For most trans men, testosterone lowers the voice within the first year or two of hormone therapy, as the vocal folds thicken. For some, though, the voice doesn’t drop as much as they’d like, or it stays unstable. This can lead to being misgendered on the phone or in conversation.
Voice masculinization surgery (VMS) is an option for trans men and transmasculine people who aren’t satisfied with their voice after hormone therapy. It lowers the pitch of the speaking voice by relaxing and shortening the vocal folds.
Voice Assessment Before Surgery
Before surgery, your vocal folds are examined with videolaryngostroboscopy, and your voice is recorded and analyzed with a spectrum-acoustic study. This measures your current fundamental frequency (the natural pitch of your voice) and helps your surgeon plan the operation that best meets your goals.
The typical adult male speaking voice averages around 100–125 Hz.
The Technique: Thyroplasty Type III
The surgeon makes a 2–3 cm incision in the neck to reach the cartilage framework of the voice box (larynx). The front-to-back diameter of the larynx is reduced, which shortens and relaxes the vocal folds. Relaxed vocal folds vibrate more slowly, producing a deeper, lower-pitched voice.
The vocal folds themselves aren’t cut. The change is made to the cartilage around them, which reduces the risk of scarring the vocal folds and causing permanent hoarseness.
Who Is a Good Candidate?
- Trans men and transmasculine people who aren’t satisfied with their voice after testosterone therapy
- In good general health
- Non-smokers, or willing to stop
- Have had voice therapy, or are willing to take part in it before and after surgery
- Have a letter of support from a mental health professional
- Have realistic expectations about the result
Hospital Stay and Early Recovery
You’ll stay in hospital for 1–2 nights. In the first days after surgery, you may notice mild difficulty swallowing, phlegm in your throat, or a feeling of a lump in the throat. These usually settle as swelling goes down.
Post-operative Care
- Day 1 to 7: You must remain silent until the first follow-up. There are no food and drink restrictions.
- Day 3 to 7: Keep the vocal cords lubricated by drinking lots of water and nebulize with a sterilized saline solution.
- Day 8 to 10: A new videolarygostroboscopic and spectrum-acoustic study is performed after the vocal rest period. The outer stitches are removed, the dressing is changed, and the speech therapy rehabilitation can start.
- Follow-up: at 3, 6 and 12 months after surgery.
The speech therapist will teach you how to use your new voice as effectively as possible. The final result is usually seen between 3 and 8 months after surgery.
Important Notes
- Reflux: acid reflux can irritate the vocal folds. During recovery, avoid caffeine, chocolate, peppermint, fatty and acidic foods, fizzy drinks and alcohol.
- Time off work: one week off is usually enough if you can stay silent at work. If your job involves talking, allow two weeks.
- Previous voice surgery: if you’ve had voice surgery elsewhere and aren’t happy with the result, our team will assess on a case-by-case basis whether further surgery is possible.
Risks and Complications
- Scar on the neck
- Infection at the surgical site
- Hematoma (blood collection) and swelling
- Bruising and, rarely, tissue necrosis
- Pain after surgery
- Hoarseness
- Little or no change in pitch, depending on individual factors
Voice Masculinization Speech Therapy
Surgery lowers pitch, but a natural masculine voice also depends on resonance, intonation and how you use your voice. That’s why speech therapy is part of the program before and after surgery.
- Before surgery: the speech therapist assesses your voice and helps you prepare.
- After surgery: you’ll learn to use your new voice naturally and without strain, over several practice sessions with our speech therapist.
Practicing without a specialist’s guidance can cause swelling of the vocal folds and set back your progress.
Video : Voice Masculinization Surgery / VMS
Tips for a Clear, Healthy Voice
Here are a few tips to help improve the clarity of your voice:
- Stay hydrated: drinking plenty of water keeps your vocal folds lubricated.
- Warm up: before speaking for a long time, try gentle humming, lip trills or tongue twisters.
- Use good posture: stand tall with your shoulders back to help you breathe more efficiently.
- Breathe from your diaphragm: deep breaths into your diaphragm, rather than shallow chest breathing, support a steady voice.
- Speak at a natural pace: not so fast that you’re hard to follow, and not so slow that you sound flat.
