Yeson voice feminization surgery

[anjaq]

Amy - this will be great to hear from someone who knows a lot about tones and voices because of being a pro singer and doing that surgery. If you can still sing at that level afterwards, it would be a very good argument for this surgery as this is what people usually say about VFS "you cannot sing, you have a restriced and hoarse voice afterwards". It would be cool if your frieind could prove them wrong. I hope she considers doing before and after recodings and sharing them. Is she in Korea now? then give her my best wishes for the recovery.
Just out of curiousity - are you really from Berlin or is that just a name?

The shift in the breaking point from chest to head voice would be interesting. As I see it now, the VFS cuts off the lower frequencies mainly. As a result average and lowest pitch is going up and you basically have to talk at a higher average frequency to get the benefits from the surgery and still maintain pitch shifts. If that new speaking range then would be in the range where the voice breaks from chest to head voice and it is not possible to change that point as it is determined by vocal tract length - I can imagine this might be quite a problem then as you would be speaking partly in chest and partly in head voice depending on your pitch at that moment and if there is a break, it would be hard to do, so I think that break has to be either shifted or be trained to not sound like a break anymore. Do I get this right, Amy?

[AmyBerlin]

Dear Anjaq -- Yes, I am from Berlin. I'm just using this as a nickname in order not to divulge my last name.

I've got some MP3s of my friend's singing voice, and she probably has tons of material herself, so a direct comparison will be possible at a later date. She's in Seoul right now, and will be for the coming week.

And no, the break does not get in the way of speaking. Because the break (depending on your anatomy) is anywhere between 330 and 390 Hz, there's enough space between that and the 200-230 Hz range, which is the target speaking frequency for women. But from what I gather from post-op sound clips, what happens to the new chest voice after surgery is that its overtone spectrum is also altered to include more higher overtones and less of the lower overtones in which the male voice is so rich.

Thus the discrepancy between chest and head voice doesn't sound that harsh anymore, plus the head voice will "speak" better because of decreased moving mass in the vocal folds. Try it out on a guitar, and play the open B string (which is near feminine speaking pitch). Then play the same note on the G string at the 4th fret, on the D string at the 9th, on the A string at the 14th, and if your guitar allows, on the bottom E string at the 19th. You will see how the same note will progressively sound darker, but also tubbier and punchier. This is exactly the same phenomenon our voices are dealing with.

Myself, I've been using a central speaking frequency of around 200 Hz on a male vocal tract without damaging my voice for the last 20 years. However, it is quite tiring to speak or sing for a long time, and it requires quite drastic resonance modification to boost high and cut lower overtones to approximate the natural female sound. In modulation, I pass the break all the time. If you concentrate on speaking and singing with your jaw quite loose, and at not all too high a volume, you will notice that you can slide past the break quite easily. It feels as though your voice is squeezing past the break in the back of the throat (at least that's my subjective image). So, if I say "Hello, dear", the "-lo" will be above the break and the other two syllables below. If you know what I mean.

Regards,

Amy

[AmyBerlin]

Hi all,

I should maybe clarify that the pitch difference of the crossover in male and female voices is just a minor third on average, according to Sadolin's textbook, and thus much smaller than the overall pitch difference of male and female voices. This implies that a relatively greater segment of the female range is in the head register. This is in part due to the somewhat shorter airway in females (which this surgery does not alter) and the different harmonic content and greater "give" of shorter, lighter vocal folds that allow for a greater approximation to the limit. So I'd probably expect the crossover point to move up a half or whole step, from a musical point of view.

Best wishes to all,

Amy

[Jennygirl]

Amy, I think you are right. If I do nothing to modify resonance (which now means intentionally relaxing and lowering the position of my larynx) my break is somewhere around E4. In HS singing baritone, my break under the same circumstances was anything above D4... So that affirms what you say.

Conversely if use the larynx position that now feels normal for speech, the break occurs around F#4-G4.

I would not be surprised if that is a major contributor to why the outcome still sounds familiar to people instead of a completely different voice?

Also I wanted to thank you for sharing the bit about the guitar. I am sure I'm not alone saying that your insight here is greatly appreciated! Thank you!!

[AmyBerlin]

Dear Jenny,

If I do nothing to modify resonance (which now means intentionally relaxing and lowering the position of my larynx) my break is somewhere around E4. In HS singing baritone, my break under the same circumstances was anything above D4... So that affirms what you say.

Conversely if use the larynx position that now feels normal for speech, the break occurs around F#4-G4.

Precisely. According to Sadolin's theory, larynx position has a direct and immediate bearing on the upper limit of the chest register, so it can be modified to a certain degree. I can also verify that if I sing classical-type music, with low larynx position, I prepare the transition somewhere around B3, and by E4 I'm past the break. If however I sing the blues, I sometimes belt a G4 or Ab4 in full-blown chest register, with the larynx position at its upper limit. I hope to be able to continue both after surgery, with the transition maybe a full or half step higher.

