About the London Voice and Swallowing Clinic
The London Voice and Swallowing Clinic is a globally renowned centre specialising in voice, airway and swallowing disorders. Mr Chadwan Al Yaghchi is a Consultant Otolaryngologist and ENT surgeon with more than 20 years’ experience and is the country’s leading expert in pitchmodifying procedures, including both voice deepening and voice feminisation surgery.
He is internationally recognised for his expertise in laryngeal framework surgery, thyroplasty techniques, and minimally invasive approaches to altering vocal pitch. His practice combines surgical precision with a deep understanding of voice physiology, allowing him to tailor treatment to each patient’s goals, whether a patient desires a subtle deepening or a more significant change.
Mr AlYaghchi teaches and lectures internationally, contributes to peerreviewed research, and is part of a small group of UK surgeons performing these specialist procedures every week.
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Speech and Language Therapy
Speech and Language Therapy is the least invasive way to achieve a deeper, fullersounding voice. It focuses on how you use your breath, resonance and speaking patterns to create a richer, more grounded sound without altering the vocal folds themselves. This type of voice therapy, involving targeted exercises and techniques, can also be recommended alongside medical options. Therapy is delivered by specialist voice therapists.
Testosterone Injections
Testosterone, injected into the voice box under local anaesthesia, can deepen the voice by thickening the vocal folds. It is a minimally invasive option and involves the following steps as part of a pre-assessment:
- Laryngological evaluation – an endoscopic (camera down the throat) evaluation of the vocal cords
- Pitch measurement – a voice recording is done in the clinic and analysed
- Blood tests – some men may be offered a blood test to check testosterone levels
The treatment is typically a course of four injections, which are spaced out so the doctor can assess the voice deepening progress. Changes, when they occur, develop gradually over several weeks. Most men will need multiple procedures to see a meaningful pitch drop. This is one of the newest methods to achieve permanent voice deepening for men and Mr AlYaghchi has witnessed pitch reduction of around 15-30 Hz in his male patients.
Extended Window Laryngoplasty
Extended Window Laryngoplasty is our preferred surgical technique for most patients. It typically achieves a pitch reduction of up to 30 Hz with a lower risk of longterm roughness or irregularity. A small incision (around three centimetres) is made in the natural skin crease at the front of the neck. A squareshaped window is created in the cartilage of the voice box, allowing the vocal folds to be gently shortened and relaxed. This produces a deeper, richer voice. The procedure is performed under general anaesthesia.
Type III Thyroplasty
Type III Thyroplasty is suitable for men seeking a more substantial pitch drop, typically up to 50 Hz, making it the most powerful option for men seeking voice deepening. It is, in the doctor’s view, the most reliable method for male voice deepening. However because it involves altering the cartilage framework more extensively, it carries a slightly higher risk of vocal ‘roughness’ or reduced projection. A small incision is made at the front of the neck. The thyroid cartilage is divided on both sides so the edges can overlap, relaxing the vocal folds further and lowering the pitch. This procedure can also be performed under local or general anaesthetic.
Recovery and Aftercare
We recommend 48 hours of relative voice rest after all voice deepening procedures. You may speak if needed, but it should be kept to a minimum. Early changes are usually noticeable within days to weeks, although full settling can take several months. Avoid shouting or straining your voice. Most people return to normal voice use gradually over 1-2 weeks.
Testosterone injections can be done in a normal consulting room and appointments are typically no longer than 30 minutes. The injections are given as a course of four injections. It is normal to have a second injection after 2 weeks (and third and fourth injections at two-weekly intervals thereafter to achieve their desired pitch reduction.
Voice deepening surgical options are performed as daycase procedures (most patients go home the same day). The surgical options take around one hour. The patient will have a followup at four weeks and three months, these can be done virtually but at least one appointment must be in person so we can perform an endoscopic examination to ensure healing is progressing as expected.
Case Studies
I cannot recommend Dr Chadwan Al Yaghchi highly enough. From my very first consultation, he made me feel completely comfortable and at ease. He took the time to listen to my concerns, never rushed any appointment, and ensured I fully understood every step of the treatment process.
As a cisgender male seeking vocal cord testosterone injections to help masculinise and strengthen my voice, I felt reassured by Dr Al Yaghchi's expertise and compassionate approach. Throughout my treatment, he carefully monitored my progress, tracking how my voice developed and stabilised over time.
The procedure itself was minimally invasive and performed seamlessly in the clinic. I experienced very little pain and was pleasantly surprised by how straightforward the whole process was. I was back at work within just 1–2 days, with minimal disruption to my daily life.
