I'm new here, I stumbled upon this place while trying to find information about male to female voice surgery.
I have been transitioned for about 6 years now started HRT in October 2010, had SRS November 2011, FFS March 2012, and breast augmentation May 2012. I am however very upset with my voice, speech therapy hasn't worked well for me, I am pretty much always "sir'ed" on the phone and even sometimes in person despite my appearance. I had a procedure done in Japan which tried to raise my voice pitch by using thread to tighten the voice box, results were good for a few months after the rest period but then I reverted back to my old voice pretty much.
I have recently contacted Yeson inspired by many peoples success stories and have been told I may not be able to have the procedure because of what they did in Japan but they have asked me to send a vocal folds image and video, voice file for analysis by their doctor before they make a decision.
I am really nervous at the moment as a surgeon I contacted in Thailand also said similar about my previous operation perhaps making me ineligible for surgery. The procedure in Thailand looks a bit more risky than the Yeson one.
Would like to hear if anyone had success with another surgeon as this may be the way I have to go although Yeson is my first choice.
Hi Anna- I'm so sorry to hear that your first voice surgery was a failure. It sounds like you had the CTA procedure which tightens the voice box. It has a notoriously low success rate
Dr. Haben in NY uses a similar technique to Yeson combined with the same CTA procedure. Perhaps he would have more experience to offer matching with your surgical history.
One member here recently had VFS with Dr. Haben and at one month is sounding great already. There is a thread with her experience in the voice forums.
Anyway, good luck and I hope this helps!
And welcome to Susan's :D
Thank you for the reply Jenny :) Yeah I wish I had never had the first voice surgery as it seems to be causing a lot of problems when trying to find a doctor for a 2nd operation.
I will definitely check out Dr Haben in NY :) may infact be the best otpion if he has experience with both methods.
Will let you know how progress goes, going to book an ENT appointment to get the videos and voice samples to send to yeson today
Yes it sounds like a version of CTA but one of the older ones. the newer ones use at least titanium plates to keep the result after longer time. Probably this tightening will have to be removed or re-done properly in a new procedure. Dr Haben may be a good choice as he does both. Another option may be Dr Thomas , however his procedure is a bit invasive for my taste, on the upside it also changes your whole larnyx in size and he can cut out any damaged materials from perviously failed VFS. He also does the other voice changing techniques, so he may be an option for you. Definitely get a proper ENT consultation with as much and as well made videos and photos of all your vocal chords, maybe you can get an Xray or soemthing to show what has been done before? Or does that surgeon have a description of his procedure?
I do not think that it should be an issue as these are different areas to operate on - the 1st VFS was on the cartilage of the larnyx, the next VFS would be on the soft tissue of the vocal folds. Both can be combined, but if you actually damaged your voice or speaking habits with the first VFS, it may be a problem as Dr Kim does not like to do surgery on someone with such issues. He warned me about it and that I should first do what I can to resolve the damage that he cannot correct before doing VFS. Also of ocurse do some voice samples of your pre VFS voice if you still have some, maybe your post VFS voice and your present voice - both in the untraine dmode and the one you are reaching when you apply what you learned in voice therapy - if that works for you at all. If you upload them on vocaroo and link it here, we can also try to say something about it and you pictures of the ENT camera if you want to share. Then send it all to yeson - I sent them my ENT video and voice analysis as well for a remote assesment last winter.
i agree with the others. Dr Habe has had some great results the past year from whati have herd from his patients
Male voice sample - http://vocaroo.com/i/s0NrBdWZBiVH
Falsetto attempt - http://vocaroo.com/i/s0bkp2k3HYDL
I can hear a lot of chest resonance in my female attempt, these are very embarrassing lol!
The ENT place I went to yesterday was completely un-helpful, they didn't want to provide me with the image, video or voice sample and the cost would havebeen something like $1500 in any case :o
Crazy! You are a woman with a really problematic voice, why would they not help you. Argh - I hate this, probably insureance has excluded anything they can link to trans for you and also the insurances are not regarding transwomen as women but as men who want to be women or something like that. For ciswomen I am sure they wou not bug around so much about doing a proper voice repair.
Maybe you can try another ENT - The ones I went to have given me all the data they took, same is true for the Endocs and other docs, uopn request I always got all the data, after all it is mine and they were paid for it by me or my insurance.
Maybe try to get the examinations done without telling them about trans* - just say that you have issues with your voice and want to have it checked because you have pain when speaking and people keep asking you about your weird voice etc - my insurance has only gotten reports from doctors so far taking about a "functional dysphonia" ;) - No mention of "trans".
