Read this article aloud. No, seriously. Read these words and all the words that follow out loud. While you do that, listen to the sound of your voice. Do you like it?  Do you think it matches your gender or is it higher or lower than you think it should be? If you’re a trans woman or a cisgender woman with a voice so low that you’re frequently misgendered during customer service telephone calls, Voice Feminization Surgery might be something to consider. Never heard of it?  Well, sit back, sip your lemon water and continue reading. 

In the last five years or so, the internet, friend circles and clinicians who provide care to the trans community have been flooded with chat about Voice Feminization Surgery. Until about five years ago, anyone seeking to surgically change the pitch of their voice would have had to grab their passport and head for Seoul, South Korea. 

As far back as 1999 the Yeson Voice Center in Seoul began successfully performing the surgeries, with the majority of their patients traveling from the United States, the U.K. and Canada. What exactly is Voice Feminization Surgery?  According to the Mayo Clinic, there are two frequently used surgical options for raising voice pitch: Anterior Glottic Web Formation and Cricothyroid Approximation. 

Anterior glottic web formation surgery creates a web or scar band at the front of the V of the vocal cords (anterior commissure). This shortens the vocal cords to help raise voice pitch. Anterior glottic web formation affects frequency range by eliminating the ability to produce lower pitches. It also narrows the airway to some degree. As a result, this surgery might be less appropriate for vocal professionals and, perhaps, serious athletes.

Cricothyroid Approximation Surgery fixes the cricoid cartilage to the thyroid cartilage, elongating the vocal cords. This results in a higher speaking pitch and a reduction in the ability to lower pitch. However, studies have found that this technique doesn’t have a lasting effect.

Physician Assistant Wesley Thompson of Amity Medical Group, an independent family medicine practice with three locations in the Charlotte area, engages and treats many trans patients. Wesley has been dedicating his time to practicing Transgender Healthcare and HIV medicine for 35 years. 

Thompson shared his thoughts about surgical voice alteration: “[Trans] clients, generally trans women, often ask about Voice Feminizing procedures. It’s a little risky, and often people can end up with a raspier voice than expected. So, I typically recommend a speech therapist. A speech therapist can train you how to speak with more feminine inflection and coach you in feminine verbiage and language.”  

He also pointed out that Voice Feminizing Therapy is more than surgery; it includes teaching people how to style their speech through vocal coaching. Thompson stated that the reason the majority of interested clients are trans women is largely because trans men who undergo testosterone therapy experience a thickening of their vocal cords, which lowers the pitch of their voices. This decreases the need or desire for any surgical modification. 

CoCo Gabrielle Channel is a local trans woman with a unique voice. Channel doesn’t have a problem with anyone who might elect to have surgery to alter their voices, but it’s not something she plans to do.

“I’m not interested in going to someone to teach me how to talk or [have] surgery. It might work for someone else, but it’s not for me. For me, it comes naturally to raise my pitch (or lower it) when I’m presenting as a woman. People accept it because it doesn’t sound phony or fake. People say I have a unique voice and respect me [for] not being fake or deceitful.”  

In Channel’s opinion, “Many trans women, especially in the Black community, already know how to control their voices.”

Also, a lot of guys who are attracted to trans women of color, care more about how trans women look than how they sound. According to Channel, an identifiable trans voice is often considered appealing for the many individuals who find trans women desirable. “Voice is part of your packaging, who you are, and that’s what they’re attracted to: who you are as a trans woman.”  

The pitch of our voices is measured in hertz (Hz). According to the Mayo Clinic, the average frequency of an adult male’s voice is approximately 107 to 120 Hz.  For females it is 189 to 224 Hz. However, voices perceived as female are most often about 165 Hz. As one might imagine, these frequency numbers aren’t the only numbers of concern for those considering surgical voice modifications. Cost is also a factor. Surgery can run from $8,000 to over $27,000, varying by surgeon, location and technique and may not be covered by health insurance. Fortunately, things are changing and options are increasing. 

Though many disparities still exist regarding the provision of inclusive health care, “Across the country, health insurance companies are increasingly recognizing the need to end systemic denials of lifesaving gender-affirming health care for transgender people,” said Noah Lewis, director of the Trans Health Project at TLDEF, in a press release.

North Carolina Health News, an independent, not-for-profit, statewide news organization dedicated to covering health care in North Carolina recently reported the following: “The nationwide trend to remove the exclusion of gender-affirming care follows President Joe Biden’s May declaration that the Department of Health and Human Services will prohibit discrimination [against] LGBTQ people by health care organizations that receive federal funding.”

In addition, a June 2020 Supreme Court decision found that discrimination based on sexual orientation and gender identity at work violated federal civil rights laws. As inclusive civil rights legislation expands, LGBTQ community members will have greater access to affirming care ­— a big deal for those who just want to live their lives in a manner that feels comfortable and genuine, one octave at a time.