I was researching voice feminization surgery yet again a while back and somehow landed on transgendermap.com:

https://www.transgendermap.com/medical/surgery/voice/feminization/

There was a reference to voicefem.com there and some youtube reviews. There are plenty of before/after Rainbow Readings for voicefem.com on their Instagram, but not many longer term reviews and really nothing about the overall process.

I wanted to not only review the results of my voice feminization surgery, but also the process itself in case anyone else is apprehensive or curious. I was also told that within the USA, mostly a latino population got the surgery. I am not latino and I don’t speak much Spanish, so I felt my review would be helpful to others. Also I wanted more of a technical angle with quantification and documented healing process. The reviews for Voicefem are just rudimentary before/after for the most part.

Barranquilla, Colombia. Is it Safe?

Is Colombia safe? There are obvious poverty and infrastructure issues in Colombia. At no point did I feel particularly unsafe, but it’s a very different place than where I live in the USA. I saw sharp dressed people walking past people in rags, digging through trash with their bare hands. Streets under construction with rebar sticking out – seemingly abandoned. There are sometimes painted lanes in the roads, and sometimes traffic lights; but largely travel seems fluid; donkeys or people pulling carts, mixed together with buses, small fiberglass cars, sedans, and motor bikes. It has the feeling of a place where whatever works, is what works. I imagine this is how many countries outside the USA are, where traffic regulations are different.

Doing research, South America in general seems to be very gay/queer/trans friendly. Anywhere in the world you can experience hate crime, and I keep that in mind anywhere in the USA; where I can feel uneasy at the gas station or grocery store, being queer and trans.

https://en.wikipedia.org/wiki/LGBT_rights_in_Colombia

Possibly due to tourism or poverty, it was recommended to not go walking around carrying a lot of bags or cell phones. Displays of wealth that can be taken off your body make you an easy target for a desperate person.

Buying Things

People sell things in the streets or even in smaller booths or buildings and many do not take credit cards. Any larger stores did accept credit cards and I could have survived without cash, but occasionally I bought from a smaller operation with cash. There was no receipt and the amount of the purchase sometimes changed at the end of the transaction… I bought 4 bottles of water and the seller originally said $2 USD. Then after I handed them $2 they said, actually $3 USD. I probably could have fought them about it, but I rolled my eyes and handed them an extra $1 USD. This indicates a culture of bargaining to me; which is less common in the USA.

Language

In Spain I feel like most people I encountered could stumble through a little bit of English. In Colombia, most people spoke absolutely no English. Even the word Water, a staple for tourists; had no give – I had to dig back to 9th grade Spanish class and say Agua. I often felt I could understand their Spanish better than they could understand my English; which makes sense since I did take a semester of Spanish decades ago; but often when traveling there are people who know at least a little bit of English. Even the best English speakers, which were often deferred to when I started speaking English; knew only a little bit.

Sticking Out

OK I’m fairly tall – almost 6 feet tall. I towered above most people. I’m also white – I encountered very few white people in Colombia. Lastly I’m trans, although I’ve had facial surgery and probably pass well enough that people didn’t realize I was trans. Even so, for a woman I was very tall. Perhaps people thought I was Scandinavian? I was looked at, hard, everywhere I went.

My partner was sometimes with me who is also tall and white, but at the time had some shadow on her face between laser sessions. I feel like she got a different kind of stare than I did… a head to toe type of evaluation; but it felt less like they were clocking her, than checking her out. Mostly it was guys checking her out in this way. My interpretation of this behavior is that the sexualization of trans women is very high, and the acceptability of being with trans women is also high. At no point did it feel like people were disrespecting either of us as women; whereas in the USA it’s common for people to perhaps maliciously misgender if you are clocked.

Communications and Arrangements

Voicefem provides a dedicated contact (Mayra) who arranges all travel, answers questions, and translates to English. From what I can tell their driver is a dedicated person as well. Mayra is also a nurse.

The Hotel is paid for and is next to the medical building. The medical facility is a private hospital of sorts. The Hotel I went to was an “ibis”, which for the most part resembled a typical mid range hotel. My main issue with “ibis” is that the beds are super firm… I have curves and this killed me, which made restful sleep a challenge at the hotel. I slept basically not at all the night before surgery… part of this I’m sure is nerves though; coupled with not being allowed to drink anything.

The hotel actually had pretty decent food! Unfortunately on Sundays the kitchen is closed in the evening, so you’ll have to grab an after hours left over, or seek out a restaurant.

Surgery: Wendler Glottoplasty

What can I say about the surgery? I was there for it, but I was unconscious. It’s a 90 minute surgery – from what I can tell, is mostly up to the skill and experience of the surgeon.

https://voicefem.com/sobre-la-cirugia/

When I woke up, my throat felt incredibly dry, and I struggled to swallow. It also felt a bit like something was stuck in my throat. One of my front teeth felt numb, like maybe it had been leaned on or knocked. My tongue was also numb from being stretched during the surgery. Particularly the left side of my tongue felt sore, like it was overextended. I was told this was normal and for a few days it might be numb.