Regarding the voice samples - I dont have the analyzer here, but it does not sound incredibly low pitched to me, yet it is not really in the average female range I believe. What strikes me about your recordings:
You are having a rahter monotonous way of speaking. This is identified as male. Have you treid to use more inflection and melody in the voice? This usually should be part of voice training or you can try to just mimick females in TV shows (not the speakers, they usually are more monotonous as well) or do yome overexaggeated "valley girl" voice at home. I think this would already impreove the voice a lot. Or are you restriced by your previous VFS attempt to have less of a vocal range? Can you test your vocal range? Do a recording and stat with a middle voice saing "ooo" or "uuu" and then go as much down as you can without breaking into vocal fry, then go up until you hit the "break" and then go over it and as hich as you can. You can of course grasp air in between. This can be analyzed for for vocal range.
Your voice sounds very weak and broken, it seems to break out at times, not able to hold a pitch and sometimes it breaks into vocal fry. The second recording is less bad in that sense than the first. But still it sounds like you have to concentrate to just keep your voice going at all? Can you comment on that? Maybe you are having some issues with the voice now as a result of the VFS or even before that which are making the voice sound less healthy and good. Maybe it is just the recording and you tried to speak softly or silently? If this is really as it is every day, you definitely should have it checked by an ENT and probably do some voice rehab to simply get your voice up to a healthy voice - independent of any trans issues!
Hi thank you for your reply. The problem I have in the UK is that I only have National Health Insurance and no private health insurance.
I would have to wait approximately 18 months for anything on the NHS system and this is not viable for me.
I've always noticed that my voice is very monotone and I have always hated this. I think that the VFS has limited my lower vocal range certainly and when my voice was last analysed 6 months or so after the VFS the average was coming out at around 160Hz.
About the recordings, I'm not sure how good my mic quality is so that may be an issue as well.
My mother has had Multiple Sclerosis for around 20 years which affects her speech a lot so perhaps some habits in my voice have come from this.
I will try to make another recording as you suggested later this evening. Maybe in 3 hours or there about.
*when I went to the ENT yesterday I didn't mention trans at all but they still wanted to refer me to the gender clinic as they thought I must at least have some kind of hormonal issue due to partially visible adam's apple.
Your public health system sounds horrible but I guess here it is not that much easier - to get surgeries approved by insurance it can take a while, but 18 months is insane.
About the previous VFS - a 160 Hz average is not too bad. CTA can only raise the voice in a limited way, so maybe you had 130 before and now are at 160. at least that is in the gender neutral range pitchwise. And of course the goal is to restrict lower pitches and cut off that range, so it is lost. The question to me is what happened to yout upper pitches - do you have a break if you go up in pitch just singing a note? Can you go beyond that break? How far? So that range would be interesting as you CAN use it to get away from the monotony in the voice which already would improve your voice even without surgery and mind you, this is even an important thing to do post op after the second VFS.
Of course you may have picked up speaking habits from your mom or have a bad mic, but to me it still sounded like the voice is all but stable. Do you have a better mic and can you maybe do a recording with some more volume, but not hold the mic too close?
Quote from: anna chan on August 21, 2014, 08:58:51 AM
*when I went to the ENT yesterday I didn't mention trans at all but they still wanted to refer me to the gender clinic as they thought I must at least have some kind of hormonal issue due to partially visible adam's apple.
So did they idenitfy you as trans or would they put anyone who has hormonal issues in a "gender clinic"? Thats insane - Why would a woman with some hormone issues have to go to a gender clinic? Its not about gender, its about endocrinology maybe and about voice for her (and for you). Sigh - this is part of why I oppose "gender clinics"
scale sample: http://vocaroo.com/i/s15QTFdoLq2R
scale 2: http://vocaroo.com/i/s0eycprlzqrT
I don't think they identified me as trans but they said I should go to the gender clinic because lots of trans women go there with similar voice issues and they would be the best people to help.
Let me know if this sounds any better. I only have a headset mic so talking with it further away is kind of difficult.
I think both scales are identical? Anyways - you can hear cleary what I meant in the 6th and 7th note you are doing . From there up , it seems normal again. At the lower pitches your voice struggles to hit the note. it breaks away from it. to me this sounds like you are holding back a lot, trying either not to sound too loudly or you are trying too hard to get the pitch low. I am not sure which it is. In the first case, using more air to make the sound - "singing it" would help. If it is the other case, then this is just natural that you are not having it easy to make a tone at the low end of your range. Assuming you followed that suggestion, this would ake the 140 Hz that the first few of the tones are your lower limit, which is about what others here have gotten post op! The 7th tone is already in the normal female range at 200 Hz, the upper limit however is only 350 Hz, which is very low. Which note was most comfortable to you, which came out naturally without effort? Try to use more power, more air. breathe deeply in and let your vocal chords make the sound with less control on your behalf. Also try to slide the scale. I will record what I meant:
http://vocaroo.com/i/s0GaYoRmPLff
I did a comfortable tone first, then slide down from it to the lowest I can get, then slide up to it as high as I could get. at some point in the sliding up, you can notice the "break" where pitch jumps a bit. I know how to eliminate that break but in this case I left it in for demonstration. The first comfortable tone I did was about 210 Hz - it is a tone I like, but sadly it is not my speaking voice, which is rather at 150 Hz and sometimes less. I went down to 95Hz then , hit my relaxed voice at 125 Hz then and went up from there to 250 Hz at which point it broke to 300 Hz and then went up to 820 Hz.
