CHARITÉ-FAQs - Voice and Transgender

Voice is influenced by many factors: breathing support, body tension and resonance are all traits of your personality and also genderspecific. Technically, feminuity within the voice is reflected by:

• speaking fundamental frequency (SFF) or pitch
• the change or variation of that pitch during speech
• the voice timbre or vocal resonance

All of those parameters can be modified by a professional voice training towards a more feminine sounding voice.

If the results are insufficient, then pitch raising surgery can be considered.

Of course their are "naturals", whose voices do sound perfectly adapted right away. Much more often, the transition of the voice is a process which may very well take several months. Sometime even longer.

Voice is individual and very decisive for your personality. Ultimately it is all about feeling comfortable with oneself. There are numerous examples of male-to-female transgenders who get there without any surgical intervention. The speaking fundamental pitch may or may not be important to achieve that goal.

For us, the central question is: what does it take to make you comfortable with your voice?

The techniques of pitch raising surgical interventions are

• anterior Web-Glottoplasty after Prof. Wendler (clinical director at the charité until 1996)
• Crico-Thyroid-Approximation (Thyroplasty Typ IV after Isshiki)
• Laser assisted glottoplasty (for reduction of the volume of the vocal folds

Since glottoplasty is best experienced, it is usually our method of choice.

If you are unhappy with your voice or how your voice is perceived by others, voice training is generally adviced.

Voice training is also advised, if your voice sounds weak or hoarse to you. 

Reasons to undergo pitch raising surgery are always individual. An voice training should always precede the decision to get surgical voice treatment.

In GERMANY we recommand to have the costs covered by your health care insurance. The possibility that more than one surgery can be necessary has to be considered.

Officially, the prerequesites for coverage of your statutory health insurance are:

• a persistent psychological strain due to your voice, even after psychotherapy and voice therapy
• the lack of a sufficient approximation of your voice to the desired gender from the point of view of an "understanding observer" oder according to objective criteria

There are three principles of pitch raising surgery:

• shortening of the vibrating vocal folds (as achieved by Wendler's Glottoplasty)
• raise of vocal fold tension (crico-thyroid-approximation)
• reduction of vocal fold volume (laser-assisted glottoplasty)

The modifications may be combined. All techniques can be associated with side effects, such as a permanent hoarseness or limits of vocal dynamics or even breathing problems.