I’m coming up on a month post surgery while writing this, and although feeling has returned to my tongue for the most part, my sense of taste on the left side of my tongue continues to evolve. For a while sweet things tasted incredibly bitter or even rotten. It was difficult to enjoy food for a while. This is one of those situations where I tell you that everyone is different and I hope you do not experience the same issues. I know from other surgeries that minor nerve damage is common and eventually it will likely resolve. I can only assume the extreme amount and duration my tongue was pulled out of the way is typical.

I also had to take out my invisalign plastic aligners (orthodontic appliance) for the surgery. Personally I don’t think it would have gotten in the way because it was anchored, but it means I had to lapse for a day on my aligners. This didn’t seem to interfere with my progress in teeth alignment.

The surgery Voicefem does is a little more traditional than what Yeson does now. From Yeson’s website:

https://us.yesonvc.com/page/2_4_2.php

Q.9. Isn’t the use of laser better than the microscopic works?

Laser creates a web in vocal folds through the vaporization of mucous membrane and this is being done to make it possible to attach bilateral vocal folds and it may leave huge scarring on vocal folds, which could be led to the problems of glottoplasty that are hoarseness and the loosening of the surgical site which decreases the pitch again by time. In that, dissecting the vocal folds membrane using the microscopic tools can draw more effective outcome by precisely preserving normal mucosa and calculating the right membrane to dissect and suture out. This technique requires extensive experience and precise skills of Dr. Kim. The paper about Dr. Kim’s VFSRAC surgery technique is published in the world’s best ENT journal, ‘Laryngoscope’ and this indicates VFSRAC is the most successful way of feminizing one’s voice and all the results we have drawn are not counterfeit but proven in the objective manner.

The price of the surgery/travel is similar between Voicefem and Yeson. I would offhandedly call Yeson the world leader in VFS. I have been aware of their work for a long time and you can find plenty of reviews online.

So why didn’t I go with Yeson? Because I didn’t want to travel to South Korea. It was only 7 hours of flying to get to Colombia, and travel is extremely painful for my back. The hardest part of going to Spain for FFS was the flights. Additionally from experience I know that my body handles scarring, swelling, and healing well. If I had a history of complications, I might have opted to travel to South Korea.
I was also told by someone who works for Dr. Spiegel that some folks who went to Korea, went back to him for revisions. Whether this is true, or what their circumstances are, I have no idea.

Domestic Options

There are also other domestic options within the USA. I got a quote from Dr. Spiegel, which was roughly twice as expensive as Voicefem and Yeson. The reason I didn’t choose Spiegel; other than the weird Amazon Prime day discounts, sales pressure for me to commit and pay for consultation the same day I contacted them, inability for Care Credit to apply to roughly half the cost, non transparent pricing, and the slew of marketing emails I received; is because when watching videos of before/after Rainbow Readings, I found one in particular where the outcome was entirely underwhelming.

I know that could just be a one off situation, but Voicefem has consistently dramatic outcomes. My fundamental frequency was measured at 100hz and I suspect before a lot of voice training it was closer to 70hz. I am one of those lucky trans women with a deep voice – deeper than the average cis man. I wanted a surgeon who had consistently dramatic results. I’m also not a singer and I’m fairly tone deaf, so my focus was utilitarian.

Speculations About Laser vs. ‘Microscopic’

I think that Yeson is correct about laser thinning of the vocal cords causing a web of scar tissue on the membrane. I also think they are probably correct that it is more apt to cause complications in some cases.

My intuition is that the laser will cause scar tissue, which will act slightly differently than the normal cord tissue. The scar tissue may even firm/tighten the cords during healing. I understand the concept is to “thin” the cords using laser treatment, but I think that’s an unrealistic idea based upon the inconsistent way laser is applied. It’s more like creating a web of scar tissue which may resemble the acoustic qualities of uniform thinning – I’m not sure. I’ve also read that sometimes additional laser work is done to create more scar tissue to change the acoustic properties of the cords.

As pictured below you can see the laser is applied imperfectly and cannot evenly thin the cords.

Restrictions After Surgery

• No talking for 2 weeks
• No spicy food 1 month 
• No crunchy food 1 month
• No citris 1 month
• No smoking 6 months
• No coffee 6 months
• No alcohol 3-4 months
• No oral sex 2 months
• No fish with bones 1 month
• No sauces (use moderately) 1 month
• No lifting heavy things 3-4 months 
• No exercise for 1 month
• Stick your tongue out in case you want to cough 6 months 
• Inform the surgeon / anesthesiologist for future surgeries, endotracheal tube needs to be size 5 or maximum 6.

