Gender-Affirming Voice Surgery: Considerations for Surgical Intervention

Christopher D. Dwyer; Sarah L. Schneider; Desi Gutierrez; Clark A. Rosen

doi:10.1055/s-0043-1761948

Seminars in Speech and Language, Table of Contents

Semin Speech Lang 2023; 44(02): 076-089
DOI: 10.1055/s-0043-1761948

Data-Based Articles

Gender-Affirming Voice Surgery: Considerations for Surgical Intervention

Christopher D. Dwyer

¹Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts

,

Sarah L. Schneider

²Department of Otolaryngology - Head and Neck Surgery, UCSF Voice & Swallowing Center, University of California San Francisco, San Francisco, California

,

Desi Gutierrez

²Department of Otolaryngology - Head and Neck Surgery, UCSF Voice & Swallowing Center, University of California San Francisco, San Francisco, California

,

Clark A. Rosen

²Department of Otolaryngology - Head and Neck Surgery, UCSF Voice & Swallowing Center, University of California San Francisco, San Francisco, California

› Author Affiliations

Abstract

The purpose of this article is to provide an overview of the current state and available evidence surrounding surgical voice care for the transgender and/or gender expansive population. The term “gender expansive” has been proposed as an inclusive term to classify those who do not identify with traditional gender roles but are otherwise not confined to one gender narrative or experience. We aim to review indications and candidacy for surgery, surgical procedure options for altering vocal pitch, and typical postoperative expectations. The role of voice therapy and considerations for perioperative care will also be discussed.

