Voice feminization surgery is a type of gender affirming surgery that can help raise the pitch of a person’s voice.

Voice surgery can help increase the pitch of a person’s voice. Voice therapy is typically included alongside surgery to help a person change the fundamental frequency and resonance of their voice.

This article takes a deeper look at voice feminization surgery. It explains the different types and uses of surgery. It also goes over what to expect before, during, and after the procedure.

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Voice can be a large part of a person’s identity. Being misgendered due to the sound of one’s voice or having a voice that does not match one’s sense of self can have significant effects on a person’s quality of life.

Voice surgery is one option to change the voice’s pitch. Voice feminization surgery is a procedure that can help an individual have a higher pitch in their voice.

Voice feminization surgery helps raise the pitch by changing the vocal cords. This may include:

  • altering their tension
  • shortening their length
  • decreasing their mass

Surgery only addresses pitch. Gender perception of a person’s voice often involves more than just this one facet.

Voice therapy

Typically, vocal surgery also includes voice therapy. It may occur before and after surgery with a speech-language pathologist.

Voice therapy can help a person with other gender affirming communication factors, such as voice volume. Other ways voice therapy can help include:

  • Nonverbal cues: These cues include eye contact and gestures.
  • Intonation: This is the way a person’s voice rises and falls.
  • Resonance: This is the tone and fullness of a person’s voice.

Learn about gender affirming care.

There are various types of voice feminization surgery. Each surgery either shortens the vocal cords, tightens them, or both.

The different types of voice feminization surgery include:

Type of surgeryWhat it involves
Feminization laryngoplasty with thyrohyoid elevation (FemLar)• removes part of the thyroid gland cartilage, which makes the Adam’s apple and larynx (voice box) smaller
• removes a portion of the vocal cords
• shortens the pharynx (throat)
• lifts the voice box
Laser-assisted voice adjustment (LAVA)• uses various lasers to vaporize and burn parts of the vocal cords
• during the healing process, the tension on the cords increases
Vocal fold shortening and retrodisplacement of the anterior commissure (VFSRAC)• removes some of the vocal fold tissue and stitches the ends together
• increases tension and decreases vibratory length to raise the pitch

Many people undergo voice therapy before considering surgery. However, many individuals have difficulty maintaining or achieving their desired pitch following therapy. Around 19% of transgender women consider surgery after completing therapy.

Overall eligibility may vary from state to state. Generally, it may include the following:

  • completion of voice or speech therapy
  • evaluation and consultation with an otolaryngologist
  • be living in a gender role that matches their gender identity for 12 months
    • exceptions include being unable to live in that gender identity due to personal safety concerns

Gender affirming hormone therapy is not a requirement for voice feminization surgery.

Insurance coverage

Commercial health insurance rarely covers gender affirming voice surgery and therapy. A 2021 review examined 150 insurance companies. Only 2.7% of those companies had favorable policies.

The review recommends further investigation regarding the reasons most insurance plans do not cover these types of treatments for transgender individuals.

Learn why gender affirming care is important.

After voice surgery, people generally require up to 30 days of voice rest. They are also advised not to yell or whisper for 6 months after surgery.

Individuals may experience raspiness in their voice for around the first 6 months following surgery.

Generally, there is little to no pain following the procedure. People can take over-the-counter (OTC) pain medication, such as ibuprofen (Advil) or acetaminophen (Tylenol) for any discomfort.

Healing begins within the first 3 months. It can take up to 12 months for a person to fully heal and for the extra effort to use their voice to fade.

For a positive outcome, individuals can follow all their surgeon’s instructions.

Any surgery has risks and complications. The potential complications of voice feminization surgery include:

  • infection
  • decreased vocal range
  • decreased clarity or irregularity of voice
  • less than desired change or no change in pitch
  • dysphagia, or discomfort when swallowing
  • deepening of pitch over time
  • scarring or puckering at incision site

Managing these complications may include voice therapy, steroid injections, or further surgery.

The following are answers to questions people frequently ask about voice feminization surgery.

How effective is vocal feminization surgery?

Recent reviews and meta-analyses show positive outcomes for voice feminization surgery.

Is voice feminization permanent?

Voice feminization surgery is generally long lasting, even permanent. There is a slight chance some people will experience a deepening in pitch over time, so further surgery may be required.

LGBTQIA+ resources

To discover more evidence-based health information and resources for LGBTQIA+ individuals, visit our dedicated hub.

Was this helpful?

Voice feminization surgery is a type of gender affirming surgery that increases the pitch of a person’s voice.

Generally, surgery is combined with voice therapy to address other aspects of a person’s voice, such as intonation and resonance.

A person typically needs 30 days of voice rest after surgery and 6 months without yelling or whispering. They may notice changes in their voice within 3 months. However, it can take up to 12 months for a full recovery.

A person can speak with a healthcare professional about voice feminization surgery and potential risks or complications.