- Use a comfortable volume: loud enough to be heard, without straining.
- Rest your voice when you’re unwell: avoid speaking much when your throat is sore or inflamed.
- Avoid smoking, excess alcohol and caffeine: these dry out the vocal folds.
- Practice good vocal hygiene: warm up, avoid overusing your voice, and take regular breaks.
Remember, speaking is a skill that can be developed and improved over time with practice and attention to technique.
Why Choose Kamol Hospital in Bangkok for Voice Masculinization Surgery
- Objective voice assessment: Videolaryngostroboscopy and acoustic analysis before and after surgery measure your vocal folds and pitch.
- Speech therapy built in: In-house speech therapists work with you before and after surgery.
- A technique that protects the vocal folds: Thyroplasty type III works on the cartilage framework, rather than cutting the vocal folds.
- Complete female-to-male care: VMS can be coordinated with facial masculinization surgery (including Adam’s apple enhancement), top surgery and hormone therapy.
- Hospital-level safety: Surgery under general anesthesia in a JCI-accredited hospital.
- Support for international patients: Multilingual coordinators and Kamol Trip help you plan your stay in Bangkok.
Frequently Asked Questions (FAQs)
What is voice masculinization surgery (VMS)?
Voice masculinization surgery (VMS) is a surgical procedure designed to lower the pitch of your voice. It’s a type of gender-affirming surgery that can help trans men, transmasculine individuals, and other gender-diverse people feel more comfortable and confident with their voice.
How does VMS work to lower my voice?
VMS typically involves a procedure called thyroplasty type III. This involves making an incision in your neck to access your voice box (larynx). The surgeon then adjusts the tension and position of your vocal cords to create a lower pitch.
Essentially, the procedure shortens and relaxes the vocal cords, making them vibrate at a lower frequency, which thus results in a deeper voice.
Should I try testosterone before considering voice surgery?
Yes. Testosterone lowers the voice for most trans men, usually within the first one to two years. Surgery is generally considered when the voice hasn’t dropped enough after an adequate period on hormones. Your surgeon will assess your vocal folds and current pitch before recommending surgery.
Can VMS be combined with Adam's apple enhancement?
Possibly. Adam’s apple enhancement is part of facial masculinization surgery, and both procedures involve the front of the neck. Your surgical team will advise on the safest plan.
Why might I choose voice masculinization surgery over voice therapy or hormone therapy?
While voice therapy and hormone therapy can be effective for some, they don’t always achieve the desired results for everyone. VMS offers a more permanent solution for those who:
- Have not achieved a satisfactory voice pitch with hormone therapy alone.
- Find voice therapy challenging or time-consuming.
- Desire a more significant and lasting change in their voice.
Are the results permanent?
The changes to the cartilage framework are permanent. Your final voice usually settles 3–8 months after surgery. Protecting your voice by avoiding smoking, managing reflux and not straining helps keep your result.
What are the benefits of undergoing VMS at Kamol Cosmetic Hospital in Bangkok, Thailand?
At Kamol Cosmetic Hospital, we offer several advantages for those who are considering voice masculinization surgery:.
- Experienced Surgeons: Our surgeons are highly skilled and have significant experience in performing VMS with exceptional results. They have a deep understanding of the anatomy and function of the vocal cords.
- Advanced Facilities: We boast world-class facilities and use the latest and greatest in surgical techniques for your safety and comfort throughout.
- Comprehensive Care: We will provide quality personalized care and support throughout your surgical journey, from the initial consultation to your post-op recovery.
- Competitive Pricing: The female to male voice surgery at Kamol Cosmetic Hospital is competitively priced, especially when compared to some other countries.
- Convenient Location: Bangkok is a beautiful and welcoming city with so much to see and do, making it an ideal destination for medical tourism.
How long should I stay in Bangkok after voice masculinization surgery?
Plan to stay in Bangkok for about 10–14 days. This covers the first week of complete voice rest, and the follow-up check, stitch removal and first speech therapy session on days 8–10. Thailand is one of the world’s most experienced destinations for gender-affirming surgery, and Kamol Trip can arrange accommodation close to the hospital.