Best wishes,

Amy

[Jennygirl]

Rargh, so interesting! I had no idea about the relation between vocal tract length to chest/head voice break. It makes a whole lot more sense now. Thanks for shedding some light!

[anjaq]

Amy that is interesting though I did not understand all of it.
The guitar example - it measn simulating this procedure by shortening the length of the chord or is it something else you mean?
I totally get how trying to not have the break means to move the larynx in a different position.
So what do you think moves up that breaking point or crossover point from chest to head voice? Is it the change in resonance that we do by pulling up the larynx? Or is it something about the surgery itself?

I am also in Germany by the way. more to the south though, Amy. Since you are in Berlin, did you or your friend consider Dr Gross at the Charité? I looked at his paper and description and it sounded just like Yesons, but I got almost no information from there, email was not replied to, its hard to get in contact with patients and if I ask about it elsewhere i will just get anecdotal evicende that VFS in general or VFS at the Charité is not good - without proof why. So I wonder if he really does the same thing, what could be the difference etc...

[AmyBerlin]

Dear Anja,

let me try to clarify: the guitar example was supposed to show how less vibrating mass (the B string, which is thin) creates a different overtone spectrum, namely one with more, and higher, overtones, than a large vibrating mass (the A or E strings) at the same frequency. This has to do with the stiffness (or inharmonicity) of the string material, and its inertia.

To bypass the break and generally to arrive at a less masculine chest voice, try to keep the lower jaw loose and don't force the tone, don't use very high volumes. This is what Cathrine Sadolin describes in her textbook "Complete Vocal Technique" as "Neutral mode" -- google that, you should find a description.

If you're singing loudly and have to deal with the break, then a higher larynx position will allow for a few more semitones before the break hits. But beware, singing in that area with male vocal folds usually generates a loud and quite masculine sounding tone if you're not being extra cautious. The surgery itself might displace the break for another semitone or two upwards, as Jenny describes.

Whereabouts in South Germany are you from? I was born in Bavaria. This, however, would lead to a private conversation that I don't know how to initiate in this forum. Maybe you can help me.

Regarding Dr. Gross's paper, do you mean Gross, M., Pitch-raising surgery in male-to-female transsexuals, J Voice 13: 246-250 (1999)? The technique indeed sounds identical to Kim's. But unless I've listened to a good bunch of his surgery results, I wouldn't submit to the procedure. My voice is too important to me. A nontrans colleague of mine, also a professional singer, had surgery with him to remove nodules and was very satisfied. I've been playing piano for her before and after, and it improved her voice a whole lot. Regarding trans surgeries, however, I have no idea of his results. There are no audio examples on the Net, no hard evidence that his procedure works and sounds good. OTOH, Kim's results are well-documented.

Regards,

Amy

[AmyBerlin]

Dear Anja,

since I'm living in Berlin and could easily attend a preliminary meeting without undue burden, I'd volunteer to call there and see if they can supply me with any postoperative recordings and/or details about the surgery they're offering, contacts to previous patients as well as the pricing of their procedure.

This would hopefully shed some light on this area as to what the market has to offer and if anything can be recommended or not.

Putting Gross's paper into perspective: he documented surgeries on 10 transwomen.
Their speaking frequency increased from 116.9±2.8 to 201.0±8.9 Hz, a difference of 84.1±8.5 Hz, that is, a generous major 6th. However, at the top, it didn't look all that good, range shrunk on average from 2.7 to 1.9 octaves. Only 1 person showed a range gain. The top note accessible was relatively unaffected in 3 patients, 4 showed considerable treble range gain, the remaining 3 lost range at the top (!). Voice loudness dropped considerably in 4 patients, was relatively unaffected in another 4, 2 showed loudness increases. However, we need to bear in mind that all of these surgeries were performed in 1996 or before, so they represent a dated procedure.

We shall see what they say when I speak to them personally.

Regards,

Amy

[Kaylee]

Dear Anja,

since I'm living in Berlin and could easily attend a preliminary meeting without undue burden, I'd volunteer to call there and see if they can supply me with any postoperative recordings and/or details about the surgery they're offering, contacts to previous patients as well as the pricing of their procedure.

This would hopefully shed some light on this area as to what the market has to offer and if anything can be recommended or not.

Regards,

Amy

Hi Amy,

I would be interested in this as well, as I'm in the UK the option to get VFS in Germany instead of Korea would save me a lot of cash (I could possibly even commute by car/train if I wanted to cut out a lengthy hotel stay!).

