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