I've been thinking about voice surgery, but...

[Miyuki]

I should probably preface this by saying I'm still a ways off from being able to afford any surgery, but due to a recent turn of events I may be able to start working and saving up money soon, and I've been thinking a lot about how I want to proceed with my transition once I can actually afford things. Finishing up hair removal my biggest priority (facial hair is nearly gone now , but there is still a lot of other hair to deal with ), along with FFS (might not need it per say, but it would definitely help with a few areas), fat transfer (because my stomach fat will not go away so I might as well put it where I actually want it to be, like say my chest for example ), and of course SRS (which I'm still holding out hope I'll find a way to get covered under insurance somehow).

But as far as surgery goes, the one thing I can't get off my mind is voice surgery. Voice is really important to me for a lot of reasons. First of all, it's the one thing you can't run away from. Lot's of things that might make you dysphoric are things you can put out of your mind and not think about, but your own voice literally resonates in your head every time you have to open your mouth. Also, I think voice is a bigger factor in passability than a lot of people give it credit for, and I personally would tend to clock someone based on voice way more than any other trait. And finally, well, this may be a long shot, since I know that there is only so much voice surgery can do, but I would really like to have a proper female range for singing. I come from a musical family, and I've never had that much interest in playing an instrument, but singing is something I really wish I could do. But even with my best trained voice, it's just too much of a strain for me right now. I might be able to sound okay within a limited range, but my pitch control is horrible when I have to sing more loudly than I would normally talk. And the stress trying to maintain a female pitch while singing puts on my voice just destroys it when I do it for too long.

That being said, here is my current voice:

Trained
Untrained

Okay, I know what you are thinking. Something along the lines of, I can't believe you think you even need surgery in the first place, right? Well, yea, I know I sound very passable, but the thing is, it takes a lot of effort for me to consistently sound like that. I have to warm up my voice every morning, I have to clear my throat constantly because my vocal chords get irritated and they tend to build up mucus when I don't talk. Worst of all, if I have to talk too much or too loudly, I can easily strain my voice and sound horse for days at a time.

The next thing you are probably thinking is why don't I just use my untrained voice because it actually doesn't sound that much different. But it's not quite that easy either. I should probably say, the reason why it sounds so similar is because when I talk all day with my trained voice, my muscles just get used to being tensed up, and I have a hard time relaxing them to the point where I am completely talking with an untrained voice. I would have to make the recording first thing in the morning to get it to sound the most relaxed possible. Even then it's not horrible, because I have good resonance either way, but if it doesn't sound good in my head I have a natural tendency to self correct. My mind is just dead set on what it wants my voice to sound like, and if it's not sounding like that I have a lot of trouble maintaining pitch.

My primary goal with surgery is to correct my voice enough that my current trained voice becomes my natural speaking voice, or at least requires minimal effort to maintain. Being able to sing in a female range would also be amazing if it were possible, and I think with a little more control and power in my high range I could do it. But at the same time, I'm having a lot of trouble deciding if I really want to go for it right not or not. It's not as cut and dry of an issue as it might seem, because within the last few years voice surgery has gone from a hack-job procedure that someone would only rationally choose out of desperation, to something that can achieve consistent, if not miraculous results for the majority of people. It's hard not to think that if I waited a little longer the quality of the procedure can only improve with time. And while it's not a huge risk, the chance of something going wrong and completely ruining my voice does exist. I did stumble upon this when doing research. She apparently recovered reasonably well, because she sounds really good in the video, but still... I guess what I really want to ask here, is for those who already have a passable voice, was the procedure worth it? Did it fully relieve the strain of maintaining your voice, and did it increase your range enough that you could sing if you wanted to? If the answer to both those questions is yes, I will almost certainly make having this surgery my next major goal. But if the results were more subtle, or the surgery left your vocal range too limited to sing well, these are things that might make me reconsider.

[iKate]

For some who have had a passable voice, they got little to no improvement with the surgery. Some have gotten some improvement. I have no idea why that is but we have been thinking here that it is due to feedback mechanisms in you that don't force your voice higher.

That's voodler, who was/is a member here. She was dissatisfied with the surgery even though we told her she was fine. It can be a hit or miss, but for many people it is a hit:

[Miyuki]

For some who have had a passable voice, they got little to no improvement with the surgery. Some have gotten some improvement. I have no idea why that is but we have been thinking here that it is due to feedback mechanisms in you that don't force your voice higher.

