Yeson voice surgery booked

[anjaq]

Thats a pretty good idea, Amy. I would love to hear this comparison and I also would love to hear if Jenny is ready to sing now, even if she will not record it - I am also looking forward to getting the first impressions of fully healed voices after the one year mark. Early the next year this should be the case for Jenny at least

And I think for 1 month, Sarah this sounds really great - of course there are rough spots in there and the vocal range seems limited, but I guess it is another month of not speaking too much anyways at the moment, right?

Jessi from Yesons is nice by the way. I sent some information of mine to her and she really replied back within a day telling me that Dr Kim will take a look at it when he is back in a week. I sent them pictures and a video of my voice exam as well as the paper by Dr Gross from Berlin to ask how their method differs. Lets see what they will say. She sent me back an info package.

[LizMarie]

These are all such startling and positive results! Congratulations!

[Jennygirl]

My guess is I'll be ready to sing somewhere around the 1 year mark, maybe a little sooner.

Right now I'm battling a sinus and chest cold of the virus variety so any progress I was making is temporarily halted

My voice is definitely getting stronger, I just haven't been that good about practicing singing very often. It will be even harder for me to record myself singing because even with my old voice I doubt I would be comfortable with it.

I'm looking forward to going home for the holidays, where I will have the opportunity to sing some at the xmas church service without others hearing me.

[AmyBerlin]

Dear Anja, dear Jenny, dear all,

I sent them pictures and a video of my voice exam as well as the paper by Dr Gross from Berlin to ask how their method differs. Lets see what they will say.

Jessie indeed appears to be a very nice and helpful person. I'm SOOO curious what Dr. Kim will have to say re the difference of the two methods.

My voice is definitely getting stronger, I just haven't been that good about practicing singing very often. It will be even harder for me to record myself singing because even with my old voice I doubt I would be comfortable with it.

I wish you a speedy recovery from your cold. And please don't get me wrong, I didn't mean to put you on the spot or pressure you in any way about singing. It's just that, as a musician, I crave for every snippet of information as to what the effect will be on the singing voice. So please excuse me for being so curious. Of course you don't have to record yourself singing if you're not comfortable with it.

Meanwhile I'm pretty sold on the idea of going to Yeson in April. The speaking voice is almost guaranteed to be better and less of a strain afterwards, and the voice I can currently use for singing is a pain in the butt to support for a mediocre sound in return. So I have nothing to lose, and everything to gain.

Amy

[Jennygirl]

I wish you a speedy recovery from your cold. And please don't get me wrong, I didn't mean to put you on the spot or pressure you in any way about singing. It's just that, as a musician, I crave for every snippet of information as to what the effect will be on the singing voice. So please excuse me for being so curious. Of course you don't have to record yourself singing if you're not comfortable with it.

Meanwhile I'm pretty sold on the idea of going to Yeson in April. The speaking voice is almost guaranteed to be better and less of a strain afterwards, and the voice I can currently use for singing is a pain in the butt to support for a mediocre sound in return. So I have nothing to lose, and everything to gain.

Amy

Thanks for the speedy recovery wish, it appears to already be working I really appreciate it!!

And that's exactly how I felt going into Yeson as well.. Nothing to lose and everything to gain

[sarahb]

Thanks guys, I really appreciate the positive feedback. It's nice to be able to talk again, although I've noticed that I can overdue it if I talk too much throughout the day. I think I still need to give my voice some time to rest after a lengthy spout of talking. I haven't been able to sleep since yesterday yet due to work and I can definitely tell it's taking a toll on my voice (along with the rest of my body, lol). Sleep and resting the voice is definitely a must once you resume talking, especially since you're vocal folds aren't used to so much activity after a month of inactivity.

I also have noticed that I have to actively try not to tense my throat muscles like I did before surgery. After so many years of talking with the higher pitch I subconsiously tense and tweak my throat and voice box, however, I no longer have to do that to get to the frequency I need so I'm unnecessarily limiting myself and lowering the quality of the voice. It's an interesting (and great!) thing to have to focus on post-op.

[anjaq]

I also have noticed that I have to actively try not to tense my throat muscles like I did before surgery. After so many years of talking with the higher pitch I subconsiously tense and tweak my throat and voice box, however, I no longer have to do that to get to the frequency I need so I'm unnecessarily limiting myself and lowering the quality of the voice. It's an interesting (and great!) thing to have to focus on post-op.

