Voice Feminization Surgery

Year Four begins for me post-voice feminisation surgery (cricothyroid approximation.) I thought I would share my experiences.

My surgery: 22 July 2023

Before I totally dive into my conclusion, it’s only fair I should explain how I got to where I am today. I began with a very low voice around 110hz…Darth Vader territory. Yeah, testosterone took to my throat big time, eh. How much that influenced my outcome is a big question…

A bit of background info on voice feminisation surgery:

I want to “Pass” as female orally; it was never my choice or option to sound male, so this has always been on my list for “Correction” For the first 13 years of my life, like most kids, it wasn’t an issue as boys/girls sounded pretty much the same.

That all changed over a few days… inconvenient for me when it happened during a school trip to Switzerland when I was 13. I left on the trip singing soprano in the school choir and returned as a baritone. For four days, I couldn’t speak at all! For most boys when their voice breaks it is a welcome start in becoming a man. I didn’t see it that way… and, I hated it.

What had happened? Testosterone modified my vocal cords and vocal tract… and it’s permanent. Once done, it can’t be reversed. From then until some ten months ago, it had been my life; living with the voice I disliked intensely.

There is only one way to change it… and that is through surgery. Now, you can modify your voice by training your R1, R2, R3, and vocal cords. I am doing that now. But to make any physical change to the voice, and attempt a revision to the transformation by testosterone, there are two major options available: Open Laryngoplasty and Cricothyroid Approximation (CTA)

CTA: The goal of this operation is to surgically move the thyroid cartilage closer to the cricoid with non-absorbable stitches. The vocal cords are not directly touched but passively stretched. This procedure results in increased vocal pitch by stimulating the contraction of the cricothyroid muscle with the suture. This increases the distance between the vocal fold attachments and raises the tension of the vocal fold.

I had one option

I didn’t choose CTA originally, I wanted Open laryngoplasty. I had signed up and paid for it, however, after a last-minute consultation, the surgeon insisted that laryngoplasty would be too difficult in my case. His recommendation was for CTA.

On the face of it CTA has a much lower risk than Open Laryngoplasty. Should it be needed, it is reversible. The downside is that for 20% of cases it doesn’t improve the pitch. I’ve never considered myself a lucky person, so all I could see was the 20% fail rate, not the 80% success.

If you are considering CTA here are my experiences with the surgery. The bits they don’t tell you in the brochure. The surgery was done under a general anesthetic, and I had no pain or discomfort afterward. For a week after the surgery, you are forbidden to speak, and the dressing on the throat covers the scar. Eating, drinking, and breathing all appeared normal, although the food was tailored to minimise the discomfort in swallowing…which worked. I had a reduction of my Adam’s apple at the same time. Telling people that you have had your Adam’s apple shaved usually gets a wince of empathy, but to be fair, I never noticed any pain or discomfort either then or now.

For a week, I had no way of knowing if I was 20% fail or 80% pass, until I accidentally said, “Morning” to the nurse who came to dress my throat… and I got a clue. I also got a telling-off for speaking. I felt no discomfort and don’t believe it had any effect on the outcome.

One week later

At the end of a difficult week, for many reasons (not to mention having SRS at the same time as CTA,) I got my chance to find out how much my voice had changed. The follow-up consultation and voice test were compared before and after. The result? Very little change.

To say I was disappointed is an understatement. It felt as if my new life wasn’t going to be the one I had banked on. There wasn’t a Plan B. There wasn’t one really, for me surgery had failed and there were no other options. What to do now?

There is a caveat to this tale; voice training was still an option; it was also mentioned the effects from surgery could improve over the next six months. I grasped at that straw…as all do I bet. In reality, some seven months later, it has not sent me into telephone conversations where I am assumed to be female. Misgendering on the phone is the norm rather than the exception: that hurts and is a constant reminder of my unsuccessful CTA.

The moral from my story is, “Don’t assume it’s going to work and don’t put all your Hope eggs in that basket.” I have spoken to others who have had CTA, and from their experiences, I would have to say it appears to be more like an 80% fail rate. Also, pitch certainly isn’t the only aspect of voice feminisation that will create a pass. To the contrary, it is unlikely, in itself, to do that.
My summary of CTA

This is not the end of the story…

It didn’t work for Alex, which is sad, but I wanted to read a success story because I wanted this surgery. For many people, my story is going to be their story. Am I being too negative? Let’s look at it another way. If you are in transition yourself, or thinking of doing so, one thing is going to be painfully clear This isn’t an easy journey. Things don’t always work out in the way you hope.

If you are already on HRT and/or transitioning, you are nodding your head furiously in agreement (or in some countries shaking it side to side) The bottom line is that this is mostly Two steps forward and one step back. In some ways, it is wishful thinking to believe you can change gender with a few surgeries, hormones, or attitudes. You can’t!

Being positive helps but accepting setbacks works

In my opinion, the voice is the No.1 gender switch. If your voice is feminine, almost everything else about you is accepted. Face, body, and mannerisms all fail to feminise you if you speak like a male. In contrast, if you speak and sound like a woman that’s it…enough. They may wonder why you have a beard or big muscles…but they won’t question that you are fundamentally female. Am I wrong…think about it.

So… the notion that a little voice operation will be enough? It isn’t, it won’t change things enough anyway. Now, I might have gotten lucky, and I mean incredibly lucky, and gotten a female voice in one procedure…but as I say, I don’t consider myself a lucky person.

M voice has raised pitch, around 2-3 semitones I’m still around 150hz, so it needs more. It is doable…my surgery wasn’t a complete waste of money (£4k); it has put me on the ladder of feminisation…it has helped. As I understand it, I need to be 180hz to pull off a female voice. 220hz is the said benchmark (A3) but that is beyond me, I think. As long as I stay around 180hz and NOT let my voice drop below 155hz I’m going to pass much of the time.

Vocal feminisation therapy

This is the next step for me. I have trans-women friends who have managed a feminised voice that passes easily. Some have done this without surgery. It is my only option now. I would still have had to do this whether the surgery had worked or not. There is far more to feminising your voice than just pitch. Indeed, the recognised major element is, “Resonance modification.” This alone will make passing easier.

The downside of voice therapy is the cost; it’s not cheap. £150-200p/hr. (in the UK) per session is a general ballpark figure. How many sessions? Twelve is a fair guesstimate. That comes from successful patients that I have heard from. Less than voice surgery you are thinking… yeah it would be.

Which course to choose?

I did try EvaF; the app is really good…sadly, it is not available anymore. It had some really useful tools like a pitch meter and a voice tracker. I understand why it was dropped (personal reasons) but I think the app is still valid on its own…I would pay a little just for that. It actually still works on my iPhone but isn’t available for my Android.