Should VFS be considered early in transition?

[sarahc]

I have seen many women here wait several years before pursuing VFS after years of voice therapy and training. But given that voice is a critical part of passing and a meaningful source of dysphoria, I wonder why women generally don't pursue it earlier in transition, especially if using a female voice causes strain.

I understand that VFS has meaningful risks, isn't always effective, creates significant personal disruption and is not a substitute for therapy. Hence, it's been thought of as an operation to pursue only as a last resort. Still, if you're going to do it, it seems like something to do earlier in transition rather than later.

What are people's thoughts on this?

[Jessica]

I do see the value in achieving a feminine voice early in transition.  My voice is the thing that gives me the most concern for my passing as a woman.  I started voice therapy only yesterday and wish I started from day one.  I was told then that I should start electrolysis first, but the voice is a dead giveaway.
I do feel therapy will help me speak like a woman, but to sound like one may require surgery.

I am one to try other options before surgery, and my suggestion is try therapy immediately and go from there.

Hugs and smiles from a California girl

[Colleen_definitely]

Voice training should be done as early as possible.  VFS should be seen as a last resort.

[Ellement_of_Freedom]

Most often it is recommended by surgeons to have VFS last. I've had FFS, I'm having SRS in January followed by VFS later in 2019 as my final transitional procedure. The reason for this is that you remove the risk of damaging the VFS results with intubation tubes for other procedures.

With procedures like Glottoplasty and FemLar coming as far as they have, the whole 'last resort' mentality regarding voice surgery is not accurate anymore. Yes the procedures come with a certain level of risk, but so does every surgical procedure.

[sarahc]

Most often it is recommended by surgeons to have VFS last. I've had FFS, I'm having SRS in January followed by VFS later in 2019 as my final transitional procedure. The reason for this is that you remove the risk of damaging the VFS results with intubation tubes for other procedures.

With procedures like Glottoplasty and FemLar coming as far as they have, the whole 'last resort' mentality regarding voice surgery is not accurate anymore. Yes the procedures come with a certain level of risk, but so does every surgical procedure.

Good point on the intubation thing. Hadn't thought of that. In addition, as you say, it's very possible in the next 3-4 years we'll see further advancement of VFS procedures.

[Colleen_definitely]

My take on it being a last resort is because voice training is more successful than people tend to think. On top of that even with vfs, if you don't learn inflection you just sound like a high pitched dude.

Of course training is scary and it takes a lot of work. Vfs is seen as easier and I'm sure it is but it's not a stand alone solution.

[sarahc]

Yes - I completely agree on the need and value of voice therapy, with or without surgery. It's not just about pitch, it's about all the other things that make up a female voice.

I guess my question is...let's say you start out doing voice therapy early in transition (even pre-fulltime) and after many months, you have a good idea of how far therapy by itself is going to take you. Why not just do VFS then?

The only reason I'm asking is because most people I've seen on this board who have done VFS do it as one of the last steps in transition (even after GRS), not one of the first steps, and I don't really understand why given the importance of voice for passing.

Said another way, for those who did do VFS late in transition, do you wish you had done it early in transition?

[Colleen_definitely]

I'm all for surgery if training doesn't get you to where you want to be in the pitch department.

I just don't like how some people seem to think that they can simply throw money at this and have a passing voice simply by being cut on. It's just not quite that simple unfortunately.

[Ellement_of_Freedom]

I've heard of people requiring botox injections and having to pay extra for VFS due to however long they strained their vocal cords to produce a female voice prior to opting for VFS. It can cause a 'vocal tremor' which needs treatment of it's own. Maybe this was from lack of training and incorrect vocal practise though, I'm not sure.

[Dena]

Speaking to high, to low or to loud will result in voice problems before or after surgery. A trained ear can detect the problems and address them before they cause issues. I would recommend therapy before surgery so you learn the proper way to use your voice and so your aware of what you need from surgery. In my case, I knew I required a good deal of change in pitch and had the surgeon offered less than was possible, I wouldn't have had surgery.

By the time you have had therapy and schedule surgery, you will probably be a ways into your transition so you may have already checked a few items off your list.

[Rachel]

I was told a 5.5 mm intubation tube and 4 months post VFS was a minimum before another intubation.

I had 9 months of vocal training and it taught me the basics of a feminine voice. My pitch and timbre were male sounding.

I have a cricothyroid subluxation which took me to 170 to 185 HZ. My range was 15 HZ after 6 months. Then I had a glottoplasty and my range is 150 plus HZ I am at about 270 to 330 HZ normal pitch and can go from 270 to 450/460 hz if I try. My vocal folds are just now starting to touch at times. My voice will need more time in order to heal. It has been almost 6 months.

I have learned so much from my vocal transition. During this last iteration I was made fun of at an operational meeting and my boss asked a very insensitive question at a high level meeting. I have had a lot of questions asked from strangers and acquaintances. I just love how people speak slower and louder after they hear me speak.

I am glad I am past my FFS, GCS (2) and hair follicle transplants (2).  My dysphoria is gone and I have a suit of armor now or better a dress of armor.

VFS can take a year to heal and there can be poor results. Anyhow, the videos and pics of my vocal cords show a beautiful piece of work done. At some point I will show a few pics. I do have a growth behind the one vocal fold and it needs to heal or be removed. I see the doctor in a month. I record my voice daily and periodically go back in time. I am making progress and it is evident each week.

