August 02, 2015

Transgender Voice Change

For individuals undergoing transgender sex reassignment transformation, perhaps the most difficult outward change to accomplish is the voice which ideally should sound like the gender that has been selected. If you look like a woman, you should sound like a woman (and vice versa).

Watch a video of Caitlyn Jenner (formerly Bruce Jenner) at the end of this article.

So what can be done to try and make the voice sound more consistent with the gender?

Overall, it is easier to make a woman sound like a man and a sex voice change is easier to accomplish  the younger the age.

Step 1: Voice therapy. Essentially, it is to try and learn how to "fake it" without straining the muscles and damaging the vocal cords.

Step 2: Hormone therapy which works reasonably well to make a woman sound more like a man analogous to what a boy goes through during puberty. In fact, in the early days of hormone replacement therapy, a not unusual side effect was masculinization of the voice.

Step 3: Surgical intervention. The human vocal pitch is determined by 4 factors: vocal cord thickness, vocal cord tension, vocal cord length, and airway diameter.

The first three factors (vocal cord thickness, tension, and length) can be understood by comparison to a violin string. The thinner the string, the higher the pitch. The tighter the string, the higher the pitch. The shorter the string (by tightening it), the higher the pitch. The final factor, airway diameter, can be understood by analogy to an organ pipe in which the smaller diameter pipe produces a higher pitch.

You can see all these factors at play in this video:

Female to Male Voice Surgery
  • Decreasing the length of the vocal cords Laryngoplasty (Isshiki Thyroplasty Type 3) whereby thin strips of the paramedian thyroid cartilage are removed in order to decrease the front-to-back length of the voicebox (thereby shortening the vocal cords making them thicker). [link]
  • Laryngoplasty (Modification of the Isshiki Thyroplasty Type 3) whereby a central cartilage window of the thyroid cartilage is mobilized and recessed posteriorly with an implant in order to decrease the length of the vocal cords (thereby shortening the vocal cords making them thicker). [link]
  • Botox injection to the cricothyroid muscles (results in the inability of the vocal cords to lengthen). The cricothyroid muscle is responsible for achieving falsetto. Downside if the results are good is that the botox does wear off and reinjection needs to occur every ~3-4 months. If this works reliably, there is a surgical equivalent by cutting the nerve that goes to this muscle thereby permanently paralyzing it.
  • Make the vocal cords thicker. This can be accomplished by injecting collagen into the vocal cords (thereby making it thicker)
Male to Female Voice Surgery - Keep in mind that this is harder to accomplish reliably compared with Female to Male surgical procedures.
  • Stretching the vocal cords to make them thinner via cricothyroid approximation
  • Decreasing the length of the vocal cords by creating an anterior glottic web
  • Laryngofissure approach accomplished by excising half the vocal cord lengths and reattaching thereby making the vocal cords both shorter and tighter.
Note that there is no surgical procedure that can change the airway diameter. As such, a sex voice change may not entirely sound completely natural even if vocal cord surgery has been performed to perfection.

** Please note that our office no longer performs transgender vocal cord surgical procedures.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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