Here is my sliding scales in praat:
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2Fp6UNXi3.png&hash=5fbdf82c1c7a2aeefb4a58580971295031351377)
this is yours:
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2FKkFBswq.png&hash=615b6b42cafdec6b931c1436296e66ef9224dca2)
Can you try doing the same thing and use more airflow when doing it - dont be scared of volume unless it is getting too loud for the mic ;)
Regarding your reading samples. The lower one comes out at 110-130 Hz which is in the normal male range. But it sounds as I said broken and you can see in the praat analysis how it keeps doing stuff that praat cannot deal with.
Interstingly the other recording is also at about 130 Hz with some words going up to 160 Hz. I think you mostly change resonance there, pitch changes just to a degree. Are you trying to raise pitch there or just traing to sound more female? Is it taking oyu effort or is it a comfortable everyday voice, that recording. It definitely is not falsetto, but to me it sounds like you are doing something positive about resonance there. In praat you can also see how monotonous the voice sadly is - It goes up mybe by 40 Hz in some few selected sylabils.
I totally can see why you want another voice surgery as 130 Hz is really low. However I think you ma ybe speaking at the low end of your range which makes it broken and hoarse. It depends of course on some things, but maybe you could just speak a bit higher pitched without much effort and it will actually sound better in that sense. I think you should before doing a VFS again and before sending voice records to a surgeon try if you can get voice rehab or voice therapy for some hours to get rid of these issues. I had some issues with the voice and Dr Kim told me to first fix that to get a good result. In voice therapy maybe you can also try to improve the prosody, the melody of the voice and increase your upper pitch range. Maybe however the damaged sound in the voice and the lack of pitch range is coming from the broken VFS you had. If that is the case, but you should check first if it really is so, then i would think a proper surgery could fix that, but it probably would have to correct the CTA you had. So as it was already said, a surgeon that knows the whole thing very well and uses different techniques may be the best choice. I heard a lot of Dr Thomas in Portland being able to fix broken voices as well as feminizing voices, even ones that are broken from previous VFS. I dont know if Dr Haben does that too, but he knows at least both techniques. There seems to be a surgeon in the UK who knows both techniwques as well, it was described in one of the current threads on voice surgery (I think by "Kathie"? who got a glottoplasty even though they planned a CTA first).
Personally if I was in that situation, I probably would look at Dr Thomas for help since he has that reputation of being the guy to go to if you had VFS before that went wrong. He does s complete reconstruction of the larynx basically and can thus remove issues from other surgeries, but his method is sadly a bit invasive with some risk of complications - and has some risk of resulting in a lowered volume or some breathyness or hoarseness which is not so much the case in Yesons. But this is not just about pitch rainig anymore...
scale : http://vocaroo.com/i/s02skbuUYEAG
comfortable: http://vocaroo.com/i/s0ebVU1QrAZb
Tried recording again as a scale and a 2nd recording with a pitch level comfortable for me.
The low pitch end of the scale just doesn't want to come out it takes a lot of effort, I do feel my voice is very weak and it may have to do with the previous CTA.
Most of my speech therapy after the CTA was done in Japanese so I have never really had voice therapy in English (may or may not be an issue but the speech therapist told me my English had a lower pitch than my Japanese)
So your low end of the voice is at 140 Hz, which is actually quite normal post-VFS and considered a rather good result. Most of the girls from Yeson have that pitch as the lowest or even are a bit lower if they push it. So this sort of confirms my suspicion that your voice is in part sounding not that great because you are speaking at the lowest pitch possible with your voice box now. It would be like me trying to speak at my lowest pitch which is about 85-90 Hz - I would strain, I would break up, I would sound weak. I would thus suspect that your natural speaking pitch should be above that, at maybe 170 or 180 Hz actually. Now why you cannot use that pitch for speaking, I am not sure. Maybe it is what others described here as having your brain trained to use the new pitch. Its what some people who had been at Yesons are struggling post op as it gives them the impression that it did not work out. It is still a bit of a mystery why it happens.
The highest pitch in the recodring is just 300 Hz flat. This is rather low. I would say , you are using only the chest voice. I heard before that CTA can eliminate the break between chest and head voice and basically only allow one voice to survive, as it turns off one of the two muscles who would otherwise do the switch between the two registers. Maybe this is what causes this, but I would expect that you have a break at 300 Hz and just feel like you are stuck underneath. Can you squeak or giggle or scream or sing in a higher pitch than that? It can be MUCH higher if that is of help.
