Voice Issues: Surgical Solutions for Women with Masculine Voices

Regarding voice issues?

I am a female, but my voice sounds like a boy's, and I am often called "sir" on the phone.
I would like to know if there are any surgical options to improve this issue, as it is really troubling me.
Additionally, I cannot speak for long periods without feeling fatigued in my throat, and I often experience a sensation of swelling.
I previously had gastroesophageal reflux disease, but I have since recovered.

Mi, 20~29 year old female. Ask Date: 2021/04/25

Dr. Ji Zhaoyun reply Otolaryngology

Hello, for the situation you described, it is recommended to undergo a laryngoscopy to rule out any masses or other vocal cord lesions, as well as to consider medication treatment.
In addition to medication, please observe the following daily care tips: avoid lying down for two hours after eating, and limit the intake of coffee, tea, cigarettes, alcohol, fried foods, and spicy foods.
Additionally, try to avoid excessive, rapid, loud, high-pitched, or breathy sounds, as these can help improve symptoms.
If it is confirmed that there are no vocal cord lesions and you are following the above care recommendations but symptoms persist, you may consult an otolaryngologist who specializes in voice therapy.
Wishing you peace and good health.
Ministry of Health and Welfare Taichung Hospital.

Reply Date: 2021/04/25

More Info

Voice issues can be a significant concern for individuals, particularly for those who identify as women but have voices that are perceived as masculine. This situation can lead to feelings of discomfort and frustration, especially when it affects daily interactions, such as being misgendered over the phone. Fortunately, there are surgical and non-surgical options available to help address these concerns.

Surgical Options
1. Voice Feminization Surgery (VFS): This is a surgical procedure specifically designed to raise the pitch of the voice. The surgery typically involves altering the vocal cords to create a higher frequency of sound. Surgeons may shorten the vocal cords or modify the surrounding structures to achieve the desired pitch. It's essential to consult with an experienced otolaryngologist (ENT specialist) who specializes in voice surgeries to discuss the potential outcomes and risks.

2. Thyroplasty: This procedure involves modifying the thyroid cartilage to change the tension and length of the vocal cords. By adjusting these parameters, the pitch of the voice can be altered. This surgery is often performed in conjunction with voice therapy to help patients achieve the best results.

3. Vocal Cord Injection: In some cases, injecting materials into the vocal cords can help improve voice quality and pitch. This is a less invasive option compared to traditional surgery and may provide temporary results.

Non-Surgical Options
1. Voice Therapy: Before considering surgery, many individuals benefit from working with a speech-language pathologist who specializes in voice therapy. This therapy can help individuals learn techniques to modify their speech patterns, pitch, and resonance. Regular practice can lead to significant improvements in voice quality and reduce vocal fatigue.

2. Hormonal Therapy: For some individuals, hormone therapy may play a role in voice changes. Estrogen and anti-androgens can affect the vocal cords and may lead to a more feminine voice over time. However, the effects vary from person to person, and it is essential to discuss this option with a healthcare provider.

Costs and Considerations
The cost of voice feminization surgery can vary widely depending on the surgeon's expertise, the complexity of the procedure, and the geographical location. It's crucial to inquire about the total costs, including pre-operative assessments, the surgery itself, and post-operative care. Many insurance plans may not cover these procedures, so it's essential to check with your provider.

Risks and Side Effects
As with any surgical procedure, voice surgery carries risks, including infection, scarring, and changes in voice quality that may not meet expectations. Some individuals may experience complications that could lead to a voice that is not as high-pitched as desired or may require additional surgeries.

Conclusion
If you are experiencing vocal fatigue and discomfort, it is crucial to seek a comprehensive evaluation from an ENT specialist. They can assess your vocal cords' condition, discuss your symptoms, and recommend appropriate treatment options tailored to your needs. Whether through surgery, voice therapy, or a combination of both, there are pathways available to help you achieve a voice that aligns with your identity and enhances your confidence in social interactions. Remember, the journey to finding your voice is personal, and support from healthcare professionals can make a significant difference.

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