I'm sure many others in UK/Europe would be interested in a clinic that can perform Yeson style basically on our doorstep!

[AmyBerlin]

Dear all,

finally I've reached someone at Charité, and set an appointment for mid-February(!). We'll see what they'll have to say.

The information on the website is partially erroneous: e.g. the telephone number +49-30-84452449 is wrong, +49-30-450555125 is correct.

Regards,

Amy

[megan2929]

Jenny: I just wanted to say that you sound like Alyson Hannigan in your Yeson video. Really amazing transformation from your old voice and now you've got me seriously considering this surgery too. I'm only on the fence about timing. I know this surgery would be a huge quality of life improvement, but I am tentatively scheduled for SRS in February and I'm debating which to do first. Ideally I think I'd like the voice surgery first but I worry that when they intubate me for my SRS surgery a few months later that they might damage my throat. On the other hand, if I have SRS first, I probably won't feel up to traveling to Korea for quite awhile so I'd be pushing off the voice surgery for a long time (maybe a year from now). Ack. decisions, decisions.

[anjaq]

Great, Amy!
I have the same concerns there about Dr Gross - they do not provide audio samples. the study was interesting but the results were recorded much less than a year post op. I think it was 2 months or so? So no wonder there was still a lot of voice missing. He also reports that the patients who did voice training afterwards regained their loudness.
Still no audio samples is bad. I sent an email and got no reply at all. But of course - paying $7000 plus travel just to do the same thing but with audio samples is kind of bugging me. But well - I am like you - rather be safe than sorry. My voice trainer said that the ones she heard who were in Berlin for VFS all had some sort of hoarseness or breathyness in the voice. Dont know if that was also within the 1 year. But I am happy that you are volunteering to find out more while  knowing about Yeson!

That tip to get rid of the break into the head voice - it totally works and it sorks great in conjuction with my voice training lessons who are focussing on being more relaxed in the jaw and such. But it only lasts for a while after doing these exercises.

It sounds like you know a lot about voice and still consider this surgery, even after 20 years, thats 5 years more than me. I cannot keep 200 Hz though, it was too straining and left me with some voice issues.

I will write you a PN as well

[AmyBerlin]

Dear Anja,

I just got finished composing a lengthy reply to your message, then the system reset the compose window. So I'll try again, see if I can remember everything and compose this message in an editor window, for safety's sake. For clarity, please let me answer your posting bit-by-bit.

the study was interesting but the results were recorded much less than a year post op.

I'm not sure if we're referring to the same study. Mine (literature quote above) was just 5 pages of text, without any recorded results. Maybe you can send me a link?

But of course - paying $7000 plus travel just to do the same thing but with audio samples is kind of bugging me. But well - I am like you - rather be safe than sorry.

Yes, it's better to play it safe. We've only got one voice, so we should give it the best treatment possible.

But I am happy that you are volunteering to find out more while  knowing about Yeson!

I can't make it to Yeson before May anyway, for scheduling reasons. So I'd need to book the surgery in March. Having the appointment with Gross in mid-February provides ample time to balance the pros and cons and arrive at an informed decision.

That tip to get rid of the break into the head voice - it totally works [...] But it only lasts for a while after doing these exercises.

It takes a while before speaking with a loose jaw becomes second nature. But it will. The loose lower jaw also eliminates much of the masculine sound of the chest register, so it's a worthwhile endeavor to learn the technique.

It sounds like you know a lot about voice and still consider this surgery, even after 20 years, thats 5 years more than me.

Well, a lot of that has to do with who I am as a person. Like many of us, I was aware of my gender dissonance from early childhood, and vocal about it. However, the topic was always rigorously silenced in my family. I also took up music at an early age, starting piano lessons at 5. As a child, I used to sing a lot, and, dare I say, very well. So when male puberty struck, it was absolutely horrific – this was the 80s, with no medical support network in place and literally no-one to turn to. So when my voice deepened, I stopped singing entirely (until my 30s). I ended up with a good baritone, but the voice never really felt like it belonged to me. And to this day, I use it merely as a working, albeit crude and imperfect tool to communicate with the world. It's like trying to knit with Chinese chopsticks for needles. It works, but the tips are too blunt, the taper is working against you and the stitches keep falling off the far end – AARGH! So I studied everything in my grasp about voice, singing and speech in order to still maintain a feminine speaking voice despite the hormonal changes.

I finished high school at 19, in 1994, and moved into my own place where I was safe to explore and finally able to do my research to tackle my transition. The Internet was still far from being a mass medium, so research was still tedious. In fall 1996 I went full-time, receiving HRT in early 1997, and SRS in Munich in early 1998. That was all the treatment available back then, and word about Ousterhout's new FFS had just begun to spread. Being young and reasonably good-looking back then, I skipped FFS, but would later follow through with it with Noorman van der Dussen in Antwerp, when the first (unflattering) signs of not being a spring chicken any more began to appear.

