There are several kinds of voice feminization surgery, which can help to change the voice your body produces if vocal training hasn’t led to the desired outcome.

Voice feminization surgeries

Voice feminization surgeries are a group of surgeries for gender reassignment of the voice. The goal is to make the voice sound more feminine, with a higher pitch, and to reduce the effort required to speak in a high and thin voice.
Surgery can fit in cases when there still aren’t satisfactory results after vocal training, or when talking with the voice achieved through training requires a lot of effort. That said, keep in mind that voice feminization surgery doesn’t affect other characteristics of a feminine voice such as resonance and pronunciation, and so even if you get it you should also get voice feminization therapy with a voice therapist. Voice feminization surgery can also help change “uncontrollable” sounds such as coughing, clearing your throat, laughing, and yawning.

There are several kinds of voice feminization surgery; it’s possible not all of them are performed in Israel:

Anterior glottal web formation

A relatively new surgery which has been getting popular over the last two decades is “vocal cord shortening surgery”, or Modified Wendler’s Glottoplasty. The surgery causes the vocal cords to vibrate at a higher pitch. It is done by sowing together the vocal cords at their front, so that the vibrating area is smaller. This leads to a higher pitch of voice, which makes the voice sound more feminine. The surgery is done entirely by endoscopy, and doesn’t leave any external scarring. The surgery has been found to be effective due to its easy recovery, few complications and lack of visible scarring.

Cricothyroid approximation (CTA)

A surgery to stretch the vocal cords, also known as Type IV Thyroplasty. Its goal is to lengthen the vocal cords, since stretched cords vibrate at a higher frequency. During the surgery the throat cartilages are brought closer together with a stitch that stretches the vocal cords. The surgery mimics the action of the cricothyroid muscle, which is responsible for stretching the vocal cords, and so creates a higher and thinner voice.
This surgery has helped trans women since the 70s. In recent years there has been some criticism of this method, due to growing evidence that the stitch tends to come loose over time, making the results temporary. Also, since there’s no change to the vocal cords themselves, just stretching them, the surgery won’t necessarily achieve the desired outcome.

Laser reduction glottoplasty (LRG)

This surgery uses a laser to sear the outer tissues of the vocal cords, raising the tension in the vocal cords. It leaves no external scarring.

Recovery

Keep in mind that it takes time to achieve your desired voice. The recovery process usually requires staying silent for about a month, and initial speech will be hoarse. Also, voice therapy training is required to learn how to use your ‘new’ throat properly.

Funding and surgeries in Israel

Voice feminization surgeries can be gotten in public hospitals and through private healthcare.

The surgery at public hospitals is part of the healthcare basket (Sal Habriut סל הבריאות) and is directly funded by your Kupat Holim (HMO) Following the approval of the The national Gender Reassignment Committee. There is an additional option to receive direct funding without committee approval through the health funds’ supplementary insurance. You can get help from: social workers and organizations to access your right to this surgery.

The surgery can be done at the following hospitals and medical centers:

• Sheba (Tel Hashomer) hospital – voice and throat clinic run by Dr. Adi Primov-Fever
  • Surgery to change the tone of voice and appearance of the throat for the trans community
  • Appointments – by phone 03-5302314 or through the online appointments system
  • You can also make appointments for consultations and surgeries through the gender reassignment clinic
  • Email – Gender.Reassignment.Committee@sheba.gov.il
• Ichilov hospital – facial gender reassignment clinic, run by Dr. Shimrit Arbel
  Voice feminization surgeries are performed by Dr. Yael Estreicher-Kedem, director of the clinic for voice and swallowing disorders
  • Phone – 03-6973676
  • Email – Dnt-c@tlvmc.gov.il
• A.R.M medical center – the multidisciplinary center for ear-nose-throat, head, neck, mouth, and jaw healthcare.
  • Private surgery, cannot be covered by the Kupat Holim like surgery in public hospitals
  • Dr. Hagit Shoffel-Havakuk – expert on vocal cord surgery, throat diseases, breathing and swallowing disorders
  • The clinic is at Assuta hospital, Habarzel 20, Ramat Hachayal, Tel Aviv
  • Phone – 072-3942614
  • Whatsapp – 0544-696961

For further reading

• Voice feminization and the surgical method at A.R.M medical center
• An interview with Dr. Yael Estreicher-Kedem, ear-nose-throat surgeon, director of the clinic for voice and swallowing disorders at Ichilov hospital
• ראיון עם ד”ר ליאור ברוך. הקול הפנימי: ניתוח נישוי קול ללא צלקת.
  לבריאותה – רפואה פמיניסטית.
• Voice Feminization Surgery – Cleveland Clinic
• Impact of Wendler glottoplasty on acoustic measures and quality of voice in transgender women: a systematic review and meta-analysis