Keywords

transgender - voice care - gender-affirming care - voice surgery - glottoplasty

Full Text

References

References
1 Coleman E, Radix AE, Bouman WP. et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health 2022; 23 (Suppl 1): S1-S259
2 Davies SGJ. Clinical aspects of transgender speech feminization and masculinization. Int J Transgend Health 2006; 9: 167-196
3 Nolan IT, Morrison SD, Arowojolu O. et al. The role of voice therapy and phonosurgery in transgender vocal feminization. J Craniofac Surg 2019; 30 (05) 1368-1375
4 Wolfort FG, Dejerine ES, Ramos DJ, Parry RG. Chondrolaryngoplasty for appearance. Plast Reconstr Surg 1990; 86 (03) 464-469 , discussion 470
5 Berg M, Fuchs M, Wirkner K, Loeffler M, Engel C, Berger T. The speaking voice in the general population: normative data and associations to sociodemographic and lifestyle factors. J Voice 2017; 31 (02) 257.e13-257.e24
6 Bultynck C, Pas C, Defreyne J, Cosyns M, den Heijer M, T'Sjoen G. Self-perception of voice in transgender persons during cross-sex hormone therapy. Laryngoscope 2017; 127 (12) 2796-2804
7 Hancock A, Colton L, Douglas F. Intonation and gender perception: applications for transgender speakers. J Voice 2014; 28 (02) 203-209
8 Hillenbrand JM, Clark MJ. The role of f (0) and formant frequencies in distinguishing the voices of men and women. Atten Percept Psychophys 2009; 71 (05) 1150-1166
9 DeVore EK, Gadkaree SK, Richburg K. et al. Coverage for gender-affirming voice surgery and therapy for transgender individuals. Laryngoscope 2021; 131 (03) E896-E902
10 Young VN, Yousef A, Zhao NW, Schneider SL. Voice and stroboscopic characteristics in transgender patients seeking gender-affirming voice care. Laryngoscope 2021; 131 (05) 1071-1077
11 Freese R, Ott MQ, Rood BA, Reisner SL, Pantalone DW. Distinct coping profiles are associated with mental health differences in transgender and gender nonconforming adults. J Clin Psychol 2018; 74 (01) 136-146
12 Coulter RWS, Bersamin M, Russell ST, Mair C. The effects of gender- and sexuality-based harassment on lesbian, gay, bisexual, and transgender substance use disparities. J Adolesc Health 2018; 62 (06) 688-700
13 Day JK, Fish JN, Perez-Brumer A, Hatzenbuehler ML, Russell ST. Transgender youth substance use disparities: results from a population-based sample. J Adolesc Health 2017; 61 (06) 729-735
14 Speech-Language-Hearing Association. Use of Endoscopy by Speech-Language-Pathologists: Position Statement. 2008
15 Azul D, Arnold A, Neuschaefer-Rube C. Do transmasculine speakers present with gender-related voice problems? Insights from a participant-centered mixed-methods study. J Speech Lang Hear Res 2018; 61 (01) 25-39
16 Azul D. Gender-related aspects of transmasculine people's vocal situations: insights from a qualitative content analysis of interview transcripts. Int J Lang Commun Disord 2016; 51 (06) 672-684
17 Azul D. Transmasculine people's vocal situations: a critical review of gender-related discourses and empirical data. Int J Lang Commun Disord 2015; 50 (01) 31-47
18 Azul D, Nygren U, Södersten M, Neuschaefer-Rube C. Transmasculine people's voice function: a review of the currently available evidence. J Voice 2017; 31 (02) 261.e9-261.e23
19 Cosyns M, Van Borsel J, Wierckx K. et al. Voice in female-to-male transsexual persons after long-term androgen therapy. Laryngoscope 2014; 124 (06) 1409-1414
20 Damrose EJ. Quantifying the impact of androgen therapy on the female larynx. Auris Nasus Larynx 2009; 36 (01) 110-112
21 Deuster D, Di Vincenzo K, Szukaj M, Am Zehnhoff-Dinnesen A, Dobel C. Change of speech fundamental frequency explains the satisfaction with voice in response to testosterone therapy in female-to-male gender dysphoric individuals. Eur Arch Otorhinolaryngol 2016; 273 (08) 2127-2131
22 Deuster D, Matulat P, Knief A. et al. Voice deepening under testosterone treatment in female-to-male gender dysphoric individuals. Eur Arch Otorhinolaryngol 2016; 273 (04) 959-965
23 Hancock AB, Childs KD, Irwig MS. Trans male voice in the first year of testosterone therapy: make no assumptions. J Speech Lang Hear Res 2017; 60 (09) 2472-2482
24 Van Borsel J, De Cuypere G, Rubens R, Destaerke B. Voice problems in female-to-male transsexuals. Int J Lang Commun Disord 2000; 35 (03) 427-442
25 Zeigler A, Henke T, Helou LB. Effectiveness of testosterone therapy for masculinizing voice in transgender patients: a meta-analytic review. Int J Transgenderism 2018; 19: 25-45
26 Gelfer MP, Tice RM. Perceptual and acoustic outcomes of voice therapy for male-to-female transgender individuals immediately after therapy and 15 months later. J Voice 2013; 27 (03) 335-347
27 Branski RC, Verdolini K, Sandulache V, Rosen CA, Hebda PA. Vocal fold wound healing: a review for clinicians. J Voice 2006; 20 (03) 432-442
28 Park C, Brown S, Courey M. Trans Woman Voice Questionnaire Scores highlight specific benefits of adjunctive glottoplasty with voice therapy in treating voice feminization. J Voice 2021; S0892-1997 (21)00256-3
29 Rapoport SK, Park C, Varelas EA. et al. 1-Year results of combined modified Wendler glottoplasty with voice therapy in transgender women. Laryngoscope 2022;
30 Chang J, Brown SK, Hu S. et al. Effect of Wendler glottoplasty on acoustic measures of voice. Laryngoscope 2021; 131 (03) 583-586
