak. Ringing in the falsetto is typical of transfemales lifting their voices. I’m sure I was there on many occasions. I sound better in the earlier part of the day, than the latter part of the day. My throat begins to hurt, gets hoarse and phlegmy. Pleasant, right?

In the late 1990’s to early 2000’s, when I started transition research, feminine vocal surgery was in its infancy, and produced more unsatisfactory results than satisfactory. It was a procedure to be avoided. At least, that was what I gleaned from the information available to me, and from actual patient commentary, at that time.

I went into this article with naiveté on the advancements of vocal surgery. I was prepared to rollout the feminization surgery -prohibition symbolthe don’t symbol, and warn every reader to avoid this procedure. Now, upwards of 2 decades later, this procedure has evolved into a predominantly successful specialty. Specialists and specialized practices focus solely on voice and vocalization. There are now more sophisticated surgical techniques, advances in surgery, and increased attention on transfemales.


“Stroboscopy is a special method used to visualize vocal fold vibration. It uses a synchronized, flashing light passed through a flexible or rigid telescope. The flashes of light from the stroboscope are synchronized to the vocal fold vibration at a slightly slower speed, allowing the examiner to observe vocal fold vibration during sound production in what appears to be slow motion.” - Paul C. Bryson, MD.

Surgeons use a stroboscope, a device used to record and view the movement of vocal folds(cords). There are two methods, through the mouth and through the nose. The nasal view tends to reveal better results than the oral view. A numbing gel on the throat dulls the gag reflex.

The lungs, the vocal folds within the larynx, and the articulators(parts of the vocal tract after the larynx; lips, tongue, palate, sinuses, et cetera) comprise the mechanics of the human voice. Both female and male vocal structures are identical, before puberty. Pubescent changes affect the pitch, timbre, tone, and resonance of the human voice. When a boy enters puberty, the release of testosterone enlarges and drops the larynx & widens and thickens the vocal cords. Females who don’t have a dominant release of testosterone, experience no change in their vocal structure entering puberty.

Female voices: Fundamental frequency (Fo) for females range 165 – 255 Hz(rose pink bar)

Male voices: Fundamental frequency (Fo) for males range 85 – 180 Hz(hyacinth blue bar)

Middle “C”: Range where female & male (Fo) overlap(gladiolus green bar)

Post-operative range: Post-operative results typically increase vocal range from between 6 notes(1/2 octave) up to 12-14 notes(1 octave +)(lilac purple bar)

Pitch -is affected by the shape of the vocal folds(cords). Narrower cords produce higher notes and conversely, wider cords produce lower notes.

  • Females sound “breathier” due to the incomplete closure of the vocal cords. There is a minute space that allows air to escape while speaking, giving the voice a more airy, or breathy quality. Thinner, more elongated vocal cords produce higher pitch notes.
  • Males have thicker vocal folds produce lower notes, hence sounding deeper, huskier, effecting the pitch. The reason is that thicker cords are heavier and take longer to close and vibrate. This in turn slows the air reflection through the larynx.

Timbre -is affected by the length of the voice box, or larynx. The longer the larynx, the deeper the voice will be.

  • Females have a thinner, shorter larynx. This shortens the amplitude of the, creating higher notes, affecting the timbre of her voice. These higher notes are characteristic of the female voice.
  • Males have a more descended larynx, which creates the tell-tale Adam’s Apple. This added length effects the timbre of the voice. This longer vocal tract causes the wavelengths to be longer, or increases amplitude. This lowers the octave of the notes to what is recognized as a male voice.

Tone -controlled by the diaphragm, the intercostal muscles, and the muscles of the larynx. Typically, tone represents mood and emotion.

Resonance -shape of the head, mouth chamber, nasal passages all contribute to reflecting the sound of the human voice.

Feminine Vocalization Surgery(ies)
  • Feminine Laryngoplasty -shortens the vibratory space between the vocal cords. This is typically done endoscopically. Minimally invasive, one end of the vocal cords are stitched together, to reduce the opening, raising vocal pitch. Commonly referred to as the umbrella term for vocal feminization surgery.
  • Cricothyroid Approximation(CTA) -stretches the vocal cords and reduces the space between. This is an invasive procedure, requiring a small incision in the neck. Typically hidden under the chin, the cricothyroid cartilage is incised bringing the voice into the falsetto range, thus raising vocal pitch into the female range. This also reduces the lower range of the voice, so for singers, it is not recommended.
  • Thyroid Chondroplasty -also known as a ‘tracheal shave,” reduces the size of the larynx. In some procedures, the voice box may be removed. This reduces the aesthetic appearance of the Adam’s Apple protrusion by reducing -shaving- the thyroid cartilage. There is the potential for the voice pitch to drop during this procedure. Patients often combine this procedure with the CTA.
  • Thyrohyoid Elevation -raises the voice box inside the neck in an attempt to shorten the pharynx (the throat) resonance chamber, cutting off some of the lower range notes. Pros are that it can add notes to the upper range. Cons are that it may remove notes from the upper range

Conditions affecting optimum results include:

  • Smoking;
  • previous throat injuries;
  • prior surgical procedures;
  • polyps;
  • coughing(asthma and heart conditions need to be disclosed);
  • ignoring post-op healing regimen;
  • prematurely exposing surgical site to sunlight;
  • neck size(shorter & thicker increase surgical difficulty);
  • lower & thicker outset male pitch vocal cords harder to operate on

If you are someone considering vocal feminization surgery, here are some medical resources for you to consider:

  • Yeson voice center is located in Seoul, South Korea, this clinic is devoted exclusively to voice and vocalization
  • Haben Practice for voice and Laryngeal surgeries is devoted to voice and laryngeal problems. The center is located in Rochester NY.
  • voicedoctor.net is based in Portland Oregon, headed by board certified Dr. James Thomas

The tvsurgeryguide has some good general information about vocal feminization surgery.

I included the above resources as a means to give my trans-sisters a place to begin their research. You should fully understand the procedures, be comfortable with the risks involved, are comfortable with the surgeon and staff, are aware of the potential for less-than-favorable results, potential risks and complications, and are willing to adhere precisely to the post-surgery recovery regimen. You, the patient, must be patient through the healing process. Greatly improving the success of the healing process is entirely in your control by sticking to the physician’s guidelines.

Before attempting any surgical procedure, it is vitally important that you do your own research. Surgery is also not a guaranteed solution. There are non-surgical therapies for adjusting your voice into a female range. We will cover some of those next week.

Since doing my research, I’m actually considering the procedure myself. After all, I’ve always wanted to visit Korea. However, Rochester is much closer. But than again, Oregon neighbors Washington….

If any of our readers have undergone Vocal Feminization Surgery, we would love to hear about it in our comments section. If you are uncomfortable sharing publicly, send me a private message at Transgender Universe.

mir, irini, peace, amn,


Here is an pre- and post- op example from the Yeson center:



TU Articles