Yeson voice feminization surgery

[Nicolette]

Thanks for the kind words! Shabbat shalom!

No problem! I read these threads in case someone gives definitive proof that VFS improves singing range and abilities. It would be interesting if you were to have this surgery to give first-hand experience, given your background.

[Jennygirl]

So Amy I have a question for you... You said when you are singing blues you sometimes belt a G4... What would be the equivalent belt for female voice? Would it be higher than a minor third more or would it be a Bb4? I feel like some Tenors can go even go as high as C5 (belting)?

Thank you for joining the thread and offering your expertise

[anjaq]

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?

Yes we are - its the one mentioned at Dr Gross website from 1999. They did not provide actual audio recordings, but they did in the study mention that they did followups and the data listed in the study is IIRc of only a few months post op - the tables there with the decreased vocal range and loudness. In the very last paragraph they mention that the patients who went through voice training afterwards regained their loudness.

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.

Yes, sounds great. I am looking forward to have such improvements.

[...]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.

I feel you - loosing my voice was one of the most horrific experiences. I never talked much and did not sing a lot but with puberty  that became worse.

To the next section i have to say - "hello sister!" - we should PM as soon as it works. Because I can almost copy your dates. I finished school in 1994 as well, Internet was not that great by then and WFT - I chose the name "Amy" for a while even (still carry it in my passport but not as first name). In all other aspects you were 2 years ahead - I came out in 1997, got HRT and went fulltime in 98, got my SRS in Munich as well in 2000. This is quite spooky!

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.

Yes i remember Dr O being the only one doing this and hearing of him. i only heard that it is more common in this year though, so I never did that.

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

Yeah I get that same thing. I have now "functional dysphonia" which means basically I overstrained my voice in order to maintain it sounding as it did. It served me well for like 5 years and then it started to loose and get harder. Which is why i am here now.

You can reply to my PN maybe when it comes to our stories - and keep the VFS stuff for this thread to not bomb it

[AmyBerlin]

Dear Nicolette,

No problem! I read these threads in case someone gives definitive proof that VFS improves singing range and abilities. It would be interesting if you were to have this surgery to give first-hand experience, given your background.

Well, VFS surely will not improve singing abilities. If you can't hold a tune now, you won't be able to afterwards either. And I would expect a narrowing of the range, as the range loss at the bottom will most certainly outweigh the range increase at the top, as the vocal folds are only being shortened, not thinned out, which would increase their ability to sound high frequencies. Given the physics of the process, I'd factor in a loss of about a 4th, but with the benefit of having a fully functional head voice. In other words, more of a functional gain than a range increase.

And yet and still, I must say, I'm really tempted to have the surgery by now :-)

Amy

[anjaq]

Well honestly the total range is not that relevant, is it? i mean when am I ever going to use 760 Hz which is my highest not eI can reach now? Would it hurt me if that would be only 700 Hz or benefit me if it is 780 Hz? i dont think so, the functional gain would be much more desireable - meaning to be able to use higher frequencies more easily and without thinking while speaking and singing.

What worries me a bit is:

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.

I tested my breaking point and it is starting at the 290 Hz range and goes up to something like 350 Hz or so. So it is lower and more close to the speaking range. If I would speak at lets say 220 Hz and then do some pitch variation, I most likely would hit it. :\

[AmyBerlin]

Dear Jenny,

So Amy I have a question for you... You said when you are singing blues you sometimes belt a G4... What would be the equivalent belt for female voice? Would it be higher than a minor third more or would it be a Bb4? I feel like some Tenors can go even go as high as C5 (belting)?

A better question is: what is "belting"? Pushing "chest voice" (which Sadolin calls "Overdrive") to its upper limit? She cautions not to try C5 or higher with a male voice, and D5/Eb5 or higher with a female voice. In any case, approximating this limit will result in a very loud and aggressive sound. As far as I'm informed, the classical tenor's high C is produced with lots of twang instead of Overdrive (another way to get a full and edgy sound at the top end). The highest I've ever had to go, and in fact, the highest I've ever been able to go in Overdrive was an A4 (on the word "leave" in the background choir alto part of Joe Cocker's "You Can Leave Your Hat On" in the key of C; the pitch sequence for these syllables is F4-F4-A4-D4-F4-E4). Bb4 and B4 are totally elusive for me, completely out of reach.

