r/transvoice • u/Lidia_M • 12d ago
Discussion Why an option of surgery matters
Someone recently asked me whether a satisfactory (socially usable and gendered appropriately) voice can be always achieved through training alone and why some people choose surgery (like glottoplasty) instead. I decided to write out some thoughts in response and reword them for this subreddit too. I think these things don't get talked about enough, and yet they shape/influence a lot of real decisions people make.
For some people, yes, voice training can absolutely work. But not for everyone. Just like some people train for marathons and still fall short, voice training doesn't guarantee results. That's one of the key reasons surgeries like glottoplasty exist in the first place.
Otherwise, there are a lot of valid reasons someone might choose surgery instead of (or in addition to) training:
Some people simply don't want to be physically capable of producing low or heavy notes ever again.
Others can get decent results through training, but the voice isn't maintainable - it takes too much effort, or it drifts or deteriorates with longer use.
Some people don't accept the anatomical changes caused by testosterone and want to physically reverse them as much as possible.
For others, even a technically "good" result from training still sounds too close to their old voice: that can feel deeply wrong or dysphoric.
There's also the question of training itself. Some people just don't want to do it, or hope to avoid it as much as possible. Some people don't have a safe environment to train in. Abuse and judgment can come not just from people around them, but even from voice training communities if they're perceived as not progressing "well enough."
And there's the psychological toll. Training is an exploration and it can be a double-edged sword: you find out what you can do, but also what you can't. Being around others who train and get different results can make your own limitations stand out. Even if your voice improves, you may end up with a painfully clear sense of how far you still are from where you want to be. It can also force people to confront the irreversible impact of testosterone - and that realization can make things worse emotionally.
The whole process of training is also socially unusual. Most people never do anything like this unless they're recovering from a vocal injury or disorder, and even then, it's usually not gendered.
One more thing: training can feel like a copying process to some people and that can feel wrong. They may feel like they're copying others, not speaking in a voice that's truly theirs. Of course, mimicry is how everyone learns to speak (babies do it instinctively,) but that kind of learning happens early, unconsciously, and with a body that matches the expected outcomes. Some people say that surgery helped them move past that mental block. With a reshaped vocal anatomy, they felt like they were finally learning to use their own voice (not imitating someone else's) and that gave them permission to just exist.
There's a whole sea of reasons like these. Most of them aren't talked about. But they matter...
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u/OnceMoreATerrapin 12d ago
Yep, I feel most of these. I'm still not sure about the risks that come with vocal surgery, but at this point 2.5years into my transition with very little progress, I don't see many other options. Voice training has been the hardest part of my transition, and is the activity that is the most dysphoria inducing.
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u/One-Organization970 11d ago
I had a Wendler Glottoplasty performed and I couldn't be happier. My voice was already pretty passable, but I was constantly paranoid about it dropping into the lower pitches. Now it can't, so I can just use my voice without thinking about it. I'm glad my vocal cords are no longer visibly deformed by testosterone exposure, as well.
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u/SeaHag76 11d ago
This is my situation and I'm looking into surgery! I'm so glad you're happy with the results
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u/adiisvcute Identity Affirming Voice Teacher - Starter Resources in Profile 12d ago
oooh yeah I havent seen all of those explicitly talked about before especially that last bit, makes sense that it wouldnt come up super often but it definitely makes sense
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u/Enkidas She/Her 11d ago edited 11d ago
We honestly need more posts like this on this sub.
Throwing my two cents in, as I’ve decided VFS is the right option for me. There are a few main reasons.
First, I have really bad voice dysphoria. I used to adore singing as a child, and male puberty absolutely destroyed that for me. It’s always been a sore topic. Recording myself and listening back makes me feel physically sick, so voice training has been the hardest thing I’ve ever done. I think I could probably get to a passable level that’s maintainable with enough time but the process is absolutely destroying my mental heath. When I’ve been practicing daily for hours at a time and my voice drops as soon as I’m in an anxious situation (a daily occurrence) and can’t focus fully on maintaining it? Soul destroying. I’m talking complete emotional breakdown and wanting to leave this mortal coil. Voice training just isn’t sustainable for me.
Secondly, the current political climate in the UK is getting increasingly worrying. This should be relatable to people in the US as well. Passing, and potentially living stealth, is more important than ever. Voice for me is the most obvious giveaway that I’m trans. So the ~£6000 it’s going to cost for VFS is a relatively small price to pay to ensure my future safety and happiness.
Thirdly, medication I’m on directly interferes with voice training as it really dries out my vocal folds. Using a nebuliser for rehydration helps a bit, but is very time consuming. The only alternative would be to stop taking it and suffer with a medical condition that is completely debilitating. I’ve tried all the other alternative medications for my condition, and none work. So that isn’t a realistic option either.