Are you originally Japanese? How well did you learn english? I do not know japanese gender voice differences at all, but maybe it would be good to do a voice therapy in english as well to get the melody and prosody there. But I think what you would need is a more general approach, not about speech but about voice. Trying to break free of the 300 Hz barrier there and to allow you to access more pitches, and also increase your speaking pitch into the mid of your new speaking range.
your comfortable note is at 240 Hz, this is WELL within the female range. If this is what comes when you totall relax the voice, my assessment would be that your voice surgery was not botched but is still holding, but something must still be wrong. The parameters then would speak for a successful voice feminization: 140 Hz as the lowest note, 240 Hz comfortable relaxed pitch - the negative is the limitation at 300 Hz which may be what pushes you to speak generally lower as otherwise you would feel that limitation while speaking.
The main goal would be in my opinion now not to increase pitch any further with another surgery, but rather see how you can regain a healthy voice and reach the upper pitch levels that seem to be blocked. In addition to that, it would probably be good to check generally for voice health, I guess Dr Kim would say you have a strong vocal tremour, so get that checked out by an ENT and see what the diagnosis is, I think some of it may be helped with voice rehab and I think it would probably be a good idea to do this before doing another surgery. In the worst case another surgery would increase your low end of the pitch range even higher to 200 Hz but not change the upper limit, then you would be locked in a 100 Hz pitch range and can never be anything but monotonous. I think to solve the riddle why the upper limitation is there is a priority. if it really is from the vfs and can be somehow reversed, then it has to be done, if it is something else, maybe voice rehab helps
To give som courage - I felt locked in a low range as well. I had that breat at maybe 350 Hz and thought I can not go beyond that without the voice breaking or cracking. I knew however i can giggle or sing a note or scream at a higher squeaky pitch, so I managed to build a bridge between these parts of my voice and use the full range when I use a female resonance.
To answer your question, no I'm not originally Japanese but I lived there for 5 years, I was born in the U.K.
I really don't seem to be able to make any higher pitched sound over 300-350Hz I certainly know I used to be able to.
I have decided to get checked by Dr. Kim and Dr. Haben as their consultation fee even with the flight is much cheaper than getting anything productive done here.
Ok - that sounds like you will be in good hands then. Hopefully they can resolve that lock at 350 Hz - that is making your voice worse, as loosing the ability for higher pitched intonations is making the voice more masculine - and if you aim for a basic pitch of about 200 Hz as most do, your range would be even more limited and resctricing, it would be even harder to get a proper feminine prosody with that and this is maybe as crucial as a high pitch or good resonance. I hope you can get this fixed, even if it means flying around the world for examinations. Where are you now? UK? If you are in Japan or the US, I would definitely also check Dr Thomas in Portland which is half way from Japan to Dr Haben ;) - I heard several people who went there and had good examinations as he does fix all sorts of voice problems. I heard two people speak who went to his and one of them had 2 VFS before - she sounds good now except she also seems to have some issues with volume and prosody, maybe thats psychological or maybe it is a result of the botched VFS before but she sounds at least clearly female.
Update:
Consultation only with Dr Haben on 16th September
Provisionally booked to see Dr Kim on 7th of October with possible surgery on the 8th depending on the consultation.
Speech therapy starting Wednesday 27th August to try and iron out voice issues.
Currently in the UK so Dr Thomas is a bit inconvenient.
Ok, that sounds like a good plan. Great you managed to get the dates fixed so fast :) - I guess Dr Thomas would be someone to keep in the back of the head if the other two surgeons say they cannot fix it...
I hope the best for you.
Had first voice therapy last Wednesday and she said I need to work on pitch and intonation, will probably be going back for another session in the near future.
A letter arrived from the ENT doctor today saying " your voice problem may be caused by a lack of Estrogen, I recommend you see an endocrinologist" ???
I send voice samples to Yeson today so will be waiting to hear back from Jessie.
Hi. Voice therapy is probably only useful if you do at least a few sessions, the first is mostly about getting to know the issues.
I definitely would check out your hormone therapy. If it is bad, it can act negatively on the voice. For example, too much estrogen can cause oedema in hte vocal chords and make them thicker and slower and the voice deeper. A lack of testosterone can weaken the vocal muscles and make it harder to control the voice generally, pitch and resonance and thus rather lower the voice and make intonation harder. If you take Spiro, the vocal chords can become thinner from loosing water, the same is true for the natural hormone progesterone which also acts as a de-watering substance. So these two make the voice increase in pitch. So let them check your hormone levels and consider taking enough estradiol, add some progesterone to it and dont go too low with the testosterone. Maybe it can support your voice.