Hope this helps,

Amy

[Jennygirl]

Thanks that does help! I guess I should be pretty happy with my break being around the F#4/G4 area!

Does your voice follow in the Tenor range? I used to sing Baritone.

[AmyBerlin]

Dear Anja,

yes, we should DEFINITELY PM. It should work now, just finished my 15. posting before. Not tonight though, it's getting late here.

Yes i remember Dr O being the only one doing this and hearing of him. i only heard that it is more common in this year though, so I never did that.

I had to. My looks started deteriorating rapidly and masculine bone structure started to emerge when I hit 35.

Yeah I get that same thing. I have now "functional dysphonia" which means basically I overstrained my voice in order to maintain it sounding as it did. It served me well for like 5 years and then it started to loose and get harder. Which is why i am here now.

I hear you. And I don't want my voice to conk out on me by the time I'm 50, so I should better seek professional help while it's still working as well as it is.

Well honestly the total range is not that relevant, is it? i mean when am I ever going to use 760 Hz which is my highest not eI can reach now? Would it hurt me if that would be only 700 Hz or benefit me if it is 780 Hz? i dont think so, the functional gain would be much more desireable - meaning to be able to use higher frequencies more easily and without thinking while speaking and singing.

This is true for daily life, definitely. My absolute limit on a good day is 830Hz, or a G#5. But there are hardly any musical uses for it, and definitely no speaking uses. I've used it once in an ending cadenza on a recording, buried somewhere in the mix, but that's about everything that note ever was good for. The functional gain of a well-speaking midrange would definitely outweigh that. But losing several 100 Hz at the top (as was the case in one of Gross's cases) would hurt deeply.

What worries me a bit is:I tested my breaking point and it is starting at the 290 Hz range and goes up to something like 350 Hz or so.

I think you're talking about larynx position variation. Jenny and I exchanged messages on that this afternoon. With a low larynx position, the break occurs at much lower pitch than with a high larynx position. But as Jenny pointed out, after the surgery you tend to use a higher larynx position anyway to match the new voice's resonance, so the break rises in proportion and gets out of the way of speaking. Plus (and Jenny, you have the new voice already, so please correct me if my conjectures are wrong), the higher overall pitch will lessen the contrast in sound between chest and head voice and make the transition much easier than it used to be with the old voice. Even now, I'm continually going back and forth between the two with the old voice, so why shouldn't I post-surgery, when it's even easier?

Love,

Amy

[AmyBerlin]

Dear Jenny,

Does your voice follow in the Tenor range? I used to sing Baritone.

Baritone here, too. E2-G4 in chest voice, extendable up to G#5 with head voice use.

With functional voice modification, I'm a dysfunctional alto ;-(

Amy

[anjaq]

I hear you. And I don't want my voice to conk out on me by the time I'm 50, so I should better seek professional help while it's still working as well as it is.

This is what drives me to this now too. It is also why I did for a while consider FFS even - This is the time to do such things , not with 50 or 60. Because it only gets harder and the earlier is done the longer one has the benefits of it as well. If it has to be done anyways at some point. And i dont want to be a granny with a guy voice because I cannot remember my voice training lessons or such

I think you're talking about larynx position variation. Jenny and I exchanged messages on that this afternoon. With a low larynx position, the break occurs at much lower pitch than with a high larynx position. But as Jenny pointed out, after the surgery you tend to use a higher larynx position anyway to match the new voice's resonance, so the break rises in proportion and gets out of the way of speaking.

Hmm - i think i am already speaking mostly with my larynx in an elevated position. Its how I get to the voice I have now compared to my pre-transition voice. So I am not sure I would gain much there. :\ - its sad really. I had to start with such bad prerequesites - low pitch, strong resonance. i had to change a lot to get to where I am now and this is what causes the strain. But if i cannot elevate the breaking point or make it go away somehow, I may run into problems with it. 300 Hz is in the regular pitch variation at a 220 Hz F0. But then again, I will not be at 220 Hz F0 after a VFS anyways. It raises pitch by ~75 Hz, which would give me 175 if I take the original voice pitch as a reference.

