Gender Affirming Voice Surgery

Voice is a critical component of gender identity expression in the transgender and gender diverse population. Particularly in transfeminine (male-to-female) individuals, hormone therapy alone often fails to achieve satisfactory voice changes, necessitating phonosurgical intervention. This review aims to examine various surgical techniques, outcomes, complications, and current trends in gender-affirming voice surgery. Recent literature on gender-affirming voice surgery was systematically reviewed, analyzing the principles, techniques, and outcomes of major surgical approaches including cricothyroid approximation (CTA) and glottoplasty variants. CTA can elevate fundamental frequency (F0) by 40–60 Hz without mucosal injury, though its effect is limited. Endoscopic approaches including Wendler glottoplasty demonstrate greater F0 elevation of 60–100 Hz with success rates of 75%–85%. Despite the potential risk of complications associated with vocal fold mucosal injury, a range of modified surgical approaches is now actively employed in clinical practice. Gender-affirming voice surgery can significantly improve quality of life in transfeminine individuals when combined with appropriate patient selection, preoperative voice therapy, skilled surgeons, and intensive rehabilitation. A multidisciplinary approach is essential for optimal outcomes.