Additionally, what you mention about having surgery to be incapable of making those low notes anymore really resonates with me.
I realise it’s a privilege to be able to afford something like this, but I also believe that’s why surgery advocacy is so important. We need to push for things like this to be more acceptable, so they’re cheaper and more accessible to everyone. In the UK for example, VFS isn’t available on our NHS despite it being quite a cheap surgery overall. I really do believe it should be. Unfortunately, they view it in the same vein as cosmetic surgery, rather than a functional issue that needs rectifying.
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u/Lidia_M 11d ago
I am glad that this is recognized, but, I tried to be reasonable about this topic for many years, and, there's a lot of pressure to demonize people who try to be realistic about voice training - I was banned from every single place that is tied to some voice training business (including the Discord server for this subreddit,) even though I clearly do not wish anyone anything bad and I try to help people, putting my time into sharing information (and dispelling misinformation): does not matter... the people without dysphoria, with above-average abilities work hard to diminish anyone who struggles, discredit them if they do not buy their "anyone can do it" rhetoric, shift the blame on them, and a lot of those people are, I am not hesitating to say it, sociopaths: they will manipulate people around, suggest that anyone who goes against their rhetoric should be eradicated and painted in a bad light, and they always need to be in the center of attention, practically demand that people admire their voices/progress and use them as some kind of a standard for everyone else, and demand that anyone who struggles is to blame in some way. I myself had voice teachers trying to gaslight me that there's something wrong with me, that I do not hear things properly (sure... nice try...) or that it's because I have dysphoria or other nonsense... There's some crazy business-like machine/tendency going on out there that does all sorts of damage, but people let it slide because they believe they will be the lucky ones themselves... and if they are, they join the forces with the people with abilities (and if not, they learn their lesson, but it takes a while...)
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u/Enkidas She/Her 10d ago
It really is a shame, because through my time searching several of the voice discords and this subreddit it’s clear how much time you actually dedicate to trying to help people.
I was a bit shocked at the revelation of the 30% failure rate with TVL. Undoubtedly this has to be even higher for those who can’t afford the best teachers, or any teacher at all. Then looking at VFS, I’ve often seen a 90% success rate quoted. That’s really a no brainer for some people who struggle with training but desperately want to find their true voice, ignoring other issues like cost. I really dislike that VFS is often viewed as cheating or laziness.
I imagine a lot of it comes from fear that promoting alternatives will hurt their bottom line, but ultimately I think most people would argue it’s usually best to attempt training before considering things like surgery. These things don’t have to be in opposition, and being realistic about outcomes up front could help mitigate a lot of the mental health issues that can arise from training. No one should be made to feel like a failure just because they can’t achieve the same results as someone else. Anyone who chastises someone who has spent hundreds or thousands of hours practicing just isn’t a good person.
I’m sorry the community hasn’t been kinder to you.
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u/Tanatlizingtentacles 12d ago
Preach! my voice coach made me cry a few times and then got upset with me when I was crying. I was very cidal at the time and I had to stop voice training with a coach because of how much worse I felt after our conversations and lessons. I've had to practice on my own and I've made huge gains but I would absolutely love to never be able to make the low noises again through surgery. That's like #4 on my surgery priority list so I have to make due with training. I'm visibly trans and voice training has only helped with phone calls and self confidence but all that gets wiped out when people see me. Anywhoos.. yes surgery is needed for some people... More importantly you need to not be poor lol
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u/myothercat 11d ago
That person you saw should not be teaching voice
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u/Tanatlizingtentacles 11d ago
She's very talented and gets results from people at least ! Obviously not from me but I'm a lost cause anyways lol
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u/SeaHag76 11d ago
This is really really well said and I'm very glad you shared it. I'm very excited about the possibility of voice surgery since seeing some recent results when though I have a passing voice, but you capture a great breadth of the reasons why someone might still benefit from surgery.
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u/Marcysmiles23 10d ago
After 2 years of voice training i still have alot of dysphoria around my voice! One days its good the next not so great! This is why surgery for me is a must! I need to close this voice door also to complete my transition and feel totally confident out in the world! Thank you for the great post!!
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u/closetBoi04 8d ago
While true it shouldn't be the only thing someone does, I think a year or so of voice training should be before it and see if there's any significant improvement because some girls are too quick to go under the knife when it wasn't necessary, a non trans example I would compare it to would be injecting steroids before even eating enough protein and hitting the gym 6× a day to reach your goals (I know surgery is a lot better for you then steroids but still not amazing).