This part REALLY interests me a lot as I think this is what would happen to me too if I decide for the surgery. I am totally used to tweak a lot with my voice box to give it the voice I have now. In part it is because of resonance control, in part because of pitch. Is it manageable to separate the two, keeping the tension where needed for resonance and loosening it up elsewhere to pitch? Does the pitch still go up if you tense it the same way as you did before or does it just change other things? I totally want to hear more of this as I believe this is probably one of the most beneficial parts for women who have been using their voices differently for a long time already and are straining it. For me at least this would be one of the main reasons to do this, to get rid of the straining it takes now to just speak regularly. Please keep telling about this and if you like, I would be interested in a description on what is happening there.

[Jennygirl]

Yeah Sarah I noticed the same thing about sleep and voice use. It is so important to rest your voice adequately until it becomes strong again. It will take a while for that to go away. After 7 months now it is almost completely gone, but a night of yelling or loud extended conversations is still enough to make my voice feel fatigued the next day. Nowhere near as fatigued as it used to get though.

Hang in there, it does get a lot stronger

[AmyBerlin]

Dear Anja,

I am totally used to tweak a lot with my voice box to give it the voice I have now. In part it is because of resonance control, in part because of pitch. Is it manageable to separate the two, keeping the tension where needed for resonance and loosening it up elsewhere to pitch? Does the pitch still go up if you tense it the same way as you did before or does it just change other things?

The two are completely separate aspects of the voice. Pitch is adjusted at the larynx level, resonance is adjusted above. And feminine resonance in the speaking range actually requires less muscular tension than masculine resonance. For me, in the beginning, it used to feel like deliberate relaxation. The exception is twang (a certain narrowing of the pharyngeal passage), which is necessary for maintaining female resonance at high volumes, which requires tension. But the muscles of the pharynx and the larynx can be worked independently, don't you worry.

Amy

[Carlita]

MAGIC!

Sarah, I think you will probably have the best sounding result from Yeson yet. You already sound fantastic already at only 1 month. At 2 months you will notice a huge difference when the upper part of your chest register starts to open up.

Way-to-go! You sound GREAT!!!

Oh, Jenny, I'm so glad YOU said that! I mean, I didn't want to offend if I said that I thought the very same thing. I think Sarah sounds incredible and 100% female. But then, all the Yeson girls sound incredible. Now I'm curious to know: is it JUST a Yeson thing, or has vocal surgery for MTFs improved across the board, so one can get the same effects from surgeons in Europe (or the States for you girls)?

I'd really like to hear before-and-afters from some other surgeons' work - see if anyone can match the all-conquering Yeson Effect!

[anjaq]

The two are completely separate aspects of the voice. Pitch is adjusted at the larynx level, resonance is adjusted above. And feminine resonance in the speaking range actually requires less muscular tension than masculine resonance. [...] But the muscles of the pharynx and the larynx can be worked independently, don't you worry.

That totally explains why it is a bit harder for me now to try and re-create something like "my old voice". Good to hear that those are different. I still would like to hear Sarahs personal experience with it if it also FEELS like that - e.g. if it is easy to distinguish it when trying to relax
Less tension sounds great in a way, though my voice therapist now actually tries a bit to increase stretching tension (but reduce "compressing" tension) to get rid of my gaps. Sadly she is on vacation now until the end of January, so I need to do my own training for a while. Maybe she will have a replacement but thats a guy and she said that he will probably not be able to lead the tones/notes that are part of the therapy (this time she said we went from a "g" up by 3 octaves almost to a higher c - I am not sure if thats really right, I think it was from a G up to a G 3 octaves higher spanning 100 Hz to 800 Hz) - which is in a way cool - my voice seems to have more room towards the top than I would have guessed.


But I have a more "technical" question again. I was at my voice therapist today, showed her the photos of my vocal chords that I posted in my thread and the video that goes with it and she said that she had never seen something like that with the double gap, the posterior one she said is a "typical womans problem" and that she has seen that often and can try to fix, though my vocal chords in that area seem to be atrophied a bit. But the anterior gap next to the commissure, that one is new for her. So she again mentioned the option of having VFS which would basically close that gap by suturing it. What she was worried about was that with such a suture there would always be a strain on the vocal chords and the new commissure, even when just breathing as when the vocal chords just open to let air through, there would still be a pull on the chords. Has anyone asked at Yesons about this or did they say anthing on this?