Quote from: anjaq on August 31, 2014, 07:29:59 PM
I definitely would check out your hormone therapy. If it is bad, it can act negatively on the voice. For example, too much estrogen can cause oedema in hte vocal chords and make them thicker and slower and the voice deeper. A lack of testosterone can weaken the vocal muscles and make it harder to control the voice generally, pitch and resonance and thus rather lower the voice and make intonation harder. If you take Spiro, the vocal chords can become thinner from loosing water, the same is true for the natural hormone progesterone which also acts as a de-watering substance. So these two make the voice increase in pitch. So let them check your hormone levels and consider taking enough estradiol, add some progesterone to it and dont go too low with the testosterone. Maybe it can support your voice.
Interesting observations. I've also heard of peoples' voices lowering after too much and/or too long on Spiro.
Of course clean vocal habits will help too - avoiding irritants (caffeine, alcohol, smoke), drinking plenty of water, avoiding excess mucous, and being ever mindful of one's breathing all go without saying as good ideas for anyone trying to get the most from their voice.
I never took spiro and I've been post-op for almost 3 years so my e and t levels should be fine , only possibility is too much e if anything but I'll get my GP to check my levels just to confirm.
I'm afraid I am guilty of caffiene and smoking but I will give up both if I go for the voice surgery.
Yeah, good idea. I understand post-op T tends towards the lower end of the female norm. E is always worth checking, I've been surprised by how my dosage required to balance a normal level has fluctuated even in years post-op.
As for smoking I knew choral singers who experimented & anecdotally found that it gave them an extra low note or two. I'm not sure if that's just inflammation or a more permanent effect (I've heard testosterone can boost cigarettes levels) but still worth noting as I'd be worried about thickening my vocal timbre.
A bit of testosterone can actually help the voice (just tiny bit! Like mid of female normal range as opposed to the low end of it) because it strengthens the muscles and thus also voice control. Too much E can be an issue, although it is mostly the ratios that count. If you take estradiol, you should also check progesterone and estrone. If estrone is more than 2 times the level of estradiol, it is a problem because it can increase water retention. If progesterone is missing and Estradiol is high, it may have a similar effect. One should strive for a regular female hormone balance which means one should have a estradiol to estrone ratio of at least 1 (better 2:1), and enough Progesterone to balance it out in order to not slide into an "Estrogen dominance Syndrome".
I heard back from Jessie and Dr Kim today.
Dr Kim "some vocal tremor and voice break along with strained voice. Also, your respiration pattern has a short span."
anyway my consultation is on the 7th October with surgery on the 8th if I'm suitable.
Ok, so you first are visiting Dr Haben and then go to Korea and are already booked for a surgery there?
Well Yeson is my first choice if Dr Kim thinks I am suitable, I'd also like Dr Haben's opinion as he seems to have experience with fixing failed vfs. Surgery is not guaranteed in Korea as Dr Kim wanted to see endoscopy before confirming surgery, due to the useless situation here with ENT I have no choice but to take a consultation in Korea really
Ok so I just got back from my consultation with Dr Haben.
I'm now a tad worried about some of his observations, he said that he is not sure what they did in the previous VFS because he said the thyroid cartilage seems to be sticking out at a lower position than the adam's apple would be expected, there is also redness caused by smoking which I kind of expected....
It looks like I will likely be changing my preferred surgeon choice to Dr Haben if there are also external fixes (re-done CTA) and the vocal fold shortening required. According to Jessie at Yeson she was unsure if Dr Kim would agree to surgery with my previous VFS failure. It seems also that my problem is not something the vocal fold shortening alone is going to fix, nevertheless I will visit Dr Kim for his opinion in early October and make a decision.
Yes - I think this is a good plan. Since Dr Haben uses both approaches, he may be actually more experienced in fixing this, since he would operate from the outside as well as fromt he inside anyways.
And please stop smoking ASAP if you want to get a good voice :)
The surgeons I've talked to and the endocrinologists at the health center I go to won't operate on or treat smokers. It can lead to complications in surgeries, slower recovery times, and increases the chance of the HRT causing blood clots (which can be fatal).
I know I struggled quitting cigarettes, but I was finally able to with the help of vaporizers. It's really up to you, and I know how annoying it was for people to tell me to quit. However, I made a deal with myself, that if I were to transition, I wanted to enjoy my authentic life as long as possible. Also, because the clinics near me wouldn't treat smokers, I had to quit before I could start HRT
I am currently using e-cigarettes :) 2 weeks left until consultation with Dr Kim.
I didn't like the e-cigarettes I tried very much, I ended up preferring the vaporizer, because it's easier and more effective to refill a tank with the nicotine liquid than a cartomizer.
I had consultation with Dr Kim today and he suggested VFS with continued botox injections after returning home to deal with the "spasmodic dysphonia" which is causing my voice to break up and tremor which he says is half of the problem. I had botox injections today and am going back for the VFS tomorrow morning so fingers crossed that everything goes well.
