Your voice is one of the most fundamental features by which the world around you recognizes and identifies you. Voice is also an important determinant in the perception of a person's gender.
What makes the voice perceived as male or female? It creates a gender specification feature with the subcomponent. One of these is the tone of the voice, that is, the thickness and thinness of the voice. The main features that determine the tone of the voice are the size of the larynx, the thickness, length and tension of the vocal cords. However, only the tone of voice is not the determining factor in whether the voice is perceived as male or female. Many factors, from the size and shape of the rib cage to the shape and size of the pharynx and resonant cavities and the intraoral cavity, play a role in the perception of the voice as male or female. In addition, speaking rate and intonation degree also enable the creation of a voice that is unique to the person. Voice tone, pitch, intonation, and resonance all interact to create the “gender” of the voice.
This situation creates a problem for a transgender person, especially a transwoman, who no longer identifies with the gender she was born with. Apart from the fact that the voice does not define the person, it may also mean that the transwoman continues to be perceived as different due to the existing male voice and therefore continues to be disturbed/harassed.
Voice in transmen
Voice change poses less of a problem for transmen. Testosterone therapy (hormone therapy) applied during the physical "transition" period causes changes in the muscle structure in the body. With the effect of testosterone on the larynx and vocal cord muscles, the transman's female voice tone often reaches a pitch range that can now be perceived as "male".
Voice thickening surgery (relaxation laryngoplasty) can be performed under local anesthesia for transmen whose voices do not deepen sufficiently with hormone therapy and are still perceived as feminine.
Voice therapy can be performed for transmen to make their voices perceived as more "masculine". Resonance and intonation studies can be effective and useful.
Voice in transwomen
Hormonal treatments and voice therapy in transwomen are generally not sufficient for the voice to reach a thinner tone. Surgical treatment is now available here vi becomes necessary. As knowledge about voice alteration surgeries increases, more and more transwomen are going under the knife to change their voices.
The male larynx differs from the female larynx in several ways. Male vocal cords are longer, thicker and have less tension. Considering guitar strings, thick guitar strings produce low/low tones, and thin guitar strings produce high/thin tones. The pitch of the sound created by tuning the guitar strings tighter or looser can be adjusted. Similarly, the voice can be thinned by changing the length, tension and thickness of the vocal cords.
Voice surgeries for transwomen
Different surgeries can be performed on transwomen to give the desired thinness to their voice. In these surgeries, the tension of the vocal cord can be increased, its length shortened or its thickness reduced.
1. Surgery to increase vocal cord tension (Cricothyroid approximation): This is the most common surgical intervention for voice thinning in transwomen. The surgery is performed under local anesthesia through a small incision in the neck. Thus, the appropriate pitch can be determined by listening to the patient's voice during surgery. Here, the laryngeal cartilages are brought closer together, stitched and fixed, and the tension of the vocal cords is increased.
2. Surgery to shorten the length of the vocal cord (Wendler glottoplasty): It is performed inside the mouth, under general anesthesia and under magnification with a microscope. Stitches are placed on the vocal cords to adjust the vocal cord length.
3. Surgery to reduce the thickness of the vocal cord (Laser reduction glottoplasty): It is performed inside the mouth, under general anesthesia and under microscope magnification. During the surgery, the vocal cord layers are thinned and tuned using a laser.
4. This is a very major surgery performed on the neck (Feminization laryngoplasty). It is a surgery in which not only the vocal cords, but also a part of the thyroid cartilage (the cartilage surrounding the vocal cords, where the Adam's apple is located) is removed along with the vocal cords. In this way, the vocal cords are both shortened and stretched.
Aesthetic larynx surgery for transwomen
The shape of the male larynx is different from that of women. neck in men A protrusion called the Adam's apple can be seen in the midline. There is no such protrusion in the larynx in women. In transwomen, it is possible to remove the Adam's apple in the larynx and create a flatter, more feminine, aesthetic neck and larynx area. This surgery is called aesthetic larynx surgery (reduction laryngoplasty). Aesthetic laryngeal surgery does not cause a change in the tone of voice, but it is often performed together with voice thinning surgeries to both thin the voice and create an aesthetically feminine larynx shape in the same session.
In this attempt to shape the Adam's apple, the cartilage surrounding the vocal cords is studied. Permanent damage to the vocal cords may occur as a result of unknowingly excessive interventions on the cartilage. Therefore, aesthetic laryngeal surgery should be performed by Ear, Nose and Throat specialists who have experience in the larynx area. Plastic and aesthetic surgeons, who have extensive experience in plastic surgery, do not have the knowledge, equipment and competence regarding vocal cords and larynx.
Choice of vocal surgery for transwomen
One of the factors that determines whether the voice is as personal as a fingerprint is that the larynx and vocal cords are also personal. Size and shape of the larynx; size and thickness of the vocal cords; Voice tone and range of voice vary greatly from person to person. Therefore, the intervention(s) required for voice thinning in transwomen also varies from person to person and is chosen individually.
While for some transwomen, a single surgical procedure is sufficient to make the voice feminine enough, sometimes more than one surgery must be performed in the same session, and sometimes the surgeries must be performed sequentially, 9-12 months apart. It is essential for the patient to maintain close contact with his physician and share his concerns and expectations openly in order to get through this difficult and long process in good health.
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