Now I'm curious to know: is it JUST a Yeson thing, or has vocal surgery for MTFs improved across the board, so one can get the same effects from surgeons in Europe (or the States for you girls)?

I know everyone is still scared about VFS. The most positive comments I got was about Dr Thomas because he also seems to change resonance which is a huge factor for those girls who cannot do that by themselves and for whom a pitch change would not be enough. I am getting more the feeling than ever now that the precision of the suturing of the tip of the "V" in the vocal chords is what makes this clinic so good. It is a delicate point and quite important it seems. I am worried a bit about what my voice therapist saying that there is a lot of pull on that and hope that this does not mean that there could be long time negative effects of this. But as long as that shape stays perfect, I imagine the voice will be great as well - I need to talk to that friend of mine who did that kind of surgery 10 years ago but hers was not that great to begin with, so it may not be a good example.

[Carlita]

I know everyone is still scared about VFS. The most positive comments I got was about Dr Thomas because he also seems to change resonance which is a huge factor for those girls who cannot do that by themselves and for whom a pitch change would not be enough. I am getting more the feeling than ever now that the precision of the suturing of the tip of the "V" in the vocal chords is what makes this clinic so good. It is a delicate point and quite important it seems. I am worried a bit about what my voice therapist saying that there is a lot of pull on that and hope that this does not mean that there could be long time negative effects of this. But as long as that shape stays perfect, I imagine the voice will be great as well - I need to talk to that friend of mine who did that kind of surgery 10 years ago but hers was not that great to begin with, so it may not be a good example.

That's a very interesting observation, and makes a lot of sense. Thanks!

My only information comes from a meeting with a voice therapist in London a few years back, when I was on the verge of transitioning, but backed off - though I'll be returning to her for real in a few months!

She worked at the Gender Clinic at London's Charing Cross Hospital, which is the leading UK centre for all forms of treatment for men and women in transition. She told me that she had always been very sceptical about vocal surgery, but that the surgeons at Charing Cross were now able to produce results that made he reel it could be the thing to do - though only after proper training - just because (as many girls here have said) it's much more relaxing when you're no longer having to work at the female voice: when it is, in fact, the only voice you have. So it sounds like they were aiming for the same end-result as Yeson, but I'd just love to hear whether they - or anyone else - has succeeded.

[AmyBerlin]

Dear Anja,

(this time she said we went from a "g" up by 3 octaves almost to a higher c - I am not sure if thats really right, I think it was from a G up to a G 3 octaves higher spanning 100 Hz to 800 Hz) - which is in a way cool - my voice seems to have more room towards the top than I would have guessed.

That range is typical. If you're a bass, you should bottom out around D (73.4 Hz). Taking the G above that (98 Hz), your (male) chest voice (the lines between chest and head voice blur if you're using female resonance) should take you up around 2 octaves from there to g' (392 Hz), which in male resonance will only be available as a shout. Switching to head voice gives you the remaining octave up to g'' (784 Hz) or a bit higher. However, the top octave is excruciatingly hard to control musically. It blends in quite easily while speaking with female resonance, but singing in this range is a tough job.

So she again mentioned the option of having VFS which would basically close that gap by suturing it. What she was worried about was that with such a suture there would always be a strain on the vocal chords and the new commissure, even when just breathing as when the vocal chords just open to let air through, there would still be a pull on the chords. Has anyone asked at Yesons about this or did they say anthing on this?

When the vocal cords are approximated for phonation, there is hardly any additional strain, since, when running in parallel, the distance covered by the vocal folds, from the former commissure to the posterior end at the arytenoid cartilages, is precisely the same. The only thing that changes is the suture in between, creating the new commissure.

When the folds open up for breathing, things are different. Then the folds have to cover a greater distance due to the new commissure. But as the arytenoid cartilages are not designed to tense the vocal folds in their open state, their elasticity alone will determine how far they will open up. Which just means they'll open up a little bit less, which shouldn't cause a problem for breathing, though. Despite the huge influence of the diameter of an opening on the amount of viscous fluid that can pass through in a given timespan (cf. Hagen-Poiseuille's law, one of the few occurences of a 4th power proportionality), I hardly believe that the opening of the vocal folds is the narrowest part of the respiratory tract and thus the limiting factor for viscous flow. Or who has ever heard of natal women choking because of their naturally smaller larynx?