Oh wow, that was a quick decision then. Good luck. How often and for how long will you need that botox - I get the feeling Dr Kim really really likes Botox as a fixall...
Just got back to my hotel after surgery and rest period, Dr Kim has recommended that I have botox injections every 3-4 months after returning home. He had to use a laryngoscope for children for my operation because the previous CTA had caused tension in the area but it went successfully...
now the torturous waiting period before I can speak and hear the results, I'll be sure to post a voice clip once I can speak again
Yay - good for you - we sure will be interested in your recording as well. Must have been a challenge to Dr Kim to work with the CTA already done. I hope this all works out. Botox every 4 Months sounds a bit bad though - do you think it can be stopped after some years or is this for life? After all it also costs money and causes pain and such
I expect it is going to be a life-long botox regime. There are apparently surgeries to fix spasmodic dysphonia but I really do not want another risky surgery to try for a permanent fix. I'll happily put up with the pain and expense of the botox injections (the botox injections actually weren't too bad, no worse than a blood test)
Ah, he did the botox right away with you? I always heard they do it some days later. interesting. Still thats 3-4 times a year a botox injection. Is that condition something you had originally or did it appear with transition, hormones, voice surgery?
I'm pretty sure I always had the condition or else it developed when I started getting thyroid problems (first overactive until radio-iodine treatment and then under active after) and it was never diagnosed, apparently the symptoms are not as noticeable at higher pitches or while singing.
Yes he did botox the day before the operation as he thought the involuntary contractions of larynx may cause breathing issues when waking up from GA
Interesting , I always wondered why he does not inject it first before the surgery to prevent damage by contractions.
Do you think as you have a higher pitch now, the condition would improve in any case, even without botox?
Quote from: anjaq on October 08, 2014, 12:57:22 PM
Interesting , I always wondered why he does not inject it first before the surgery to prevent damage by contractions.
My thought on the 1-week post-op timing is that maybe he wants the musculature intact at first to hold everything together for the initial heal? Especially if there's swelling/extra mass inflating the now-female-sized vocal folds that would not be properly supported in the initial heal otherwise.
Regarding the actual benefit of the botox in regards to tremor, accounts I've read seem to be that it softens the mechanisms supporting/controlling the voice. But then why the extra week of total voice rest for those who have the botox? Possibly to avoid extra strain that could be induced by trying to use botoxxed vocal musculature?
It's interesting speculative theory in any case.
My guess would be that he also corrects assymetries andsuch, some may be caused by muscles. if the muscles relax, he would not see them maybe? German clinics seem to give the botox right away tough to ease the healing right from the surgery date
I'm very curious to hear how the botox helps you, I've noticed a slight bit of degradation in my upper upper range (C5+). I'm not sure if it's because I have ceased vocal exercises or because of the vocal tremor... All I know is that I haven't had a single botox injection since the surgery, and Dr. Kim was positive that I will need it just the same as you.. The exact diagnosis as outlined in my packet from Yeson is "focal laryngeal dystonia".
Even without the injections, I don't think I've been read since I went to Yeson. My voice passes with zero effort, it's just not even a thing for me. I do kinda want to give the botox a shot, though, just to see.
Why would you want the botox again jenny, does it not also make the voice a bit unstable overall? I mean, I read from many that they were having some issues with the voice post op and said it probably is due to the botox. I dont quite get if botox improves the voice or if it actually makes it harder to use it properly.
BY the way Jenny - did you make any long term vodeo or recordings? I have been looking for any long term recodings but the most long term I found was a 8 month recording of you I think - I was wondering how Sarah and Abby are doing now in the long run. I have my day in Berlin (consultation with FacialTeam, consultation with the Berlin voice doctors and maybe a lunch with Amy ;) ) in a month and after that I will have to decide soon if I want VFS and also begin to decide upon FFS as I basically cannot get much more info and need to listen to my intuition then. I also joined a Facebook Yeson patient group recently, but there are no long term post ops in there, sadly.
Hi Jenny and Anjaq
I had my post-op consultation with Dr Kim today, he said there was a little swelling but nothing to worry about and I have been instructed to remain silent for an extra week and he prescribed extra medication including clonazepam with is the same thing my mum takes for her Multiple Sclerosis.
My diagnosis says:
spasmodic dystonia with muscle tension dysphonia
vocal folds asymmetry with tension discrepancy
Quote from: Jennygirl on October 14, 2014, 03:08:50 AM
I'm very curious to hear how the botox helps you, I've noticed a slight bit of degradation in my upper upper range (C5+). I'm not sure if it's because I have ceased vocal exercises or because of the vocal tremor... All I know is that I haven't had a single botox injection since the surgery, and Dr. Kim was positive that I will need it just the same as you.. The exact diagnosis as outlined in my packet from Yeson is "focal laryngeal dystonia".
