Voice Feminisation Surgery


Voice Feminisation Surgery



Voice feminisation surgery

Female voice has a higher pitch compared to male voice. However, pitch is only one aspects. Intonation, resonance, vocal quality and articulation are all important aspect of the feminine voice. Language, voice loudness and non-verbal communication all play part in the social perception of a person as female.

During puberty, a born-male person develops a larger larynx (voice box) with longer vocal cords (14mm in males vs 10 mm in females). In addition, under the effect of testosterone the muscle bulk within the vocal cords increases. The longer, bulkier vocal cords vibrate at a lower fundamental frequency (pitch). The average speaking fundamental frequency of adult males is approximately 107 to 120 Hz, while for females it is 189 to 224 Hz. Voice pitch over 165Hz is generally perceived as female voice.

The fundamental frequency of the vocal cords (as with strings in a musical instrument) is related to their length, bulk and tension. Surgical pitch increase can be achieved by changing these parameters. The bulk of the vocal cords can’t be reduced once a person has gone through puberty, so surgery will aim to either shorten the cords (glottoplasty) or increase tension (cricothyroid approximation).


The aim of this procedure is to adjust the proportions of the vocal cords. Female vocal cords are shorter than male. Glottoplasty reduces the length of the vibrating segment of the cords leading to higher pitch.

The procedure is performed endoscopically via the mouth with no external wounds or scars. Using CO2 laser, the lining of the front part of the cords is removed and the two sides are sutured together (diagram at the top of the page). The voice can be further fine-tuned using the laser to ‘tighten’ the vibrating segment of the cords.

Cricothyroid approximation (CTA)

This procedure increases the tension of the vocal cords, in the same way guitar strings are tightened, leading to increase in pitch. The procedure will involve placing permanent suture between the cartilages of the voice box via an open surgical approach under general anaesthesia.

CTA can achieve greater pitch elevation compared to glottoplasty however the results can be more variable. The procedure will be an appropriate first option in individuals with really deep voice or if reduction of Adam’s Apple is required as the two operations can be combined.

Tracheal shave (Adam’s Apple reduction)

This can be a stand alone procedure or combined with CTA. The procedure will give a feminine contour of the neck. The degree of the reduction is limited by the position of the vocal cords as damage to the attachment of the vocal cords (anterior commissure) will lead to permanent damage of the voice.

Female to male transgender voice

Surgery to lower the voice is rarely required in female to male transgender as testosterone hormonal treatment will lead to structural changes of the vocal cords lowering the pitch. However, there are surgical options available including division of the cricothyroid muscle or Type 3 (relaxing) thyroplasty.

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