In addition to the official list, I was also told I could not laugh or sneeze. I learned to silent laugh, and cough with my tongue sticking out.

Surprises

• The majority of communications happened through WhatsApp. There was no form to sign, no real electronic signature process, no formal process. I communicated directly with Dr. Antonio Ballestas to confirm payment was received. Being that there were very few mentions of Voicefem more broadly in trans space, I was taking a leap of faith when I deposited the $8,000 USD electronically for the surgery/hotel/etc.
• I was told that transfers from TransferWise had failed historically, so I did a transfer of $10 USD first, to confirm that it was received, before transferring the remaining balance. There was no issue using TransferWise, but the Memo field did not seem to transmit – only who the payment came from.
• My surgery was on a Saturday. This is a bit unusual I think, but quite typical for Voicefem.
• The day before surgery, I received an Insurance email from: Pan American Life, De Colombia. There was no mention about an insurance policy being taken out in my name, and it made me feel a little paranoid. Mayra confirmed it was for the surgery in case of complications.
• The water in Colombia I was told was not drinkable… after looking it up, the water seems to be chlorinated and fine. I’m not sure why I was told it was not drinkable, but I didn’t want to take any risks, so I purchased drinking water as needed.
• If coming from the USA, the electrical outlets in Colombia are compatible and no converter is needed.
• The day of the surgery I had to sign several contracts in Spanish, which I was unable to read and didn’t have the opportunity to carefully review. I was told it was to allow the surgery at the facility and to allow digital record keeping.
• The day of the surgery, my surgery was pushed back a few hours due to an emergency childbirth. Mayra was really kind and stayed with me while I waited. We spent the time talking effectively in spite of some language barriers.
• Waking up from anesthesia was quite different post VFS compared to FFS. I knew I couldn’t cough, but my throat was so dry and I felt like I couldn’t swallow, etc. I ended up coughing enough anyway that they used an atomizer to try and soothe my throat. I was worried I might have popped some sutures. I kept hearing people telling me to breathe. It was kind of a panic compared to my previous experiences with anesthesia, which were more like waking up kind of groggy. I asked the doctor if my experience was typical, and he said it was.
• As noted in the surgery section, my tongue having some numbness and taste being modified, lasting for over a month post surgery, has been a surprising amount of time to have residual effects from extension/clamping during surgery.
• The hospital did not have guest wifi because of a previous ransomware attack some time ago. Their solution was to disable guest wifi. This kind of sucks during recovery, so if they haven’t fixed it and you’re reading this, be sure to bring some offline media to entertain yourself.
• Because of the nature of the surgery, crunchy foods are not allowed to be eaten for 1 month. The hospital served me several helpings of liquid, jello, and mush. Food seems to always be really satisfying when you’re recovering from a surgery though!
• Because I was concerned I might have screwed up my surgery, I asked if Dr. Antonio could verify my sutures were still intact. He did this before the end of his work day and I walked out with him and Mayra as they closed up the office. I’m very grateful he could give me this peace of mind before I traveled back to the USA. Honestly he seems like a really good doctor with real concern over his patients.
• I was told I would need to get a certificate from the medical/health department at the airport in Colombia, before departing. Eventually my partner and I figured out we had to walk outdoors to get the medical building. The medical folks immediately figured out I had glottoplasty and I typed out information on my phone to provide to them. Their computer wasn’t working and everything was hand written.
• No Coffee for 6 months really took me aback. Coffee is one of my few joys in life and it has been hard to give up. I smell coffee in the morning when my partner is drinking it – which is better than nothing. Also I had to start drinking prune juice to induce bowel movements since coffee can’t be used for a while.
• You are sent home with some medicine – one of which is an injection ampule. You must intramuscular inject yourself during recovery back home. Glass ampules are not used often in the USA, so this may be surprising even to those who are used to injecting hormones regularly.
• A breathing tube was provided by the speech therapist. For some reason I was also given instructions to presumably sterilize the tube. The instructions were to bring water to a boil with a small amount of vinegar added, then turn off the heat and place the tube. The tube is ready once the water has cooled. This tube is used for strengthening the voice during recovery.
• Voicefem recommends starting talking at 2 weeks post surgery. This is quite different from Yeson which is a month post surgery. I asked the surgeon why 2 weeks instead of 1 month and he simply said because you can start talking at 2 weeks. I also asked him what he thought of botox for the vocal cords, which Yeson recommends and he said it was unnecessary and would prevent starting to talk at 2 weeks.

Traveling without Talking

I bought a cheap $15 USD tablet I could write on using a pen or my finger… don’t bother. Check out an accessibility app called: Tell Me. Install that on your phone and use it to talk for you. It also makes it easy to adjust the speed/pitch. My kiddo who is only 6 can’t read very well and the default voice talks a little too fast for her. Being in Colombia it would definitely talk too fast for Spanish speakers trying to understand English, as well.