I don't actually care if my speaking voice goes any higher. I think it's fine the way it is, and would probably sound weird if it was much higher. I'd just like to know if the surgery would help relieve the strain of maintaining it.

[anjaq]

Ok, I think there are a few things to say to this.

First of all, there are sadly no guarantees - some people have big differences in the voice, others have little, statistically you can pick methods and surgeons that give ou a higher chance of a positive outcome, but no one can be sure.

Same basically is true for the upper range and female singing voice. In most cases the pitches that are easy to reach will be in a more female range, so you can sing better in the middle part of your vocal range - HOWEVER the voice break will not change, it still will be there, so you will still have to work around this when singing. And I heard from some others and experience it myself that if your vocal range is very large, so you can go very very high pre-op, it may be that you actually loose some notes on the top. If your upper limit was rathe rlow, then you may actually gain some notes on the top. Lets say your upper limit is 450 Hz, then your upper range will more likely increase than if your upper range is 850 Hz, in which case it may even go down a bit. Personally for me, singing is much more fun now, so I can just sing along at the campfire in the middle range and sound like the other women there, but I do have actually a bit more trouble in the very upper parts as I seem to get more muscle tension there. But that may still resolve itself, just 7 months post op now.

Many have reported - some were frustrated about it, others thought it was the goal of the surgery so they were happy - that if you have a good trained voice and it is higher in pitch than your original voice by some seminotes, you will often end up in your trained voice post op, but with much less effort and strain. So I think this expectation is one that most likely will be met. There is something about the trained voice that seems to make your brain want to reproduce it, so I guess that is why this happens so often - no matter if the trained voice is much higher than the original voice or not.

Another change of the surgery is in the sound of the voice - I listen to your voice samples and the untrained voice mostly seems to differ in the way it sounds - more snarling, low undertones, vocal fry - those sounds change with surgery. Your pitch difference is not that big, its more that in your trained voice you minimize those extra sounds? Maybe pitch goes up by a note or even 2 in your trained versus the untrained voice - but not much more I'd say. Maybe you should actually do an early morning recording.

[Dena]

I am taking a guess here and it might be wrong. I am suspecting you aren't doing a trained voice or you are doing it all the time. The difference between the two is sitting with you neck muscles relaxed, feel the position of your larynx. It shouldn't move much if you speak in the chest voice. If it moves up you are in the trained voice. I have used my trained voice for hours on the phone without problems which makes me think you are attempting to reach the desired pitch with your cords instead of your larynx. If your physical size is small the doctors might consider a greater pitch bump than your current trained voice but you should consider bundling up the samples and shipping them off to the doctors for their opinion before you commit to a doctor.

If you have questions about producing a trained voice let us know and we will be happy to help you.

[Miyuki]

Ok, I think there are a few things to say to this.

First of all, there are sadly no guarantees - some people have big differences in the voice, others have little, statistically you can pick methods and surgeons that give ou a higher chance of a positive outcome, but no one can be sure.

Same basically is true for the upper range and female singing voice. In most cases the pitches that are easy to reach will be in a more female range, so you can sing better in the middle part of your vocal range - HOWEVER the voice break will not change, it still will be there, so you will still have to work around this when singing. And I heard from some others and experience it myself that if your vocal range is very large, so you can go very very high pre-op, it may be that you actually loose some notes on the top. If your upper limit was rathe rlow, then you may actually gain some notes on the top. Lets say your upper limit is 450 Hz, then your upper range will more likely increase than if your upper range is 850 Hz, in which case it may even go down a bit. Personally for me, singing is much more fun now, so I can just sing along at the campfire in the middle range and sound like the other women there, but I do have actually a bit more trouble in the very upper parts as I seem to get more muscle tension there. But that may still resolve itself, just 7 months post op now.

That is somewhat encouraging at least. My upper limit right now is about 500Hz, so it is on the low side. If that were to improve it would make things a lot easier. I guess I could live if all I accomplished was just to make the notes in the female range feel more natural. I doubt I'm ever going to sing professionally, so just being able to sing in a female voice for fun and have it feel natural and unstrained would make me happy.

