Research Article| Volume 34, ISSUE 1, P63-68, March 2023

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Gender-affirming voice surgery: Pitch elevation

  • Joseph Chang
    Address reprint requests and correspondence: Joseph Chang, MD, Department of Head and Neck Surgery, The Permanente Medical Group, 710 Lawrence Expressway, Department 296, Santa Clara, CA 95051.
    Department of Head and Neck Surgery, The Permanente Medical Group, Santa Clara, CA
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Published:January 18, 2023DOI:
      Voice and communication are a critical contributor to gender presentation. Various options are available for gender affirming voice care depending on the needs of the patient, and include hormone replacement therapy, voice therapy, and voice surgery. Despite a traditionally poor reputation, more recent literature has shown voice surgery, particularly anterior glottoplasty, to be a low risk and effective treatment for pitch elevation that may be considered as an adjunct to voice therapy.


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        • James SE
        • Herman JL
        • Rankin S
        • et al.
        The report of the 2015 U.S. transgender survey [Internet].
        National Center for Transgender Equality, Washington, DC2016 ([cited 2022 May 30] Available from:)
        • Leung Y
        • Oates J
        • Chan SP.
        Voice, articulation, and prosody contribute to listener perceptions of speaker gender: A systematic review and meta-analysis.
        J Speech Lang Hear Res. 2018; 61: 266-297
        • Simpson AP.
        Phonetic differences between male and female speech.
        Lang Linguist Compass. 2009; 3: 621-640
        • Hillenbrand JM
        • Clark MJ.
        The role of f(0) and formant frequencies in distinguishing the voice of men and women.
        Atten Percept Psychophys. 2009; 71: 1150-1166
        • 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: 2472-2482
        • Azul D
        • Nygren U
        • Sodersten M
        • et al.
        Transmasculine people's voice function: A review of the currently available evidence.
        J Voice. 2017; 31 (261.e9-23)
        • Nygren U
        • Nordenskjold A
        • Arver S
        • et al.
        Effects on voice fundamental frequency and satisfaction with voice in trans med during testosterone treat-a longitudinal study.
        J Voice. 2016; 30 (766.e23-34)
        • Chang J
        • Brown S
        • Hu S
        • et al.
        Effect of Wendler glottoplasty on acoustic measures of voice.
        Laryngoscope. 2021; 131: 583-586
        • Brown S
        • Chang J
        • Hu S
        • et al.
        Addition of Wendler glottoplasty to voice therapy improves transfemale voice outcome.
        Laryngoscope. 2021; 131: 1588-1593
        • Mora E
        • Cobeta I
        • Becerra A
        • et al.
        Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male-to-female transsexuals.
        Laryngoscope. 2018; 128: 2101-2109
        • Yang CT
        • Palmer AD
        • Murray KD
        • et al.
        Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: Results of surgery.
        Ann Otol Rhinol Laryngol. 2002; 111: 477-485
        • Titze IR
        • Palaparthi A
        • Mau T
        Vocal tradeoffs in anterior glottoplasty for voice feminization.
        Laryngoscope. 2021; 131: 1081-1087
        • Rohlfing ML
        • Kuperstock JE
        • Friedman D
        • et al.
        An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery.
        Laryngoscope. 2020; 130: E206-E212
        • Markow M
        • Janecki D
        • Orecka B
        • et al.
        Computational fluid dynamics in the assessment of patients’ postoperative status after glottis-widening surgery.
        Adv Clin Exp Med. 2017; 26: 947-952
        • Kim HT
        A new conceptual approach for vocal feminization: 12 years of experience.
        Laryngoscope. 2017; 127: 1102-1108
        • Anderson JA
        Pitch elevation in trangendered patients: anterior glottic web formation assisted by temporary injection augmentation.
        J Voice. 2014; 28: 816-821
        • Remacle M
        • Matar N
        • Morsomme D
        • et al.
        Glottoplasty for male-to-female transsexualism: voice results.
        J Voice. 2011; 25: 120-123
        • Hong KH
        • Ye M
        • Kim YM
        • et al.
        Functional differences between the two bellies of the cricothyroid muscles.
        Otolaryngol Head Neck Surg. 1998; 118: 714-722
        • Neumann K
        • Welzel C
        • Berghaus A
        Operative voice pitch raising in male-to-female transsexuals. A survey of our technique and results.
        HNO. 2003; 51: 30-37
        • Hamdan A
        Cricothyroid approximation using a silastic sheath: A new approach.
        Middle East J Anaesthesiol. 2012; 21: 909-912
        • Tschan S
        • Honegger F
        • Storck C
        Cricothyroid joint anatomy as a predicting factor for success of cricoid-thyroid approximation in transwomen.
        Laryngoscope. 2016; 126: 1280-1283
        • Kanagalingam J
        • Georgalas C
        • Wood GR
        • et al.
        Cricothyroid approximation and subluxation in 21 male-to-female transsexuals.
        Laryngoscope. 2005; 115: 611-618