The Role of Therapy in Voice Feminisation Therapy: What You Need To know

If you’re considering voice feminisation surgery such as glottoplasty, you might be wondering why your surgeon recommends voice therapy before and after surgery.  The truth is, in the vast majority of cases, it maximises the surgical outcomes.

More people work to feminise their voice through voice therapy alone.  As a recognised core procedure in the NHS, trans feminine clients can be referred for this or seek the assistance of a private Voice specialist SLT.  With therapy alone, a high proportion of individuals achieve their goals.  However, of all the treatments trans fem clients seek or undergo, voice therapy is the least passive, involving a commitment to course of treatment and a little patience!  A couple of sessions alone or a few attempts to self -modify with training videos is rarely enough.

Voice surgeries for trans individuals were not included as a core procedures in the NHS trans services protocol.  However, there is now a greater availability of voice feminisation surgeries in the private sector. The most popular is a glottoplasty involving shortening the vocal folds.  Wouldn’t a surgery specifically designed to lift the voice pitch be enough to feminise it? This is the hope of many individuals – a quicker route to the desired outcome.  

In reality, as for any surgery to the vocal folds, the voice needs to be rehabilitated after surgery.  All vocal surgeries require a period of vocal rest after (no talking for one week in the case of glottoplasty) and then a gradual build of the voice. Voice rehabilitation post-surgery should begin approximately 2 weeks after surgery.  The next phase, over the next 4-6 weeks involves voice rehabilitation exercises with the specialist SLT, gradually building up the strength and function of the voice.  

Typically, vocal hoarseness is the main presenting side effect of the surgery. The amount varies form person to person but it is a prevalent feature in the first month after surgery. The post-surgery rehab exercises aim to work with the altered vocal cord mechanism to raise pitch, by aiming to reduce hoarseness and working on resonance placement.  Without resonance balance, larynx discomfort can occur and the surgical outcome tends to be more limited.   

Whilst surgery primarily changes pitch, other voice fem aspects including intonation variation and speech delivery style are largely enhanced through voice training/therapy guidance. The ‘therapy’ aspect of voice therapy is crucial and often overlooked.   

One of the main reasons individuals do not progress through the stages of voice feminisation surgery is that the confidence levels may not grow, even when fem voice is achieved.  There may also be a struggle adjusting to, or using the changed voice. Part of a voice therapists role is to help support clients through the the voice change process.

Voice use is largely linked to social activity; having the confidence to use voice in the variety of life’s social settings is the true success of those seeking voice modification.  Vocal confidence development is therefore a vital part of voice change. It often takes more time than people think to achieve this vocal comfort – even after voice surgery.    

In the quest to speed up the process of achieving a female voice, many hope that voice therapy beforehand can be skipped.  Outcomes demonstrate however that pre-surgery voice gains with therapy maximise any surgical pitch gains in pitch.

Pre-surgery voice therapy aims to safely modify the voice according to the clients self-defined goals – in a manner that does not cause vocal strain or hoarseness. The later goals of voice training and therapy work to develop voice flexibility and the ability to project the voice safely when required. Therapy for these elements becomes even more crucial post-surgery to minimise loss of volume, intonation and vocal strain, known initial side effects of pitch surgery.  

For individuals seeking voice feminisation surgery, considering a combined approach with therapy before and after will maximise any surgical benefits.  Therapy enhances the protection and potential of the voice and seeks to eliminate hoarseness and build vocal strength. Whilst a majority continue to achieve their voice goals with specialist therapy alone, a combined approach for some individuals can be an effective option, particularly those who have struggled with pitch. For some people, voice surgery provides a psychological boost which allows them to then focus on further voice exploration. 

For those interested in learning more about voice therapy alone, there are resources available to explore this option. Ultimately whether opting for surgery, therapy alone or a combination of both, the goal is to achieve a voice that comfortably aligns with one’s identity and expression.