Even without the injections, I don't think I've been read since I went to Yeson. My voice passes with zero effort, it's just not even a thing for me. I do kinda want to give the botox a shot, though, just to see.
Hey Jenny!
Just wondering if you ever go back to see your ENT in LA? I think her name was Dr Amanda Salvado.
It still really amazes me how life changing this surgery is. People just treat me so differently now. :) :)
Isn't it wonderful, Charlotte!?
I had an appt set up but I forgot about it and never rescheduled. I don't have insurance so as well it is very expensive for me to see her.. $450.
I don't have any real issues with my voice, so it's hard to make that cost feel worthwhile!
No I don't have any long term recordings either, I suppose that is long overdue.
First of all, I want to be very careful to not step on anyone's toes. I'm not criticizing anyone's surgical result at all.
Maybe it's my perception, but I haven't seen a lot of before and after videos (I think I've been able to find about 5 trans women on Youtube) from women who have went to Yeson. Dr Thomas' website has quite a few before and afters. From what I have seen, the end result for the Yeson technique seems to be less dramatic, but also A LOT less invasive and more natural.
Sometimes the dramatic change is impressive with Dr Thomas' patients, I'd say that probably 1/3 of the surgeries I could definitely live with, 1/3 are just satisfactory, and 1/3 would be unacceptable/disappointing result for me.
I did some voice analysis myself and found that at my normal speaking voice, I'm about 122, with my highest pitch being 320 and my lowest being 108. You can listen here (https://drive.google.com/file/d/0B1dfgYWiWrnabk9UZmRLRGxKaEU/view?usp=sharing) to my normal speaking voice. This is totally relaxed without any effort to change pitch at all.
So according to this:
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.nyspeechandvoicelab.net%2Fwp-content%2Fuploads%2F2013%2F07%2Fpitch-chart-image.jpg&hash=97c90873e378af777d3b5e46ee0f153b6a0d993a)
122 puts me right at the cusp between masculine and gender ambiguous which kind of is my life experience. I made this (https://drive.google.com/file/d/0B1dfgYWiWrnaQkpUTnU3X1pQeG8/view?usp=sharing) for my voicemail (217 Hz) with considerable concentration, and I can't keep this up for long or with any kind of comfort.
I really do want surgery and am at a point I can afford it, so I'm looking for input. Thoughts?
Hi. I cannot access your voice files sadly without creating a google drive account. so I cannot say anything on that. But you seem in about the same range as I am with normal speak when I speak very relaxed. When I do enough change that it still is not too much effort, I am at about 150-160, in the ambiguous area. Its possible to live there I think, but its not always easy especially when relaxing means to go down to the borderline again.
The 1/3 ratios are what actually some surgeons seem to tell people here - 1/3 is improved and good, 1/3 is same as before maybe higher pitch but more huskyness, 1/3 actually is worse. I could not live with those odds.
I have not been impressed by many of the results from Dr Thomas, but some seem to be good. I have not yet heard any really bad voice from Yeson, but maybe those who were disappointed (according to Yesons own stats it should be some small percentage) dont like to speak up. heard with some that the change was less than they hoped for, at least in the first months, it seems this actually does change for most of them though. I think no dramatic changes are needed. few people really need a 220 Hz voice.
The big advantage of Dr Thomas seems to be that he also changes the chape of the voice box, so resonance will change. I imagine it like this - Yeson will just take your voice, modifies it, lift up the pitch you can easily produce, cut off some lower pitches so you cannot reach them and they cannot be produced as undertones to your voice anymore. Dr Thomans on the other hand completely gives you a new voice - pitch, the way it sounds - all of it. I can imagine both procedures will be suited for certain people. If you never ever can make a feminine sounding voice, maybe it would be Dr Thomas. If you can do a feminine voice but it is just annoying and hard to keep it up, I think this is what more of the people who went to Yeson report as their experience
Quote from: anjaq on November 03, 2014, 04:44:19 PM
I have not yet heard any really bad voice from Yeson, but maybe those who were disappointed (according to Yesons own stats it should be some small percentage) dont like to speak up. heard with some that the change was less than they hoped for, at least in the first months, it seems this actually does change for most of them though. I think no dramatic changes are needed. few people really need a 220 Hz voice.
Yeson will just take your voice, modifies it, lift up the pitch you can easily produce, cut off some lower pitches so you cannot reach them and they cannot be produced as undertones to your voice anymore.
These seem to be the main points. Having a huge part of your my voice that I cannot use, which is constantly coloring & limiting the part that I can, has just always been unacceptable to me and can finally be resolved in a next-gen way.