I am looking forward to the PM

[Jennygirl]

I think you're talking about larynx position variation. Jenny and I exchanged messages on that this afternoon. With a low larynx position, the break occurs at much lower pitch than with a high larynx position. But as Jenny pointed out, after the surgery you tend to use a higher larynx position anyway to match the new voice's resonance, so the break rises in proportion and gets out of the way of speaking. Plus (and Jenny, you have the new voice already, so please correct me if my conjectures are wrong), the higher overall pitch will lessen the contrast in sound between chest and head voice and make the transition much easier than it used to be with the old voice. Even now, I'm continually going back and forth between the two with the old voice, so why shouldn't I post-surgery, when it's even easier?

Love,

Amy

I think you are right on the money with the larynx position. To talk with it in a down position sounds silly altogether.

I wonder what makes that chest/head transition more flowy? Perhaps from the shorter vocal cords?

[Lena from Kiev]

as the vocal folds are only being shortened, not thinned out, which would increase their ability to sound high frequencies.

Ivanchenko (an ENT surgeon in Moscow) both ties vocal folds together like Yeson does (though the stitch is not as far away from the anterior end as Yeson did for Jenny) and thins out vocal folds with Coblator device. Also, he can combine that with Adam's apple reduction (incision over it). $2000 for everything for Russians, I don't know about foreigners.

[AmyBerlin]

Dear Anja,

I had to start with such bad prerequesites - low pitch, strong resonance. i had to change a lot to get to where I am now and this is what causes the strain. But if i cannot elevate the breaking point or make it go away somehow, I may run into problems with it. 300 Hz is in the regular pitch variation at a 220 Hz F0. But then again, I will not be at 220 Hz F0 after a VFS anyways. It raises pitch by ~75 Hz, which would give me 175 if I take the original voice pitch as a reference.

it's very hard to give you any pointers not having heard your voice. But a 100 Hz F0 is exceedingly low. You're probably a bass, range-wise. And this makes it hard to give you any tips, because I can't relate firsthand to how your voice feels for you. And this also explains why you put such incredible strain on your voice to speak, because you need to compensate much more than I ever had to. In comparison, my F0 is 130 Hz, actually more toward the upper end of the male range, so I only need to push it up by a fifth to be in safe female territory, whereas for you it's almost an octave.

Love,

Amy

[AmyBerlin]

Dear Jenny,

I wonder what makes that chest/head transition more flowy? Perhaps from the shorter vocal cords?

Let me give you the explanation I once got from a voice teacher, and it made sense to me:

Imagine your throat as a variable acoustic filter, and consider two "settings" of it, Neutral (which we'd use in head voice) and Overdrive (which we'd use in chest voice). This is Sadolin's terminology, I'm just using it for convenience's sake. Below the break, we can use either (using the loose jaw, that is, the Neutral setting, below the break, is equal to extending the head voice down into the chest voice range), whereas above the break, for reasons of physics, only Neutral will speak, not Overdrive.

These two acoustic filters emphasize certain frequency bands in the acoustic spectrum, and cut others, much like an equalizer does on a mixing console or stereo system. Now we're basically dealing with two equalizer settings, one for Overdrive and one for Neutral. Overdrive is basically a very strong low-mid boost, whereas Neutral cuts the low mids, but emphasizes the high mids, but less so than Overdrive.

Now we're feeding two distinct input signals into this system, the sound of the male vocal cords and the sound of the shortened, female vocal cords. What happens?

The male signal concentrates a lot of power in the low midrange, but less so in the high mids. Run this through the Overdrive filter and presto: its natural strength on the low mids is further emphasized, and almost all of the signal's strength passes through. Run it through Neutral, and most its power is consumed by the low-mid cut, and the hi-mid boost doesn't compensate a lot, because the original signal didn't have a lot of power in this frequency band, anyway. So you wind up with very strong Overdrive, but very weak Neutral.

Now consider the female signal. It has less low-mid strength, but more hi-mids. So it hardly profits from the huge lo-mid boost Overdrive imparts, but also doesn't lose as much from Neutral's lo-mid cut. But as Neutral brings out its hi-mid strengths, the two filters produce signals of almost equal intensity and clarity. And so you get a nice balance between chest and head voice, and the two don't sound all that different at all.

And you can imagine it's easier to blend two signals of equal strength (to make it across the break, the female case) than a very strong and a very weak one (the male case).

Maybe it makes sense to you too.