Bottom line: when the folds are apart and have a Y shape post-surgery, they're relaxed. When you tense them for singing or speaking at elevated pitch, they're approximated and in parallel, so there's no transversal component to the pull, and thus tearing up the Y juncture should be impossible. As far as physiological considerations go, the surgery should be safe.

I need to talk to that friend of mine who did that kind of surgery 10 years ago but hers was not that great to begin with, so it may not be a good example.

Was she a patient of Dr. Gross's?

Regards,

Amy

[anjaq]

Thaks Amy for the great reply, yes it makes a lot of sense. I think I read somewhere that there is a risk of having some feeling of breathing less freely but it seems to be minor. The new commissure has to hold quite a bit still, I think - originally it is held by the cartilage I think, the new commissure then only is help by the vocal chords themselves... but you are right, there should not be too much strain on them when they are open, except maybe the additional strain coming just from the different shape which causes a bit of tension by itself...

I have not met that friend in a long while, I will have to see if she has time and ask her where she did that and how it went. I remember that she had a very deep voice and then had a very high voice - too high for her stature and since she did no training at all before the surgery, she sounded not quite good afterwards for a while. I need to check up on her. Another friend told me it sounds ok now, but still too high pitched for a tall woman

So 800 Hz is normal to reach? Ok. She made it sound a little bit like the TG people she has in her training dont always reach up that high, but maybe thats more a mental block for them.

[sarahb]

Some great information Amy! You're like an encyclopedia of knowledge about the voice I'm so interested to hear your experience once you get the surgery.

So I flew into Austin, TX last night and today was my first full day of vocal activity with meetings and discussions at work, picking up a rental car, ordering food, etc. I got questions from a couple of people on why I couldn't talk before, but nobody remarked about my voice and how/why it sounds different (ahh, I must still sound like a guy! lol j/k). This is the most comfortable I've felt talking since I started transition! I still notice myself pausing before speaking, but then I speak and out comes (in Jenny's words) a pleasant surprise.

It just feels so natural to be speaking with this voice. Before the surgery one of my main desires was to achieve a voice I can call my own. I now have that! There is still a long road to full recovery, but every day I just get more and more excited to talk. There are things that I actively did before to try and limit the amount I have to talk that I'm noticing are changing. For instance, I would try not to make eye contact with people so they didn't try to spark up a conversation. Even when in a conversation, I would look away and try to end the conversation as soon as possible so I didn't have to talk as much. That's slowly changing as I realize that I no longer have to worry about my voice, and that's a great thing, not just for the fact that I feel so comfortable now, but also because I always felt like I was being rude and came off as too good to talk to them, which was far from the truth. I love conversing with people, and it's awesome to be able to feel comfortable doing it again.

[AmyBerlin]

Dear Anja and Sarah,

So 800 Hz is normal to reach? Ok. She made it sound a little bit like the TG people she has in her training dont always reach up that high, but maybe thats more a mental block for them.

The thing is that when trying to reach for approximately c'' (523 Hz) or higher, the vocal folds automagically kick into flageolet (which is known as "whistle register" in women), which means that they don't vibrate over their entire length any more, but are stiff in front (at the commissure) and in the back (at the arytenoids), leaving only a vibrating middle section. In this way, the effective speaking length and weight are reduced to help reach these high notes. Singers often say the cords "zip up".

Although everybody should be physically able to do this, it doesn't come easy for everybody. I've always done it naturally, so I can't say. But if you haven't found that way of phonation, you're likely going to top out far below the g''.

Before the surgery one of my main desires was to achieve a voice I can call my own.

Thou speakest to my condition. Although the practiced voice that I have does pass well, and before FFS I would routinely start a conversation with people if I felt I was getting a double take because of facial gender cues, the voice never felt like mine. It felt more like an implement to make noise with, which I had to then go about chiseling into an approximation of a female voice. So the voice for me never was an extension, expression, and mirror of my soul, but rather an object, a foreign body, a crude and primitive instrument that was very hard to play at any level of perfection. If the surgery can change that, I'll be a happy camper.

Love,

Amy

[anjaq]

The thing is that when trying to reach for approximately c'' (523 Hz) or higher, the vocal folds automagically kick into flageolet (which is known as "whistle register" in women), which means that they don't vibrate over their entire length any more, but are stiff in front (at the commissure) and in the back (at the arytenoids), leaving only a vibrating middle section. In this way, the effective speaking length and weight are reduced to help reach these high notes. Singers often say the cords "zip up".

