Voice Therapy V.S. Voice Feminisation Surgery

Unveiling the truth: voice therapy v.s surgery

In the realm of voice feminisation currently, more surgeons now offer pitch raising surgery. The most common of these is glottoplasty which involves surgery to shorten the length of the vocal cords (also known as vocal folds). The allure of surgery can be tempting yet the reality is that full voice feminisation is possible for most individuals who seek appropriate voice therapy.  In this blog post, we’ll delve into the intricate world of voice modification and explore why prioritising specialist voice therapy is a strategic choice.

The profound impact of expert voice therapy

There’s no doubting that effective outcomes are often reliant on expert level practitioners delivering the treatment.  Only some Voice Specialist SLTs (Speech & Language Therapists) work with gender affirming voice.  When it comes to realising your vocal aspirations, investing in an experienced clinician can lead you to the voice you’ve long envisioned.  This, together with a little time, motivation and confidence building are the key elements required.

Confidence is not often discussed but is a pivotal element in successful voice modification.  Nobody goes from low confidence to high confidence levels overnight. Confidence grows over time, and with specialist, guidance and a sound voice programme.  There are sticking points in any course of therapy, voice or otherwise where progress seems to stall – a voice therapist’s support can help you navigate through these and get to the next level.  It’s usually at the ‘sticking points’ that the allure of surgery can grow stronger.  

Why voice surgery to feminise voice can be tempting 

Voice feminisation surgery allure holds the promise of a quick fix – go in for surgery, come out with a feminine voice. Who doesn’t like the idea of achieving something with less work? The advancement in surgical techniques has been a welcome development but as for all surgeries, it is not totally risk free. A loss of vocal power or range can be possible trade offs after surgery as well as a possible  degree of hoarseness. 

It can be that previous therapy tried by the client hasn’t been specialist enough to assist them to the level of voice change desired.  Some may have dabbled with modifying their own voices or followed the advice of various YouTube tutorials and found they could not effect any significant voice change.   Individuals may harbour doubts about how effective voice therapy can actually be or doubt what they themselves would be capable of achieving.   Contrary to these reservations, there is a body of evidence attesting to the value of voice therapy as a standalone solution. 

A little courage and a sound voice programme

In my own practice, we gather stats from all our clients going through the Antoni Method voice programmes at baseline (session 1), intermediate and end stage intervals. These include average pitch but also subjective data – how the client themselves actually feels about their voice pre and post treatment.  Voice recordings show the perceptual voice changes that occur.  Services that can provide this type of evidence can help clients believe in the possible effectiveness of voice therapy.  Client experience and testimonials also help build a clients trust so that they don’t have to take a clinician’s word for it – they can hear it from others who’ve been through the process.

Recently, a client named Gina realised her voice goals in 8 sessions of therapy.  What makes her case especially valuable as an example is that like so many other clients, she had avoided seeking voice therapy out of total fear. Although fully socially transitioned for three years, she reported at session one that “I didn’t want to try voice therapy in case I failed. By not doing it, I felt like I was avoiding possible failure”. Over time however, Gina felt her voice didn’t align with who she was and found the courage to try therapy.  She described the experience of voice therapy as having been “as important as hormone therapy for me – it’s made such a huge difference, especially to my confidence”.  Not only did Gina achieve her voice goals, she did it in less sessions, before completing the full core voice programme. It can often be the case that individuals do a lot better that they think with therapy and it isn’t always a slow process – for some, things can change quickly.

The voice feminisation voyage

Voice change is a deeply personal journey, and it affects each person differently.  Lack of self-belief and limited awareness of the range of acceptable possible voice outcomes are common. They can be  effectively addressed and steered through with the help of an experienced voice therapist.  The journey tends to be as important as the destination because of the self-learning that takes place and personal security this can bring.  

It may be true that the older you get, the more challenging voice change may be, but it always tends to yield some benefit and certainly worth trying before considering surgery.    Speech therapy is not only more cost effective, a full course of treatment typically costing one fifth of the price of surgery, it also provides crucial supported voice practice opportunities – the very thing that tends to make the most difference.  Individuals who find that they could not advance their voice journey far enough, in spite of completing their course of therapy, have the option of considering voice surgery.  It can be especially indicated for those who prefer a higher pitch than they have been able to achieve via their efforts with therapy alone.  Joint ENT and SLT working is optimal for all clients who have voice feminisation surgery.  Voice therapy  can maximise  surgical gains and vice versa – sometimes a combined approach provides the optimal voice outcome

In conclusion: The value of speech therapy

  • Aims to eliminate any vocal roughness or hoarseness – this is strongly recommended  before any surgery takes place
  • Can achieve the level of voice change required for a majority of clients without the need for surgical intervention, including safe voice projection 
  • Helps develop social confidence and comfort using your voice
  • Whereas voice feminisation surgery primarily elevates the pitch of the voice, voice specialist speech therapy works on many feminine voice elements such as resonance and intonation and vocal tone
  • For any clients who do go on to have surgery, voice therapy can help maximise the potential benefits from surgery
  • Voice therapy can help individuals to build voice projection ability post surgery
  • Any post- surgery hoarseness or voice difficulty can usually be successfully remediated with specialist voice therapy.  (Note not all Voice Specialist SLTs have experience with this, so research your clinician/service)