Voice feminization surgery raises the pitch of your voice, making it sound higher. The procedure changes the length, tightness or size of your vocal cords. Transgender women or transfeminine people may choose to have this surgery as part of their transition. Healthcare providers recommend voice feminization therapy before and after surgery.
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Voice feminization surgery is a type of gender affirmation surgery to raise the pitch of your voice (how high or low it sounds). Surgery permanently changes your vocal cords so your voice sounds higher.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Your vocal cords (also called vocal folds) are bands of soft tissue in your larynx (voice box). Qualities like how thick or long your vocal cords are control their pitch. On average, men and people assigned male at birth (AMAB) have vocal cords that produce lower pitches than women and people assigned female at birth (AFAB).
During voice feminization surgery, a laryngologist shortens, thins or tightens your vocal cords permanently to give you a higher pitch.
Voice feminization surgery helps some transgender women and transfeminine people raise their pitch so their voices better align with their gender identity.
You may also choose to have surgery to raise your pitch if you:
You can. Voice feminization therapy can help you raise or lower your vocal pitch and shape your sound to express yourself the way you’d like. It’s an alternative to surgery, which changes your voice by changing your vocal cord structure. Typically, therapy is recommended before surgery because it’s low-risk and reversible. It helps people manifest their vocal gender identity on its own or in combination with surgery.
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Most trans women who have surgery work with a speech-language pathologist to receive voice therapy beforehand. It’s also a good idea to continue therapy after surgery to help adjust to your voice changes.
About 1% of transgender women have voice feminization surgery. More people (about 14% of transgender women) choose nonsurgical voice feminization therapy instead.
Most people do voice feminization therapy before surgery. A speech-language pathologist (SLP) works with you on:
Your surgeon and SLP will also make sure you don’t have any existing voice disorders that could prevent a successful surgery.
For some procedures, your laryngologist operates using a thin, lighted tube (laryngoscope) that goes into your mouth and reaches back to your larynx. Other procedures require incisions (cuts) on the outside of your throat.
You’ll receive general anesthesia no matter the procedure. This medicine puts you to sleep so you don’t feel pain during surgery.
There are different approaches to voice feminization surgery, including:
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The time you’re in surgery depends on the specific procedure. The most common type, anterior glottal web formation, typically takes one to three hours.
Your laryngologist and SLP care team will follow you closely after your procedure. Depending on the procedure you choose with your care team, you may have additional minor procedures to get the best results. You’ll likely need a period of voice rest (no speaking) immediately after the surgery for five to 14 days. You may also need to do additional SLP therapy to maximize the effect of the procedure.
Voice feminization surgery is usually outpatient. This means you’ll likely get to go home the same day as your procedure.
The major benefit of voice feminization surgery is that you can achieve a pitch that more closely matches your gender identity. Many people who have the procedure consider it an important part of transitioning.
Unlike voice therapy alone, surgery can:
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Voice feminization surgery can successfully raise your pitch. Of the different procedures, anterior glottal web formation raises pitch the most. The final results will depend on how high or low your pitch is before surgery.
Still, success depends on your treatment goals. How high or low someone’s voice is only accounts for about 40% of how we perceive gender based on speech and communication. The other 60% comes from things you learn in voice therapy, like loudness, resonance, pitch variation and nonverbal cues.
This is why it’s so important to talk with your laryngologist and SLP before surgery so everyone’s on the same page about what a successful voice transition means for you.
Risks of voice feminization surgery include:
Although it’s rare, surgery can lead to conditions like:
Working with a laryngologist who regularly performs voice feminization surgery reduces your risk of complications. Ask your healthcare provider about potential risks based on the type of procedure they recommend for you.
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It may take six months to a year for your vocal cords to fully heal and your voice to adjust. Don’t feel frustrated if your voice doesn’t sound as you hoped right away. In time, you’ll be able to hear the full results of your higher pitch.
After voice feminization surgery, you’ll need to be on vocal rest for five to 14 days. This means no talking (not even whispering!), laughing, singing or coughing. Be prepared to communicate with text messages or notes.
During recovery, you may need acetaminophen (Tylenol®) to help with pain from common side effects like a sore throat. You may need to eat soft foods only for the first few weeks.
Usually, within two to three weeks after surgery, you’ll meet with your laryngologist to see how you’re healing. They can advise you on next steps during this appointment, like when it’s safe to continue voice therapy. They’ll let you know when you need your next check-up.
Most people notice major changes in how they sound within the first six months and then again at the one-year mark.
Before leaving the hospital, make sure you know what side effects to expect and which changes are signs of a complication or an emergency.
Go to the emergency room (ER) immediately if you’re:
Most people who get voice feminization surgery have tried voice therapy but haven’t felt completely satisfied with increases in pitch. But surgery is a big step. Even if you know your voice should sound higher to feel more like you, you may still wonder, “Is it worth it?” The short answer may feel frustrating: It depends on you and your goals.
Making sure you and your care team are aligned on your transition goals is the best thing you can do to ensure you get the voice care you deserve. This is why it’s such a good idea to work with a laryngologist who specializes in gender affirmation care. They can help you understand what results to expect from surgery and which changes will require working with a speech-language pathologist (SLP). The care team you assemble makes all the difference when it comes to what counts as a successful surgery.
Last reviewed on 04/01/2024.
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