Through this, my feminine voice has served me well, I never had problems passing on the phone and such. But as I get older, it becomes more and more strenuous to maintain the voice quality I've gotten used to. And plus, as my business as a musician expanded, and I had to communicate my musical ideas to singers and choirs, I had to take up singing again. Applying the full force of my armamentarium of vocal technique to the process, I was able to morph my natural baritone into a mediocre alto to – what? – direct a choir in stealth mode. But it's a daunting process, you put in twice the effort for half the result. And you never quite lose the anxiety that something would go wrong, that the voice would slip or break. So I'd give the world for a safe surgical option to fix just that.

I will write you a PN as well

I was able to receive it, but not to reply to it. Something seems to be desperately wrong with my account, I'm not allowed to answer or write personal messages, I can't use an avatar picture, and have only very limited choices in terms of profile settings. Maybe one of you reading this message is a moderator and can help me out. Thanks in advance!

For the time being, Anja, please send me another private message with your email address included, in order for us to communicate that way in the meantime. Thanks!

Hugs,

Amy

[AmyBerlin]

Dear Megan,

Ideally I think I'd like the voice surgery first but I worry that when they intubate me for my SRS surgery a few months later that they might damage my throat.

Yeson's patient information brochure states there should be a waiting period of 2 months before and after VFS without further procedures under general anesthesia.

Regards,

Amy

[AmyBerlin]

Hi all,

a quick addendum to my Reply #834 above: I was notified that my account problems were due to not having posted 15 comments yet. So everything's in order, let's keep the conversation going.

Amy

[Nicolette]

That tip to get rid of the break into the head voice - it totally works and it sorks great in conjuction with my voice training lessons who are focussing on being more relaxed in the jaw and such. But it only lasts for a while after doing these exercises.

If this has been explained in a PM, would you mind explaining this again on this forum? It sounds rather interesting and maybe useful for singing.

[AmyBerlin]

Dear Nicolette,

If this has been explained in a PM, would you mind explaining this again on this forum? It sounds rather interesting and maybe useful for singing.

It is extremely useful for singing. And the discussion was here in this thread. But, to reiterate and expand: If you are at a soft to medium volume, keep your lower jaw loose and you can slide past the break. Right at the pitch when you pass it, you can feel the tone constrict a tiny bit at the back of the throat, but this is barely audible. If you want an edgier, louder tone, there's also a trick to bypass the break: imagine you were holding your breath before you head for the break and keep this "hold" up as you go up or down past the break. This will also slide you past. The tone might get a little bit of a whining, pleading quality the first few times you do it, but this is easily controlled. And if you need super high volume, think more of a scream, not a shout. Screams slide past the break, shouts don't.

And, on an OT note: are you quoting Rabbi Waldenberg's responsum in your signature, in which he recommended that MtF transpeople substitute "shehafchani l'isha" in the appropriate location of the Morning Prayers – "Blessed are you, Lord, [...], who has made me into a woman"? Not that I find the wording totally fitting, but it's a good sign that slowly but steadily, even the Orthodox world is coming around. Keeping Joy Ladin on board is cause for hope. And joy. Chanukkah sameach, by the way!

Regards,

Amy

[Nicolette]

Dear Nicolette,

It is extremely useful for singing. And the discussion was here in this thread. But, to reiterate and expand: If you are at a soft to medium volume, keep your lower jaw loose and you can slide past the break. Right at the pitch when you pass it, you can feel the tone constrict a tiny bit at the back of the throat, but this is barely audible. If you want an edgier, louder tone, there's also a trick to bypass the break: imagine you were holding your breath before you head for the break and keep this "hold" up as you go up or down past the break. This will also slide you past. The tone might get a little bit of a whining, pleading quality the first few times you do it, but this is easily controlled. And if you need super high volume, think more of a scream, not a shout. Screams slide past the break, shouts don't.

Wow, thanks. I have postponed a piano music exam because it requires sightreadingsinging and includes a vocal range going up to C5, which means singing around the dangerous break point, F#4/G4. I will try out your instructions.

edit: oops, I meant sight-singing.

[AmyBerlin]

No way! [goosebumps] I never thought anyone would be that perceptive! This always stuck in my mind when I was taught religious education at school. The irony is that I'm now man-made. Of course, Liberal Judaism has always been very accepting. My liberal rabbi even wanted to offer me financial support when I was transitioning in '94. I didn't know about Joy Ladin, but I do now. Thanks. And yes, Happy Hanukkah! You made my day.

Thanks for the kind words! Shabbat shalom!

Amy