I hike on Saturdays with an 85 pound pack. There are three hills on the 5 plus mile hike. One is a steep and long hill, one is long and moderately steep and one is very long. I only have the feeling of restricted air passage on the one hill. I go a pace that is pretty fast and my breathing is a little restricted. I panicked a bit the first time I took the hill on after my glottoplasty. I am use to it now. Spinning I do not have an issue

Rachel

[OU812]

Personally I consider VFS on an even tier of importance with SRS, and most likely worth getting first.

Learning to use your instrument optimally is one thing - having an instrument that is capable of doing what you are telling it to do is what VFS gives you. The modern glottoplasty procedures tend to yield fantastic or at the least "better" results.

People can argue for training all they want... but in the end... do you want to be able to yell? Cheer? Speak in a variety of registers and volumes? Do you want the ability to do all of this sounding flawlessly female, without people clocking you or having doubts, and without being hideously self-conscious of your voice? Do you want to actually live your life?

If you answered yes, and you were not blessed with the voice of Ross Matthews, I cannot imagine why someone would pass up what VFS offers - the ability to use your voice and hear yourself.

[Devlyn]

Funny how pleasing other's need for you to conform to their ideals equates to "actually living your life".

I'll stay out of that prison. 

[Lucca]

Funny how pleasing other's need for you to conform to their ideals equates to "actually living your life".

I'll stay out of that prison. 

One could say the same about HRT or SRS, why is voice any different?

[Allison S]

Guys don't really seem to care much but women give me a VERY peculiar look when they hear me speak. Some would be smiling before I talk, then... A frown! Lol I do find it funny [emoji12]
I wouldn't jump into any major surgery, and yes, somedays my voice does bother me... But I think having VFS is only really wise to do if you're "passable" in every other way

Sent from my VS501 using Tapatalk

[Devlyn]

One could say the same about HRT or SRS, why is voice any different?

It isn't any different, if described in terms of needing to bolster others perceptions. 

[sarahc]

Personally I consider VFS on an even tier of importance with SRS, and most likely worth getting first.

Learning to use your instrument optimally is one thing - having an instrument that is capable of doing what you are telling it to do is what VFS gives you. The modern glottoplasty procedures tend to yield fantastic or at the least "better" results.

People can argue for training all they want... but in the end... do you want to be able to yell? Cheer? Speak in a variety of registers and volumes? Do you want the ability to do all of this sounding flawlessly female, without people clocking you or having doubts, and without being hideously self-conscious of your voice? Do you want to actually live your life?

If you answered yes, and you were not blessed with the voice of Ross Matthews, I cannot imagine why someone would pass up what VFS offers - the ability to use your voice and hear yourself.

Yes - this is my perspective as well. I'd put VFS and SRS on the same level. I've seen so many women who've said that VFS has done so much for their confidence because they don't have to worry about one little slip in the voice. And as you say, it's not just the speaking I care about but all the other girly noises that I want to sound feminine (or worry about accidentally coming out masculine-sounding).

My view is that you basically start voice therapy at the same time that you start hair removal, very early and prior to full-time. You take voice therapy for 9-12 months and see where you are at. If you still have doubts about the confidence in your voice, you should be aggressive in your VFS timeline. I know the surgery has lots of risks, but the upside in confidence seems massive.

What's wrong this thinking? I'd love hear counter views. Am I discounting the risks too much?

Sarah

[KathyLauren]

Perhaps my information is outdated, but my understanding was that the success rate of VFS was lower than for other procedures.  Certainly, I have heard the results of VFS gone wrong, and it was not pretty at all.

That and the fact that insurance wouldn't cover it were enough to convince me that it was not for me.

[Alexa Ares]

Voice does seem to be something that can be worked on. Training it will work, to a good degree, and someone can really improve. Look at how actors learn accents. Its the same.

For VFS, I would say for those of us, who are extremely dare I say it passable, having a very female sounding voice can be good. For those of us who are not, it would be a mixed bag.

Candice Cane, on that reality show, we all watched but had very mixed feelings about, pointed out to Caitlyn how her voice was Her, Her journey. Some of us will relate to this, others won't.   Its a journey you may want people to know about..

As for the safety, If anyone has read some of my posts, Im pretty pro surgery all round and consider myself a future member of the plastic posse once I hit 60 years old....
However, I will say VFS is not widely done in the States, Not done at all in the UK (best standards in the world) so beware...
My rule of thumb - If Dubrow and the other one on Botched won't do it its not that safe!

It looks like a very tough recovery. You can't avoid talking for long. Muscles will struggle to heal if used alot post surgery.

I would not compare it to GRS, or FFS. As frankly some Cis Women do sound Manly and theres nothing wrong with that!
GRS gives you the body of a Anatomical Woman. FFS puts you into the facial range, the voice though, its less of a issue.

I would see it as a last resort if voice training can't get you what you want.
A bit like Butt implants if the Hip Thrusts and Abductions don't give you the Booty you need.

Thats my 2 cents. Will add lastly, I am of the disposition that even if I ever after a Caitlynesque spend of $$$$$$$ looked Cis Female, I would still want people to know Im Trans. so the voice for me, isnt that big, For others though ......I guess you risk what you need to get where you want to be.

[Alexa Ares]

Perhaps my information is outdated, but my understanding was that the success rate of VFS was lower than for other procedures.  Certainly, I have heard the results of VFS gone wrong, and it was not pretty at all.

That and the fact that insurance wouldn't cover it were enough to convince me that it was not for me.

Its got a bit better with results, from what Ive heard, however it is still considered high risk and I would not recommend this. A botched voice is a big problem!