Voice feminization surgery is a procedure that alters your vocal cords so that your voice sounds more typically feminine.
Some trans women, transfeminine people, and other gender-expansive folks may opt for voice feminization surgery when medically transitioning. As such, voice feminization surgery is a type of gender affirming care.
Because certain vocal characteristics are associated with gender, many trans and gender-expansive people undergo voice training or voice surgery to make their voices sound more typical of their gender. A cisgender woman may also have voice feminization surgery to make their voice sound more typically feminine.
Some people turn to voice training instead, which is done with a speech therapist, and decide they don’t want surgery. Whether you opt for surgery depends on your personal transition goals.
- Cricothyroid approximation: This procedure, which is the most common type of voice feminization surgery, tenses and lengthens the vocal folds by stitching the cricoid cartilage closer to the thyroid cartilage.
- Anterior commissure advancement or Wendler glottoplasty: These methods involve shortening the vibrating length of the vocal folds by suturing your anterior vocal tissues together.
- Laser-assisted voice adjustment: During this procedure, a carbon dioxide laser destroys pieces of the vocal folds, making them smaller and tenser.
- Laser reduction glottoplasty: In this surgery, a carbon dioxide laser destroys the anterior part of the vocal folds, which are then sutured so that they become tense.
The type of voice feminization surgery you undergo will depend on your:
- personal transition goals
- current vocal pitch
- anatomy, age, and overall health
- surgeon’s experience and expertise
Before you undergo voice feminization surgery, your surgeon should explain exactly which method they’re using and what happens during the procedure.
Society associates certain voice characteristics with certain genders. For example, deep voices are typically associated with men.
If you have a voice that doesn’t match what’s typical of your gender identity, it might trigger gender dysphoria. It might also make it difficult to “pass” as your gender — meaning that people assume you’re not your gender — if that’s something you’d like to do.
Some trans women, transfeminine people, and other gender-expansive folks want their voices to sound more typically feminine.
Estrogen hormone therapy doesn’t affect the voice, so you might have to do voice training (also known as voice therapy) or have voice feminization surgery in order to sound more feminine.
Voice therapy is done with a qualified speech therapist who has training in helping gender-expansive people alter their voices. In some cases, you might achieve your desired voice with voice therapy alone. However, you might decide you’d like to undergo voice feminization surgery, too.
Voice feminization surgery can increase the pitch of your voice. It can:
- reduce the effort it takes for you to maintain the voice you’d like
- make your voice sound more authentically high-pitched
- help you avoid mistakenly lowering your voice
You’ll likely need speech therapy before and after your surgery to help you care for your vocal cords and adjust your voice to meet your goals. Surgery alone doesn’t always change the voice exactly how you might want. However, this is a matter of personal choice.
It’s important to note that not all trans and gender-expansive people aim to alter their voices. If you’re happy with your voice, or if you choose not to change it, that’s perfectly valid — your transition journey is unique to you!
You might need medical clearance from your primary physician before you can get voice feminization surgery. If you have a chronic medical condition, such as a history of heart disease, your surgeon might ask you to undergo testing to make sure you’re healthy enough for the surgery.
Certain kinds of voice feminization surgeries are typically not recommended for people over age 40. This is partly because, as you age, you lose elasticity in certain tissues, which makes the healing process more difficult and less predictable. However, you may still have other options.
You do not need to have had other gender affirming surgeries before voice feminization surgery. It’s recommended that you do not have any surgery that requires a general anesthetic and a “breathing tube” for at least 6 months following voice feminization surgery, since this can affect how your vocal cords heal.
If you smoke, some surgeons recommend that you stop smoking before the surgery. This is because smokers’ vocal tissue takes longer to heal.
Your surgeon might also recommend undergoing speech therapy before and after surgery to maximize your results and educate you on how to care for your vocal cords as they heal.
In the United States, voice feminization surgery starts at around $5,500 and can increase to $9,000 or more. This does not include fees for speech therapy, overnight stays in the hospital, or any additional costs.
Voice feminization surgeries are not covered by government or private medical insurance. This means that Medicare and Medicaid do not cover voice surgeries.
You might find assistance programs that can help you pay for voice feminization surgery (and other kinds of gender-affirming care), such as:
Some healthcare practices might offer payment plans and assistance programs to make voice surgery more accessible.