- you mean a bit like this?!?
Correct me if I am wrong but this sounds quite a bit like what I am doing at normal speaking range - vibrating only in the middle section. This is odd...

it doesn't come easy for everybody. [...] if you haven't found that way of phonation, you're likely going to top out far below the g''.

If this would be similar to what I do regularly, it would make sense that I would be able to do that in the upper range as well

This is the most comfortable I've felt talking since I started transition! I still notice myself pausing before speaking, but then I speak and out comes (in Jenny's words) a pleasant surprise.

It just feels so natural to be speaking with this voice. Before the surgery one of my main desires was to achieve a voice I can call my own. I now have that! There is still a long road to full recovery, but every day I just get more and more excited to talk. There are things that I actively did before to try and limit the amount I have to talk that I'm noticing are changing. For instance, I would try not to make eye contact with people so they didn't try to spark up a conversation....

This sounds so awesome and amazing. Indeed this is how it is for me too - I know most people will not say something about my voice or think weirdly, but I still dislike using it a lot and if so I keep checking it constantly. Just speaking without thinking  sounds like the greatest thing ever!!  I guess one still does watch to sound "clean" and not buzzing or rough, but that would feel much less alien, its more about sounding nicer and not so much about sounding female - so its not linked to dysphoria, so your post there really makes me long for this again. I know I promised my voice therapist to concentrate on therapy first, but this topic does not leave me alone

[AmyBerlin]

Dear Anja,

- you mean a bit like this?!?

Au contraire. These pictures show that you developed a failure to have good cord closure. As your therapist said, a gap in the back is common in people who use a breathy voice, but the gap in front is a mystery to me. And yet and still, as the vocal cords are not touching at the anterior and posterior end, their entire mass will participate in the vibration.

Flageolet is an entirely different thing: the front and back (or sometimes only the front) of the vocal cords close tightly and do not participate in the vibration at all, so only the remaining portion takes part in the sound-producing process.

I know I promised my voice therapist to concentrate on therapy first, but this topic does not leave me alone

It's like one of these hoarded dreams, isn't it? Folk wisdom says if something sounds too good to be true, it probably is. But we're quickly amassing a pile of reliable data that this is indeed one of those rare exceptions; a solution to the age-old problem.

Best wishes,

Amy

[anjaq]

Thanks for explaining that part on the vocal chords. I was just getting the "only part of the chords are active" thing as this is what my phoniater said. She also said however that the mass does not swing completely. The parts that are in the "gaps" seem to be rather stiff. I honestly dont know what is going on there - my voice therapist says she has never seen something like it - always "me the oddball" LOL. Lets see what Dr Kim says, I sent in the pictures So if I can go up to that high notes however, I guess I am able to close these gaps under these circumstances maybe. So I guess my therapist is right in going up there with me a lot to get into that mode more...

It's like one of these hoarded dreams, isn't it? Folk wisdom says if something sounds too good to be true, it probably is. But we're quickly amassing a pile of reliable data that this is indeed one of those rare exceptions; a solution to the age-old problem.

That is what I was thinking - "if it sounds too good to be true it probably is", I guess this is why I am bugging poor Jenny and others here so much about it - I am sorry for that.
I dont know what a "hoearded dream" is but certainly this topic feel like something that has a strong pull. In a way it is like back then when it was about SRS - the same mixture of fear, anxiety, excitement, longing... Back then at some point I got drunk and let go and found that it did not make sense to keep pondering as I knew that I was going to do it anyways - this time I am not ready for that yet though. We'll see...

[AmyBerlin]

Dear Anja,

So I guess my therapist is right in going up there with me a lot to get into that mode more...

Flageolet is not for speaking. It's a mode that should be used for singing only, and only for the top notes. If you're trying to take the flageolet to the midrange, you could develop a "split" on the voice (which sounds like two notes at the same time), as the voice keeps slipping in and out of flageolet.

[...] this time I am not ready for that yet though. We'll see...

Not me. This surgery is basically what I was waiting for since age 14. Up until that time, I had a mezzo, clear as a bell. If there's anything that can restore this, or at least give me a nice, round alto, I'm SO ready to get on that table :-)

Amy