Many have reported - some were frustrated about it, others thought it was the goal of the surgery so they were happy - that if you have a good trained voice and it is higher in pitch than your original voice by some seminotes, you will often end up in your trained voice post op, but with much less effort and strain. So I think this expectation is one that most likely will be met. There is something about the trained voice that seems to make your brain want to reproduce it, so I guess that is why this happens so often - no matter if the trained voice is much higher than the original voice or not.

I'm sure that a big part of the reason my voice settled where it is is because that is just where my brain wants it to be, and thinks that it sounds right, so I think my trained voice now is similar to what it would have been without the effects of testosterone. Maybe some people just feel disappointed having the surgery and ending up with no noticeable changes, but really if your voice sounds fine the way it is, that's probably the way it should stay. There is a point at which making a voice higher just makes you sound like a cartoon character or something.

Another change of the surgery is in the sound of the voice - I listen to your voice samples and the untrained voice mostly seems to differ in the way it sounds - more snarling, low undertones, vocal fry - those sounds change with surgery. Your pitch difference is not that big, its more that in your trained voice you minimize those extra sounds? Maybe pitch goes up by a note or even 2 in your trained versus the untrained voice - but not much more I'd say. Maybe you should actually do an early morning recording.

The vocal fry isn't something I had before, it developed because I put too much strain on my voice by doing things like forcing myself to maintain a high pitch even when it was really tired. It doesn't seem to be getting worse at the moment, but I am concerned that it may worsen over time if I don't do something to reduce the strain on my voice eventually.

My untrained voice doesn't sound like my old voice anymore in a lot of ways. The pitch is the same (about 160Hz naturally, which is high for a male voice), but I'm used to talking with more resonance and intonation now, which is not something I can just turn off. My trained voice tends to hover around 200hz, so there is actually a substantial pitch difference, but it just goes to show that pitch isn't everything. I will try to do a voice recording tomorrow morning and see how that sounds, but my best guess is probably really bad in my head, but still sort of okay when I hear it recorded.

[Miyuki]

I am taking a guess here and it might be wrong. I am suspecting you aren't doing a trained voice or you are doing it all the time. The difference between the two is sitting with you neck muscles relaxed, feel the position of your larynx. It shouldn't move much if you speak in the chest voice. If it moves up you are in the trained voice. I have used my trained voice for hours on the phone without problems which makes me think you are attempting to reach the desired pitch with your cords instead of your larynx. If your physical size is small the doctors might consider a greater pitch bump than your current trained voice but you should consider bundling up the samples and shipping them off to the doctors for their opinion before you commit to a doctor.

If you have questions about producing a trained voice let us know and we will be happy to help you.

Uh... I'm honestly not sure. When I first started training my voice I did have to tighten my throat more to achieve the right pitch. I quit feeling the need to do that so much as time went on, and I assumed that was just my voice breaking in, but maybe I was starting to rely on my vocal chords more. My larynx isn't very mobile no matter what I do with my neck muscles anyway, and even if I tighten my neck muscles a lot it doesn't move very much. It wouldn't surprise me to find out I was doing the most of the work with my vocal chords, because now I have to really strain my neck muscles to move my laranx enough that it affects my pitch. Doing it that way does feels easier on my vocal chords, but there's no way I could keep it up for very long. And I'm not small. I'm not huge, but I am about six feet tall.

[Dena]

If you are that tall, the doctors will target 190-200 Hz which isn't much of a move off your untrained voice. A few visits to a speech therapist might be worth while if you can't figure out what's going on. It is a bit strange somebody our size having a voice that high but it happens.

[Miyuki]

If you are that tall, the doctors will target 190-200 Hz which isn't much of a move off your untrained voice. A few visits to a speech therapist might be worth while if you can't figure out what's going on. It is a bit strange somebody our size having a voice that high but it happens.

Yea, seeing a speech therapist might be a good thing to consider. Especially since I've probably got a year to deal with my voice as it is before I'll have to money to seriously think about planning the surgery. It's weird though, because while my natural speaking range has always been high, my high range singing sort of sucks, so go figure. I'm also starting to think 160Hz may be an overestimate of my original voice. It was on the high end, but maybe 140-150 would be more like it. I didn't have a freakishly high sounding voice, and with a more male resonance and tone I sounded more or less normal, though I often got confused with my mom when answering the phone, since she has a fairly low voice for a woman.