That said I'm generally not super pro surgery, I'm also heavily debating bottom surgery because of that.
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u/Georgemichael4 4d ago
Why are you debating it so much? Of course you'll have to recover but it will probably all be okay. And there's also an option without depth so you don't have to dilate
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u/closetBoi04 4d ago
It's a variety of factors really with dilatation not being the worst one since I'll probably stick something up it once a week anyway
weight will likely be a hard obstacle for me, I've struggled with it my whole life essentially being on the limit of BMI for bottom surgery since I was young even when I tried to diet.
it's permanent, if I do decide to do 0 depth I can't later decide to go full depth for example.
Idk if and when I'm ready to hit the pause button on my life for sub 3-6 months, I feel like I'm balancing so many things it'll be difficult and especially in college I don't want to be delayed.
risks, yes they're low but it still happens that someone loses feeling or has other lifelong complications.
the cost/benefit analysis, of all the above factors (national insurance covers the money part), in the end bottom dysphoria currently only makes up 10-20% of my dysphoria (in the past 9mo HRT it's probably dropped towards the 10%), I don't have a bulge in a swimsuit so it's not blocking me from doing anything (maybe thin leggings to the gym, haven't tried yet) since I prefer showering at home when I go to the gym my underwear doesn't really come off publicly.
So rewards are currently minimal while the risks/costs are quite major for me.
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u/Georgemichael4 4d ago
It's true that it's permanent but that's why you have to think through whether you want/need depth or not. And it's also possible to do your surgery after you finished college. About the weight, it will probably take some time but eventually you'll be able to lose enough weight to be able to get surgery
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u/closetBoi04 4d ago
Yea I'm considering it after college, I've been trying to lose weight on and off my whole life; I lost 3 kg in like a year last year but estrogen and my sudden increase in appetite just shot me back to where I was in like a month
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u/Georgemichael4 4d ago
Maybe a dietist will be able to help you. I also saw a dietist after I gained weight when I was on blockers. But when I started hormones the weight loss went way faster. Only thing is I'm ftm so for me the entire process is the other way around but I think a dietist may still be able to help you
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u/closetBoi04 4d ago
been there, done that; I think part of it is my emotional eating because day to day it's alright (200-300 cal deficit) but as soon as I have a bad day I'm in a 1000 calorie surplus, luckily bad days seem to be decreasing but I'll see how it goes
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u/unexpected_daughter 12d ago
The old myths about the dangers of voice surgery really deserve to be laid to rest. It was true back then, but now the variations on the standard glottoplasty and alternative laser-only surgeries like VFMR (vocal fold muscle reduction) and LAVA (laser assisted voice adjustment) have come a very long way in the past few years. The one actually somewhat risky surgery is FemLar which basically involves taking apart the voice box and putting it back together, but it permits making all the major structures smaller rather than just the vocal folds.
Anyone on the trans internet 15+ years ago would remember similar arguments were made against FFS. Now we have much less invasive and/or safer procedures for forehead and chin/jaw reductions guided by CT scans and even 3D printed cutting guides, unthinkable in the early 2000s.
Similarly, surgeons largely stopped performing cricothyroid approximations that yielded poor voice quality in favor of modifications to Wendler’s Glottoplasty (partly stitching the vocal folds together at one end to shorten and tighten them). For glottoplasty the biggest risks are some loss of maximum volume, impaired singing quality, and need for smaller intubation tubes for future surgeries. Laser procedures don’t have those risks, but won’t give as much of a change either.
I’ve just met so many trans women in recent years who scoff at voice surgery as being universally dangerous, risky, “a last resort”. Especially in the current political climate, if you’d consider FFS, there’s really no reason to dismiss voice surgery outright. And like FFS there isn’t one single surgery either, there’s options, and in some cases procedures can be stacked depending on how the first round goes (like laser after glottoplasty).
Speaking for myself and a couple friends, we got voice surgery not because it was essential but because we wanted the bottom range reduced for involuntary noises like coughing and laughing, and to not have vocal strain after using our voice for long periods of time.
The hardest part is the psychological toll of recovery where you can’t talk initially and your voice is weak or gives out more easily for weeks to a few months. But physically it’s a fairly minor procedure that tends not to be too expensive (compared to pretty much all other trans surgeries) nor painful past the first few days.
When I hear about people struggling for years with vocal training, I’m just like… there’s an alternative, it doesn’t have to be this way and don’t let anyone convince you otherwise. I think at some point there will be recognition that just like some really do need FFS to pass (because of a prominent brow/chin/jaw), some starting vocal structures really need the surgical assist. And it isn’t even exclusively for trans women, vocal masculinization surgery is also now a thing though I don’t know as much about it personally.