Since having the injections, my confidence has increased enormously, both personally and professionally. Having a voice that better reflects how I want to sound has made a genuine difference to my everyday interactions and self-confidence.
Dr Al Yaghchi combines exceptional clinical skill with genuine care for his patients. I am incredibly grateful for the positive impact his treatment has had on my life and would wholeheartedly recommend him to anyone considering voice enhancement treatment.
As an older male it was very frustrating to be misgendered on the phone; call handlers would not believe I was the man on the account and it chipped away at my confidence. Friends and family told me I was imagining it, but I was aware that while most men in my family have deep or very deep voices mine hadn’t really changed in puberty.
I work in the finance sector and am a senior and experienced member of my team, but I believe my higher pitched voice (and the fact I look very young for my age) meant I was often interrupted, not listened to or dismissed in meetings. My voice was more like a teenager, than an older male.
I started to see a voice coach and she had an app we could record on and it gives you data on how ‘masculine’ your voice is. My data showed my voice as 40% feminine – it was validating to have the ‘proof’ that I wasn’t imaging it. She recommended that I see Mr Chadwan Al Yagchi, a surgeon who specialises in voice deepening procedures.
I was not keen to have surgery – which carries the risk of lower volume, less projection – but was excited to hear there was a new, less invasive option: testosterone injections in the voice box. Mr Al Yagchi explained that some men miss out on voice deepening during puberty, they don’t have the right peak of testosterone at the right time, which aligned to what I felt. I see the procedure as ‘self-improvement’ about giving me back something I missed out on.
The first injection was an unusual experience. You have a numbing throat spray that makes you cough a little. Then an endoscope is passed down the back of the nose and then the surgeon injects 50mg testosterone into each side of your voice box. For me personally I noticed the biggest drop after that first injection, but it was also the most sore in the day or so after. You have a course of injections every two weeks, my experience was I saw less change than that original big drop in pitch (although the vocal chords were also less sore after the procedure).
I was tested for testosterone levels in the blood, which was important to me as I had a big fear of triggering the male pattern baldness effect. The testosterone in my blood was very, very low – the effect is very much localised to the region.
The biggest surprise is how differently I am treated now – particularly at work – people will say that voice pitch doesn’t make a difference to them, but colleagues act very differently towards me now. I am still the same person with the same experience, but I have that gravitas in my voice and am not cut off mid-sentence and people listen more.
I am very happy with my new voice: I still sound like me, just with a deeper voice that matches my identity more. I feel it’s correcting how my voice should have sounded after puberty. It’s honestly the best thing I’ve done in the last decade and would recommend the procedure to other men who feel insecure about their voice pitch.
Frequently Asked Questions about Voice Deepening Approaches
Speech and Language Therapy
Yes. Therapy can improve resonance, breath support and speaking patterns, which can make the voice sound fuller and slightly deeper. A pitch reduction of about 10-15 Hz can be achieved in most cases.
Most men notice changes over several weeks, but progress varies depending on goals and practice.
For some men, yes - especially those seeking subtle deepening. Others may use therapy alongside or before considering medical or surgical options.
Testosterone Therapy
Testosterone can thicken the vocal folds and deepen the voice in men but the effect varies. Men with either low testosterone or a naturally higher pitched voice tend to see the most dramatic pitch reduction before and after.
No. It is only appropriate after medical assessment. Some men will not benefit from testosterone for voice deepening. Those with habitually deeper voices may not see benefit (as they have learnt how to drop their voice beyond the physiological limit of their cords.
Changes usually occur gradually over few weeks and will depend on how many injections a man has.
No testosterone is injected directly into the vocal cords during a consultation – there is no requirement to take testosterone outside of these appointments.
The treatment is very new and as such there is limited long-term data currently. However, the experiences at the clinic shows sustained vocal deepening, suggesting that testosterone injected into the voice box permanently alters the vocal folds.
Extended Window Laryngoplasty
The incision is placed in a natural skin crease to minimise visibility.
Most men return to normal voice use gradually over one to two weeks.
There is a possibility of some roughness, but the risk is lower than with Type III Thyroplasty.
Most patients describe the recovery as very manageable with standard pain relief, such as Ibuprofen and Paracetamol tablets.
Type III Thyroplasty
It may appear slightly less prominent due to changes in cartilage shape.
No. This procedure can affect pitch control and projection.
No. Performing both can destabilise the cartilage and is not recommended.
Yes. However, if you are taking testosterone, your voice may deepen naturally and surgery may not be necessary. Visit the Voice Masculinisation page for information for trans men.