[Dena]

The voice section has software for voice work stuck to the top and I used software called Pitchlab on my iPhone so I can check my pitch were ever I am. I think 170Hz is pretty close for your untrained voice and you really came out lucky if that is your chest voice because therapy should give you a comfortable voice in the feminine range.

[Miyuki]

I don't think there's any way my "real" untrained voice is 170Hz though. I think I just need to give my vocal chords a chance to rest for the night and the reality will be more apparent. I was looking for a decent recording of my pre-training voice, but sadly I don't think one exists. I was never a fan of having my picture taken or being recorded in any way. I am sure beyond a shadow of a doubt though, that my untrained voice was in the high end of the normal male range, so the fact that I can't naturally get it there anymore probably means my vocal chords have changed in response to the way I've been using them. Not sure if that's a good thing or a bad thing in terms of future surgery... If I have actually stretched my vocal chords to the point they have become more thin, maybe what the surgery would do is just tighten them back up to normal again so I would have a more full range and not need to strain myself just to talk normally. That actually would make sense too, given that my high range and pitch control when singing are so poor. My muscles are probably overworking themselves just to keep my vocal chords tight, and the looseness would even explain the vocal fry.

[Dena]

The surgery shortens the effective length by tying them together. The CTA stretches the cords but the CTA tends to be combined with the tie. You don't need much of a bump and you like to sing so the tie would be your best options. Besides that, it cost less than the two combined.

[Miyuki]

I was actually thinking of going to Yeson, which does shortening by cutting and suturing the vocal chords together. Based on my research, this is more likely to increase my range and allow me to sing well than Dr. Haben's version of the procedure. I probably should have said so earlier, but I didn't realize Dr. Haben wasn't also doing vocal chord shortening until I checked his website just now. Maybe that's not as critical of a thing for everyone, but if my vocal chords really are loose...

Edit: Or I should say, Dr. Haben's tieing procedure does technically shorten the function part of the chords, but it doesn't tighten them, or make the overall size shorter. The CTA would do the tightening, but I'm worried without actually shortening the cords by removing part of them, the tightening he does would leave me with limited range control.

[Dena]

Nobody cuts a cord. A cord is a nerve and it might not rejoin again. Both doctor work by tying the cords but they use a different procedure to do the same thing.

[Sydney_NYC]

If you are that tall, the doctors will target 190-200 Hz which isn't much of a move off your untrained voice. A few visits to a speech therapist might be worth while if you can't figure out what's going on. It is a bit strange somebody our size having a voice that high but it happens.

My voice is now trained (I can't even do my old one anymore) an average between 190-215 Hz. At first when I heard my own voice I thought it should be higher, but given that I've 6'7", it just would not match my height too well. If your averaging 180Hz or higher, I thing there is more gained by working on resonance and head voice than pitch.

[anjaq]

I checked the recordings in Praat and actually the untrained voice comes out at about 150-160 Hz, the trained one at about 180 Hz - so there is a difference but its not huge. 150 Hz would still be a possible untrained voice and would be in a "male range" technically, but from the recordings I would say your voice is already modified in some ways - either resonance or maybe its because of the prosody...

What I usually think is, if the original voice - pre everything - is about 140-150 Hz, voice training can give one a relaxed feminine voice at about 170-180 Hz - mostly by the changes one has to do anyways to get a female resonance and voice melody. That range is close to your trained voice now.

So there are 2 things open - what is your REAL untrained voice like - is it lower than 150 Hz or not. If it is not, then i would think voice training should be able to give you a relaxed voice in your desired range, that of your trained voice recording. However, voice training has to be done properly. If done DIY or over the net, it can go wrong and then one strains to get the trained voice which, with better techniques, would be a relaxed voice. So my advice then would be to visit a trans-friendly and knowledgeable voice therapist to get rid of the bad habits that strain your voice.
I personally used a lot of this too - strained my voice just to reach 145 Hz - up from 110 Hz. With voice therapy the 145 Hz became my relaxed trained voice. I still wanted surgery though because 145 as a trained voice - well go figure

I would be very careful about the singing part though. I know some Yeson patients are singers and they attained a good singing voice, some reported some issues with the singing post op. Diplophonia or loss of power and control in the very upper range. So singing in the modal voice and a bit beyond probably will improve, going in the very high pitches may actually be harder - depending on how hard it is now for you. I guess only some of the singers who are long term post op can talk about this. Amy from Berlin and J-Mi would be the ones who fall into that category.

