What to Know About Vocal Feminization Surgery

The evolution of the voice is an important factor for many trans people. For trans men, vocal change often begins with hormone therapy. The introduction of testosterone will cause a physical change to occur in the vocal folds. However, the results are not the same for trans women who undergo voice feminization hormone therapy. The anti-androgens and estrogens used will not alter the voice, so some mtf people may choose vocal feminization surgery to help achieve their goals. Today we are going to discuss the basics of feminization surgery, as well as non-surgical methods, so you can better understand which option is best for you. Here’s what to know about vocal feminization surgery:

What happens during surgery?

The goal of feminization surgery is to raise the overall timbre of the voice, thereby creating a more feminine quality. So what does that mean exactly? Most mtf people will naturally have the ability to create both low and high sounds. Typically, low sounds are perceived as more masculine, and high sounds as more feminine. Surgery will eliminate your ability to create ultra low sounds, allowing your middle and high voice to take center stage. The overall impression of the voice will now be higher, and more feminine.

The most common types of surgery are Anterior Glottal Web Formation, and Cricothyroid Approximation (CTA). In Anterior Glottal Web Formation, a web is created between the vocal folds, shortening their length. As a result, the vocal folds will lose their ability to create the low-sounding pitch that is often associated with the masculine voice. The overall timbre of the voice will now sound higher and more feminine.

In CTA surgery, the cricoid cartilage is attached to the thyroid cartilage, causing the vocal folds to elongate. The effects of this are similar to Anterior Glottal Web Formation: a higher sounding voice and a reduction in the ability to create low pitch. However, studies have found that the effects of this surgery are not long lasting.1

What to expect after surgery

As with any surgery, unwanted side effects can occur. The voice could become too high in pitch. It could become too rough, or overly breathy sounding. In addition, vocal surgery will sometimes cause a narrowing of the airway, making it less desirable for some singers and athletes.

The results of surgery will vary widely depending on what type of surgery you choose, and whether or not you incorporate voice training. While surgery can successfully eliminate low-sounding pitch, it is not enough to create a completely feminine sounding voice. Why? Because there are more layers to feminization than just pitch. Other important elements, such as bright tone, subtle nasalization, and crisp diction will be achieved by changing your speech/singing patterns with voice training. This training is a crucial part to achieving success after surgery.

Feminization surgery is not right for every transgender woman. You may want a more neutral voice, or you may prefer to develop your voice using voice training and therapy exclusively. Each person is different and has unique path that is right for them.

Non-surgical methods for feminization

For those who choose to bypass surgery, voice training can be a powerful tool for vocal transformation. With precise and consistent training, individuals can learn to craft their vocal sound into whatever they prefer: masculine, feminine, neutral, or any other desired option.

So how does it work?

For most people, training will begin with learning about your resonance chambers. Within the body, there are three chambers where the voice resonates (vibrates). How we use these chambers when we speak and sing will determine the quality of the voice.

voice feminization surgery
The three resonance chambers, called R1, R2, and R3, are highly mutable, and respond with great sensitivity to changes in vocal technique. The R1 chamber is located inside your neck, and is commonly referred to as the “primary gender control knob” of the voice. How it is used will have a profound effect on the perceived gender of the voice. If you put your hand lightly around your neck and swallow, you will feel something move. This is your larynx. The larynx (also called the voice box) is a cartilage structure that holds the vocal folds. It moves up and down inside R1 when we speak and sing. When R1 is expanded, the larynx will drop, causing the voice to sound lower and more masculine. By contrast, when R1 is constricted, the larynx will move upwards, causing the voice to sound higher and more feminine. Most people will not be aware that their larynx is moving constantly, and they will have little to no ability to control it. Through careful practice, the R1 chamber can be trained to maintain a more constricted position, keeping the larynx high and allowing the voice to naturally assume a more feminine quality.

R2 is the chamber inside your mouth, and it is largely controlled by the position of your tongue. When the tongue is flat against the bottom of the mouth or pulled back into the throat, the space inside R2 increases. When the tongue is pulled forward, or brought close to the roof of the mouth, the space inside R2 decreases. Learning to control the amount of space inside R2 will help individuals harness feminine qualities like brightness, and subtle nasalization. Learning to control the tongue can also help the larynx to stay in a raised position.

R3 is the area between the tip of the tongue and the lips. If used correctly, it can amplify the choices we make in R1 and R2 by further sharpening our pronunciation, brightness and general clarity.

As you embark on your journey of vocal training, it’s important to remember to guard your vocal health. Changes in the voice should happen gently and gradually. Pushing these changes to happen too quickly can result in vocal injury, and will often lead to a voice that is harsh and uncomfortable. Working closely with a voice coach will enable you to integrate these methods in a healthy manner.