A New Conceptual Approach for Voice Feminization: 12 Years of Experience

Abstract

Objectives/hypothesis: Voice feminization has been developed with various surgical techniques to increase voice pitch. The purpose of this study was to evaluate 12 years of experience using a new endoscopical surgical technique, vocal fold shortening and retrodisplacement of the anterior commissure (VFSRAC) and retraining the voice pattern performed in female patients with androphonia or male-to-female transsexuals.

Study design: Retrospective study.

Methods: A retrospective study was performed on 362 patients who underwent VFSRAC (34 with androphonia, eight with androgenital syndrome, four with aplastic anemia treated with androgens, three with pseudohermaphroditism, and 313 male-to-female [MTF] transsexuals) and phonatory pattern rehabilitation between 2003 and 2014. Subjective and perceptual assessments, aerodynamic and acoustic assessments, and a videostroboscopic assessment were evaluated pre- and postoperatively in the female androphonia group and the MTF transsexual group.

Results: Mean preoperative fundamental frequency (F₀ ) was 144.1 Hz, and mean postoperative F₀ was 207.4 Hz, 6 months postoperatively. The mean increase of F₀ in the female androphonia group was 53.0 Hz but was 73.6 Hz in the MTF transsexual group after the postoperative phonatory pattern retraining program. Voice femininity increased on the postoperative subjective assessment. Acoustic and aerodynamic assessments were within the normal range. Regularity of the vocal fold mucosal wave were maintained in the normal range. These findings suggest that patients could achieve a natural phonation pattern after surgery.

Conclusions: Our new approach for voice feminization, VFSRAC, and retraining of the phonatory pattern was effective for patients who wanted a natural feminine voice.

Level of evidence: 4 Laryngoscope, 127:1102-1108, 2017.

Keywords: Voice feminization; androphonia; glottoplasty; male-to-female transsexual; phonatory pattern; retrodisplacement of anterior commissure; transgender; vocal fold shortening; voice therapy.