Before you have voice feminization surgery, you’ll meet with your surgeon and care team to:
- discuss your medical history (including any chronic health conditions and current medications)
- discuss your transition goals and what you want your voice to sound like
- assess your current vocal cords, often through a videostroboscopy (viewing the voice box with a scope)
- determine a care plan, which may include speech therapy as well as a plan for surgery
Your surgeon and speech therapist may suggest that you undergo speech therapy before and after surgery. This can help you maximize your results so that you can achieve your desired voice, or at least get very close to it.
You may also be asked to stop smoking if you smoke and to drink plenty of water to keep your vocal cords healthy. They might also suggest avoiding alcohol if you drink, because alcohol can affect your vocal folds.
In short, the following will happen during voice feminization surgery:
- A healthcare professional will give you general anesthesia.
- In order to access your vocal cords, your surgeon may either use a laryngoscope (a small tube that goes through your mouth) or make an incision on your neck to directly access your throat.
- Depending on the type of surgery you and your surgeon have discussed, they will either stitch cartilage together (cricothyroid approximation) or stitch anterior vocal tissues together (anterior commissure advancement or Wendler glottoplasty). If you’ve opted for laser-assisted surgery, a carbon dioxide laser will vaporize specific parts of the vocal folds to make them tenser.
Voice feminization surgeries last roughly between 1 and 3 hours. The length of the surgery depends on the type of surgery you get.
All surgeries have potential complications, and it’s important to be aware of the risks before you agree to the surgery.
The risks of voice feminization surgery include:
- difficulty speaking, especially for the first 6 to 12 months
- fluid buildup in your vocal cords (edema)
- enlarged Adam’s apple (which could be addressed with a tracheal shave)
- scarring on the voice box
- scarring outside the throat
- vocal cord dysfunction
- vocal fold paralysis
There is also a risk that your voice will either sound too high or not high enough. Although an experienced surgeon will do what they can to give you a moderate increase in pitch, other factors can affect how your voice ends up sounding.
These factors include:
- your age and individual anatomy
- how your postoperative recovery goes
- whether you smoke or vape
- the health of your vocal cords
- whether you do speech therapy before or after surgery (or both)
It’s important to remember that it can take up to 12 months for your vocal cords to heal fully and your new vocal pitch to emerge. If it’s not what you wanted, or if you’d like to change other aspects of your voice, consider contacting a speech therapist who does voice training for transgender people.
Although voice feminization surgery has its risks, it can be hugely beneficial to your mental wellness. It’s up to you to decide whether the cost and risks are worth it.
Changes in voice
Surgeons usually recommend going on “vocal rest” for about 30 days. This gives your vocal cords the chance to heal. Talking during this period can affect how your tissues heal, causing permanent damage to your vocal cords. After vocal rest, you can use your voice mostly as usual for 6 months, avoiding yelling and singing.
After vocal rest, your voice won’t immediately sound more feminine — in fact, your voice will sound hoarse and strange while it heals. Surgical laryngitis, as it’s called, usually resolves within 12 weeks.
According to the Center for the Care of the Professional Voice, your voice might be hoarse for the first 6 months. You’ll likely notice a change in your voice at the 6-month mark, but your voice will continue to change for up to a year after surgery. It will likely feel harder to speak initially, but this feeling will go away after 6 to 12 months.
Post-operative pain is usually managed with ibuprofen and acetaminophen. You typically don’t need to stay in the hospital overnight, although this depends on the hospital’s policy. A cool compress may be used on your throat after surgery.
As for scarring after voice feminization surgery, the neck incision is usually small. After the stitch is removed, you can shower, but be gentle when washing and drying your scar. Once it heals, you can use anti-scar cream if you’d like.
Voice feminization surgery can increase the pitch of your voice, helping you sound more typically feminine. For trans and gender-expansive people, this can help reduce gender dysphoria and produce a voice that’s more congruent with your identity.
If you’re considering voice feminization, you could start by consulting a speech therapist who specializes in voice training for transgender people. Voice therapy can produce noticeable results with minimal risks. However, if voice therapy doesn’t produce the changes you’d like, voice feminization surgery might be a good option to consider.
Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.