Voice feminization: surgery or speech therapy ?

For some years now, it has become increasingly common to hear of voice feminization, not only for transgender women, but also for cisgender women who have a deep voice and the voices of actors, actresses, or comedians who seek to increase the elasticity and plasticity of their voices when embodying different female roles.

There are currently different voice feminization techniques:

  • speech therapy
  • tonal augmentation surgery (ENT surgery)

But what is currently the best solution?

What is the most reliable and effective voice feminization technique?

Which is the least dangerous, the one that offers the most guarantees?

In this article we will try to review the pros and cons of each of them.

Feminize not only the voice, but also the way of speaking, and communicating.

As a speech therapist specialized in feminization of the voice for 15 years, I have worked with all kinds of transgender female patients, cisgender women, actors, and various others of all different ages and with different medical and clinical histories. I have worked with several dozen patients having undergone vocal cord surgery (Wendler’s Glotoplasty, LAVA, transposition of the previous committee, etc.) and with patients who present totally healthy vocal cords.

In 2005 I created a speech therapy methodology called the Astudillo Method, that allows a voice to be feminized in 20 minutes and automated in 15 sessions. An effective intervention that is perpetuated without regression respecting the vocal cords of the patient and without surgical intervention. This method requires 3 months of work at a rate of 30 minutes per session and involves constant daily work and personal practice. It is clear that in the face of this, surgery can be seen as an “easier” or “faster” solution, however, speech therapy can afford to guarantee very good results, without regression and ensure the respect of the vocal cords without risk of injury. It must also be said that full recovery (scarring, reduction of inflammation, etc.) will not be reached until six months and sometimes almost a year after surgery and that surgery always needs pre and post-operative treatment at the speech therapy level; all this without guaranteeing the desired results.

SURGERY: feminization or tonal increase?

Regarding surgical intervention, it must be said that the term “voice feminization surgery” is not entirely appropriate. It is indeed a surgery to increase the height of the voice, that is, a surgery to increase the fundamental frequency (central note of the speech). But femininity cannot be summed up on a mere high note. Indeed, the concept of femininity and feminine voice encompasses other parameters such as expressiveness, emotions, rhythm, and miming.

When we are faced with a patient who has undergone surgery on the vocal cords in search of a tonal increase, we usually find the following side effects (based on my own professional experience):

  • A decrease in the maximum training time (TMF) that is explained by the reduction of the air space between the vocal cords.
  • A reduction in projection capacity and intensity during speech due to this reduction in airspace between the vocal cords.
  • A total or partial loss of vocal extension to both bass and treble, directly affecting the melodic aspect of the voice and speech.
  • A loss of the head voice or difficulty reaching or maintaining it.
  • Patients complain of not having enough air when they speak. The speech is choppy, the inspirations that are appreciated during the speeches are very pronounced, the patient complains generally of a shortness of breath.

From a speech therapy point of view, we are faced with a pathological voice..

From a social point of view, this type of voice can sometimes be considered by society as feminine on its side or its aerial sound. But be careful, if you are a woman looking for a more feminine voice, you cannot discard the emotional aspect of your voice, nor leave aside the involvement of your body and your personality during the speech. If thanks to surgery you gain some high notes when you speak, it will not act at all on your global femininity or on your facial or body expressiveness. Here we are faced with too narrow a definition of the concept of femininity since a female voice cannot be summed up as a simple tonal increase.

On the other hand, it is important to take into account the fact that this type of surgery is too recent to know the effects on your voice in the long term, especially regarding aging of the vocal cords and larynx. Currently, no surgeon can predict what your voice will be like 10 years after having surgery.

Other effects of surgery that should be mentioned since they affect your social and professional life:

    • Una A general anesthesia is necessary (hospitalization, rest, etc.)
  • Un A vocal rest of 7 to 10 days is imposed by the surgeon after surgery. During this period, you will not be able to speak or cough (watch out for stitches that may come loose).
  • After vocal rest, your voice will be hoarse and dysphonic (healing phase, inflammatory picture, antibiotics) and depending on each patient, this effect can last several months depending on the healing of each one.

The surgeon will give you an appointment for a a postoperative review after one or two months (depending on the surgeon) and will advise you to consult a speech therapist or speech therapist after the intervention (and sometimes also in the best case before the intervention).

But do you know why? Do you really understand the importance of speech therapy or speech pathologist intervention after surgery?

Postoperative speech therapy intervention

It is important to point out that in recent years, post-surgical speech therapy treatment has always been, in short, a “re-education of the vocal gesture” seeking to cure the side effects of surgery, rather than being a feminization treatment of the voice itself. It is important to understand the side effects on healthy vocal cords of surgical techniques called “feminization” (previously cited) to understand at what level the speech and language pathologist should intervene.

The main objective of the speech therapist or the Speech Pathologist during post-surgical treatment is not focused on the feminization of the voice itself, but rather on a search for rebalancing the vocal gesture, especially at the respiratory level:

  • The first step will be to reestablish a pneumo-phonic coordination that will allow the patient to feel less choked when speaking,
  • reduce air loudness during speech to increase vocal quality as well as intelligibility,
  • palliate the decrease of the inter-chordal space by increasing the approach of the vocal cords (increase sound, reduce air),
  • reduce the added muscle tensions during the vocal gesture both at the vocal level, body level,
  • and to develop the head voice in a search to increase the vocal extension in order to increase the melody during the speech and consequently, achieve more femininity.

Regarding preoperative treatment, it will consist mainly of developing the patient’s local potential and proving that speech therapy techniques will suffice to obtain a more feminine and natural voice. If, despite this, the patient decides to undergo a surgical intervention to increase her tonality, she should still be prepared to perform voice feminization exercises that will be carried out during postoperative treatment.

After a brief analysis, if you wish to undergo a tonal augmentation surgery, such as Wendler’s Glotoplasty for example, we advise you to consult a speech therapist or speech pathologist first in order to assess your vocal potential before making your decision. Indeed, vocal cord surgery currently offers you no guarantee of femininity. And what is sure, is that the side effects previously mentioned in this article can appear all at once or only some, but you will never know how to predict with certainty what the post-surgical vocal result will be.

Mariela ASTUDILLO RAMIREZ

Speech therapist specialized in voice feminization

Whatsapp: 0034 625 14 46 47

Email: contacto@femivoz.es

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