[Miyuki]

Here is another recording of my voice I did just now:

Untrained

My voice wasn't completely unused since I was asleep, but pretty close. I think the range in this recording is a little lower than the previous one, so this one probably is more in the 140-150Hz range that I thought my original voice was in. But now because of the way my vocal chords have changed, I have lost the ability to go much lower than this without a ridiculously bad vocal fry. Even in this recording it's pretty bad.

Nobody cuts a cord. A cord is a nerve and it might not rejoin again. Both doctor work by tying the cords but they use a different procedure to do the same thing.

I see... I must have been misunderstanding how the procedure was done at Yeson, because I thought I remembered people posting about having part of their vocal chords removed. In that case I would have to give Dr. Haben more consideration, because the travel expenses would be a lot less if I went to him. I even have family who live reasonably close to his practice that I could stay with if I went there.

I checked the recordings in Praat and actually the untrained voice comes out at about 150-160 Hz, the trained one at about 180 Hz - so there is a difference but its not huge. 150 Hz would still be a possible untrained voice and would be in a "male range" technically, but from the recordings I would say your voice is already modified in some ways - either resonance or maybe its because of the prosody...

What I usually think is, if the original voice - pre everything - is about 140-150 Hz, voice training can give one a relaxed feminine voice at about 170-180 Hz - mostly by the changes one has to do anyways to get a female resonance and voice melody. That range is close to your trained voice now.

So there are 2 things open - what is your REAL untrained voice like - is it lower than 150 Hz or not. If it is not, then i would think voice training should be able to give you a relaxed voice in your desired range, that of your trained voice recording. However, voice training has to be done properly. If done DIY or over the net, it can go wrong and then one strains to get the trained voice which, with better techniques, would be a relaxed voice. So my advice then would be to visit a trans-friendly and knowledgeable voice therapist to get rid of the bad habits that strain your voice.
I personally used a lot of this too - strained my voice just to reach 145 Hz - up from 110 Hz. With voice therapy the 145 Hz became my relaxed trained voice. I still wanted surgery though because 145 as a trained voice - well go figure

I would be very careful about the singing part though. I know some Yeson patients are singers and they attained a good singing voice, some reported some issues with the singing post op. Diplophonia or loss of power and control in the very upper range. So singing in the modal voice and a bit beyond probably will improve, going in the very high pitches may actually be harder - depending on how hard it is now for you. I guess only some of the singers who are long term post op can talk about this. Amy from Berlin and J-Mi would be the ones who fall into that category.

I was afraid this was going to be a very tough decision, and it looks like I was right. So it looks like the only thing I can really be sure of is that I'd have an easier time doing my trained speaking voice as it is. As far as anything beyond that, it would be just a matter of luck. Well, I've got at least a year to think about it, and hopefully I'll be able to find a good voice therapist to consult with in the mean time to help figure out if I could be doing anything else that would help. Any recommendations for someone in Minnesota?

[iKate]

Untrained sounds feminine.

[Miyuki]

I guess I can't argue with that, but it sounds really bad in my head, and I'm pretty sure the pitch is technically in the upper male range.

[anjaq]

Here is another recording of my voice I did just now:

Untrained

It is the same link as the "Untrained" in the first post! Are you sure this is correct?

I see... I must have been misunderstanding how the procedure was done at Yeson, because I thought I remembered people posting about having part of their vocal chords removed. In that case I would have to give Dr. Haben more consideration, because the travel expenses would be a lot less if I went to him.

Not really - yes, he removes part of the membranes that cover the vocal chords and puts it back in place later after making the suture, while others cut this away and remove it, or use a laser to burn it away - but the only one I believe who actually cuts vocal chords is Dr Thomas?
I would choose the surgeon by what you feel is the best work , the best results, the best chances of getting a good voice - I would put geographical considerations at the very end of the priority list, right next to financial issues. Seriously. Who cares if the flight is some hours and there are some $100 more going into this, what matters is that you get the best outcome. For me, I travelled 16 hours in a plane instead of 3 hours in a train, paid 8000EU instead of getting it on NHS just to get this done properly. So if you choose Haben over Yeson, do it because you like his results, his technique, the quality of his work etc - and not because it saves some bucks and some time travelling!