Indeed, among those who have not had prior voice feminization surgeries, the only bad word I've heard about Yeson's VFS are a few who "didn't get as significant a change as they'd hoped for," or something along those lines; kind of a meager complaint, really, compared to the daunting 1/3 ratios that stood up until recent years.
You have to remember, we're talking frequency and anatomical ratio. Most people's F0 is going to be within 100-150hz or thereabouts. The difference between 175hz-225hz is three adjacent white keys on a piano. It's not a huge difference considering your voice was previously six or more adjacent piano keys lower.
As the numbers grow, the inflation scales. Even 75hz upward from 220hz is only four adjacent piano keys higher (ofc nobody's voice is tweaked that high, but just to demonstrate the inflation.)
@martia Regarding resonance, yours was fine - it's clear that with that pitch range as your 'relaxed' speaking range, resonance would not be an issue. My observation from watching lots of videos is that post-op Yeson people tend to inherit their prior 'highly-feminized' voice as a natural, better-sounding speaking range - and from there, you can use that "upward reach" for inflection and prosody, rather than trying to just set your voice on that shelf and keep it from falling - that's what is actually unnatural to the anatomy of the voice, causes breathiness, tremor, etc in those of us who actually are quite good at voice feminization, but have to use no less effort than the rest in order to make it work.
Makes sense, aye? ;)
Quote from: anjaq on November 03, 2014, 04:44:19 PM
The 1/3 ratios are what actually some surgeons seem to tell people here - 1/3 is improved and good, 1/3 is same as before maybe higher pitch but more huskyness, 1/3 actually is worse. I could not live with those odds.
I can't either. I've been stewing on both of your responses for a while and I just can't see taking that big of a risk. For me, the more I thought about it, the more I thought of it as what is the best I can do, with the least amount of risk?
Quote from: anjaq on November 03, 2014, 04:44:19 PMI have not been impressed by many of the results from Dr Thomas, but some seem to be good. I have not yet heard any really bad voice from Yeson, but maybe those who were disappointed (according to Yesons own stats it should be some small percentage) dont like to speak up. heard with some that the change was less than they hoped for, at least in the first months, it seems this actually does change for most of them though. I think no dramatic changes are needed. few people really need a 220 Hz voice.
And the worst case with Yeson is that I spend 10k and get very little change. I have to live with the results and my job might be in jeopardy with a bad result. It seems, so far, that the bad with Thomas is a lot worse than the bad Yeson.
Quote from: anjaq on November 03, 2014, 04:44:19 PMThe big advantage of Dr Thomas seems to be that he also changes the shape of the voice box, so resonance will change. I imagine it like this - Yeson will just take your voice, modifies it, lift up the pitch you can easily produce, cut off some lower pitches so you cannot reach them and they cannot be produced as undertones to your voice anymore. Dr Thomans on the other hand completely gives you a new voice - pitch, the way it sounds - all of it. I can imagine both procedures will be suited for certain people. If you never ever can make a feminine sounding voice, maybe it would be Dr Thomas. If you can do a feminine voice but it is just annoying and hard to keep it up, I think this is what more of the people who went to Yeson report as their experience
I've read both you and Rachelicious' comments over since you posted them and let them sink in a bit. Anja you're right, those odds with Thomas are hard to live with. I think I'm going to look into Yeson or Michael Haben. I'm having dental work done this year (30k USD worth), so I'm looking at this as gathering information and education and saving for next year, probably towards the fall.
Quote from: Rachelicious on November 03, 2014, 06:03:23 PM
@martia Regarding resonance, yours was fine - it's clear that with that pitch range as your 'relaxed' speaking range, resonance would not be an issue. My observation from watching lots of videos is that post-op Yeson people tend to inherit their prior 'highly-feminized' voice as a natural, better-sounding speaking range - and from there, you can use that "upward reach" for inflection and prosody, rather than trying to just set your voice on that shelf and keep it from falling - that's what is actually unnatural to the anatomy of the voice, causes breathiness, tremor, etc in those of us who actually are quite good at voice feminization, but have to use no less effort than the rest in order to make it work.
Makes sense, aye? ;)
That makes total sense, and THANK YOU for your responses. Both give me enough outside perspective to be comfortable and move forward with this.
I need to understand the techniques of each of the surgeons better. If I understand correctly there are 5 surgical methods for VFS (http://yesonvc.net/en/disease/feminization_surgery_02.asp), being cricothyrodiopexy, laser assisted thyro-arytenoid muscle resection, laser assisted voice adjustment: LAVA, anterior web creation and thyroid cartilage and vocal fold reduction.
I'm curious about Haben. From what I've read he does a mixture of LAVA and anterior web creation? Has anyone contacted his practice to ask? It seems from this, that Yeson does a mixture of these techniques, based on the patient's vocal presentation/anatomy? I'm wondering if Yeson does mostly anterior web creation (this does seem like the least invasive) only? The more I think I know, the less I seem to. LOL