31 Casado-Morente JC, Benjumea-Flores FL, Romero-Gómez B. et al. Comparison between two surgical techniques for increasing vocal pitch by endoscopic shortening of the vocal folds. J Voice 2022; S0892-1997 (22)00165-5
32 Roblee CV, Mendes C, Horen SR, Hamidian Jahromi A. Remote voice treatment with transgender individuals: a health care equity opportunity. J Voice 2022; 36 (04) 443-444
33 Kim HT. A new conceptual approach for voice feminization: 12 years of experience. Laryngoscope 2017; 127 (05) 1102-1108
34 Isshiki N. Phonosurgery. Japan: Springer Tokyo; 1989
35 Song TE, Jiang N. Transgender phonosurgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2017; 156 (05) 803-808
36 Van Damme S, Cosyns M, Deman S, Van den Eede Z, Van Borsel J. The effectiveness of pitch-raising surgery in male-to-female transsexuals: a systematic review. J Voice 2017; 31 (02) 244.e1-244.e5
37 Van Borsel J, Van Eynde E, De Cuypere G, Bonte K. Feminine after cricothyroid approximation?. J Voice 2008; 22 (03) 379-384
38 Schwarz K, Fontanari AMV, Schneider MA. et al. Laryngeal surgical treatment in transgender women: a systematic review and meta-analysis. Laryngoscope 2017; 127 (11) 2596-2603
39 Orloff LA, Mann AP, Damrose JF, Goldman SN. Laser-assisted voice adjustment (LAVA) in transsexuals. Laryngoscope 2006; 116 (04) 655-660
40 Koçak I, Akpınar ME, Cakır ZA, Doğan M, Bengisu S, Celikoyar MM. Laser reduction glottoplasty for managing androphonia after failed cricothyroid approximation surgery. J Voice 2010; 24 (06) 758-764
41 Wendler J. Vocal pitch elevation after transsexualism male to female. Proceedings of the Union of the European Phoniatricians 1990
42 Aires MM, de Vasconcelos D, Lucena JA, Gomes AOC, Moraes BT. Effect of Wendler glottoplasty on voice and quality of life of transgender women. Rev Bras Otorrinolaringol (Engl Ed) 2021; S1808-8694 (21)00134-8
43 Remacle M, Matar N, Morsomme D, Veduyckt I, Lawson G. Glottoplasty for male-to-female transsexualism: voice results. J Voice 2011; 25 (01) 120-123
44 Mastronikolis NS, Remacle M, Biagini M, Kiagiadaki D, Lawson G. Wendler glottoplasty: an effective pitch raising surgery in male-to-female transsexuals. J Voice 2013; 27 (04) 516-522
45 Thomas JP. Feminization laryngoplasty - a comprehensive approach to reducing the size of the larynx and pharynx. Otolaryngol Clin North Am 2022; 55 (04) 739-748
46 Nuyen BA, Qian ZJ, Campbell RD, Erickson-DiRenzo E, Thomas J, Sung CK. Feminization laryngoplasty: 17-year review on long-term outcomes, safety, and technique. Otolaryngol Head Neck Surg 2022; 167 (01) 112-117
47 Thomas JP, Macmillan C. Feminization laryngoplasty: assessment of surgical pitch elevation. Eur Arch Otorhinolaryngol 2013; 270 (10) 2695-2700
48 Bultynck C, Cosyns M, T'Sjoen G, Van Borsel J, Bonte K. Thyroplasty type III to lower the vocal pitch in trans men. Otolaryngol Head Neck Surg 2021; 164 (01) 157-159
49 Kocak I, Dogan M, Tadihan E, Alkan Cakir Z, Bengisu S, Akpinar M. Window anterior commissure relaxation laryngoplasty in the management of high-pitched voice disorders. Arch Otolaryngol Head Neck Surg 2008; 134 (12) 1263-1269
50 Tucker HM. Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 1985; 94 (6, Pt 1): 547-549
51 Webb H, Free N, Oates J, Paddle P. The use of vocal fold injection augmentation in a transmasculine patient unsatisfied with voice following testosterone therapy and voice training. J Voice 2022; 36 (04) 588.e1-588.e6
52 Hembree WC, Cohen-Kettenis PT, Gooren L. et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. Endocr Pract 2017; 23 (12) 1437
53 Hembree WC, Cohen-Kettenis PT, Gooren L. et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017; 102 (11) 3869-3903
54 Safer JD, Tangpricha V. Care of the transgender patient. Ann Intern Med 2019; 171 (10) 775-776
55 Titze IR, Palaparthi A, Mau T. Vocal tradeoffs in anterior glottoplasty for voice feminization. Laryngoscope 2021; 131 (05) 1081-1087
56 Oles N, Darrach H, Landford W. et al. Gender affirming surgery: a comprehensive, systematic review of all peer-reviewed literature and methods of assessing patient-centered outcomes (Part 2: Genital Reconstruction). Ann Surg 2022; 275 (01) e67-e74
57 Gross M. Pitch-raising surgery in male-to-female transsexuals. J Voice 1999; 13 (02) 246-250
58 Anderson JA. Pitch elevation in transgendered patients: anterior glottic web formation assisted by temporary injection augmentation. J Voice 2014; 28 (06) 816-821
59 Meister J, Hagen R, Shehata-Dieler W, Kühn H, Kraus F, Kleinsasser N. Pitch elevation in male-to-female transgender persons - the Würzburg approach. J Voice 2017; 31 (02) 244.e7-244.e15
60 David AP, Knott PD, Rosen CA, Young VN, Park AM, Seth R. Clinical feasibility and efficacy of the externally scarless transoral chondrolaryngoplasty. Facial Plast Surg Aesthet Med 2022; 24 (S2): S41-S43
61 Banuchi VE, Helman SN. Scarless neck feminization: chondrolaryngoplasty through endoscopic transoral vestibular approach. Laryngoscope 2022;
62 Khafif A, Shoffel-Havakuk H, Yaish I, Tordjman K, Assadi N. Scarless neck feminization: transoral transvestibular approach chondrolaryngoplasty. Facial Plast Surg Aesthet Med 2020; 22 (03) 172-180
63 Chung J, Purnell P, Anderson S, Hoelke C, Bender-Heine A, Lambert HW. Transoral chondrolaryngoplasty: scarless reduction of the Adam's apple. OTO Open 2020;4(03):2473974 × 20938299