Love,

Amy

[anjaq]

it's very hard to give you any pointers not having heard your voice. But a 100 Hz F0 is exceedingly low. You're probably a bass, range-wise. And this makes it hard to give you any tips, because I can't relate firsthand to how your voice feels for you. And this also explains why you put such incredible strain on your voice to speak, because you need to compensate much more than I ever had to.

I know - this is the main reason why I think I could benefit from Yesons. To make it easier for me to get and stay in that range. I managed to get it up by about 40-80 Hz depeding on how well I do now (40 when I am tired, 80 when I want to sound more feminine), the 40 still is rather ok, I do not strain a lot, but the higher ones are straining. And 140 Hz which is my average pitch when talking without effort is just still in the male range. I compensate by using resonance and modulation and all that and people usually do perceive my voice as female, especially since I frequently use the 160-180 Hz range, so they just assume it is a matter of maybe having some sore throat occasionally etc. But on the phone, F0 seems more important and I get more "male gendering". Well, I am trying training now to put less strain on it, but i think if I want to be in the 180Hz plus range permanently, I will need to consider the VFS. Otherwise I would have to keep relying on the other voice parameters to get a lower pitched voice gendered correctly - which may work, some women have low F0 and still get gendered correctly. But I am not sure I like to be that or can do as well as they do without a female shaped and sized larynx..

[megan2929]

Ivanchenko (an ENT surgeon in Moscow) both ties vocal folds together like Yeson does (though the stitch is not as far away from the anterior end as Yeson did for Jenny) and thins out vocal folds with Coblator device. Also, he can combine that with Adam's apple reduction (incision over it). $2000 for everything for Russians, I don't know about foreigners.

Personally as a gay trans woman, I would be terrified to travel to Russia right now.

[Jennygirl]

Well this seems relatable to bring up... Dr. Kim told me that with the vocal cords being stretched ever so slightly from the suture, they are also slightly thinned out (imagine stretching a rubber band, it gets thinner).

Also effects from HRT can make the vocal cords thinner, he said. The voice will continue to get better the longer one has been taking estrogen. He related it to older men whose voices tend to go up in pitch as they age (testosterone levels drop and the vocal folds thin out). He told me all of this during the pre-operative exam.

[Lena from Kiev]

I would be terrified to travel to Russia

But not to Korea or USA? Interesting...

[anjaq]

Well this seems relatable to bring up... Dr. Kim told me that with the vocal cords being stretched ever so slightly from the suture, they are also slightly thinned out (imagine stretching a rubber band, it gets thinner).

Also effects from HRT can make the vocal cords thinner, he said. The voice will continue to get better the longer one has been taking estrogen.

I am not sure of the latter. I have been on E2 for 15 years now and I casn still eek out s rather fair simulation of my old voice, though it is not easy to do for me but I think that is more psychological than actually vocal chord issues. Ok, I did not get the best HRT, so maybe that is not great evidence, but I definitely had no T to speak of.
That thinning of the chords by stretching them - will it last? I know there is that method of vocal chord stretching as a main avenue of a certain technique of VFS (cycrothyroid appoximation I think?) and it works for a while but then the chords "relax" and unstretch, the voice gets lower in pitch again.

But not to Korea or USA? Interesting...

I must say I would feel safer in Portland or Seoul as a transwoman (or a lesbian or a lesbian transwoman) than in Russia with its not that great reputation about trans/homophobia. I dont know Russia well enough but I was to Hungary and was scared at the nationalists patrolling the streets at night - I did only leave the hotel once at that time ...

Plus as with any surgeon doing this - I would want to see details on his technique and hear voice samples as well as get contact to (english/german speaking) patients first. Dr Gross is not on top of my list because I could not find that information on him yet, even though I could probably get the VFS there on insurance money and without a far trip.

[Jennygirl]

Anja- I think what you are referencing with the stretching approach is done by Dr. Toby Mayer in Beverly Hills. I am actually having my FFS with him. He places sutures laterally on the voice box which adds tension to the vocal cords.

The look on his face when I told him about Yeson was kind of like "well, f***" lol. He has been doing the stretching method for years with variable amounts of success. It depends on the person, and he is not a voice doctor but a facial plastic surgeon first and foremost. On the voice samples and satisfaction rate spoken from his mouth, I could not recommend it.

Cricothyroid approximation is a different approach by forcing a person into a falsetto voice at all times and is one of the old procedures that allowed VFS to gain such a negative reputation... because it hardly ever sounds natural.