You’ll receive a letter from the surgeon stating that you had Glottoplasty and cannot talk for 2 weeks. I digitize everything paper I receive (take a picture with my phone) and have a folder handy with all my medical history and surgeon letters. I don’t look or sound anything like I used to, and my IDs are all older. Having an easy place with all my transition history and letters helps if I run into any trouble from people who think I’m lying about my identity. Having a travel companion isn’t exactly vital… but it kind of is. You’ll need a roller bag and to board the plane early with help from others if you do not have a travel companion. I would also highly recommend you mask for travel so you’re not sick during the 2 weeks of recovery, since coughing/sneezing is to be avoided as much as possible.

Medicine

I was asked if I had any allergies and I do not. I assume this list of medicine is fairly standard for those who do not have a history of allergy. Additionally this medicine cost is not included. I was told it cost approximately $130 USD.

• Flutox (levronc) syrup #2 bottles. Cough suppressant/antihistamine/antitussive. Use: take 1 spoon every 12 hours for 14 days, after hospital. I preferred to use the syringe which was a 5ml/cc dose. The hospital discharged me with an extra bottle, so I have a full unused bottle.
• Segregam/Pantoprazol 20mg pills #1 box × 14 pills. Proton Pump Inhibitor/Acid Reducer. Use: take 1 pill daily 30 minutes before breakfast for 14 days.
• Alenat/OraZit/Azitromicina 500mg #1 box ×3. Antibiotic. Use: take 1 pill daily for 3 days.
• Duo Decadron 2ml #1. Steroid anti inflammatory. Use: apply injection 14 days after surgery. This comes in a glass ampule. Care must be taken when opening the ampule – you should definitely look up a video or instructions on how to do this. Note: if this ampule breaks incorrectly or is ruined in some other way, you will not have a second dose. Also note that typically a filtered draw needle is used with ampules. The single needle provided is not filtered, so I would recommend you not work too hard to extract the medication from the ampule (ie don’t bother trying to get the last little bit out); because it may include bits of glass! The application is intramuscular so I did the thigh. I did make sure to aspirate first before injecting because on the off chance this contains bits of glass, I do not want them going into a blood vessel directly.

Antibiotics are always difficult during recovery. I’m generally ‘regular’ when it comes to pooping, but the combination of general anesthesia, antibiotics, acid reducer, etc. made pooping really difficult. I eventually resorted to laxatives and then prune juice to stay regular.

Long Term Consequences of Wendler Glottoplasty

I wanted to mention that this surgery has long term consequences that I wasn’t initially aware of. As you can see in the pictures, about 1/3rd of the vocal cords are sutured. This means your breath throughput is 1/3rd more restricted (the vocal cords acting as a bottleneck for the movement of air in and out). Certainly your brain and body will adjust, but I believe my athletic performance is lower post surgery. Additionally for future surgeries with general anesthesia, they must use an intubation tube #5 or #6; for reference an adult ‘male’ size is #8 and an adult ‘female’ size is #7. Indeed a #5 or #6 tube is in the pediatric range of a 5 year old and a 10 year old child.

Using a larger tube may destroy the ‘web’ of tissue, undoing the results of the surgery. For this reason some people recommend getting VFS as the last surgery. I’m not too worried about the order of surgeries personally, but will be quite paranoid when I am getting SRS that the correct tube size be used!

Voice Therapy

Voicefem provides 2 months of voice therapy; 5 times a week, 30 minutes per day. The exercises start off very rudimentary and seem more related to stretching, strengthening, and breathing.

Talking Schedule

Starting at 14 days after surgery, how much I was allowed to talk went as follows each day.

Week 3 (minutes): 5, 10, 15, 20, 25, 30, 35

Week 4 (minutes): 40, 45, 50, 55, 60, 60, 60

Week 5 (hours): 1.5, 1.5, 2, 2, 2, 3, 3

Week 6 (hours): 3, 4, 4, 4, 5, 5, 5

Week 7 (hours): 6, 6, Normal

The voice check was the day with 5 minutes, and all I could muster was a whisper sounding voice. This was so disheartening that I cried for a while. I uploaded the recording to the Dr and therapist and they said it was normal and sounded good. I really wanted to write this and put it on the internet somewhere in case someone else starts whisper talking at first and is worried.

By 3 weeks I was getting some less whisper sounding voice.

Voice Therapy Exercises (1st month)

This is not a comprehensive guide to voice therapy during recovery, just a brief mention of some portions for those who are curious. I would have liked to see this to know what to expect during recovery.

The exercises started out with movement of the tongue, lips, blowing through a tube with 4 fingers of water, and some sounds which I couldn’t make at first.

As time progressed the elaboration of these basic exercises increased. More physical movements were added, such as massaging the neck, moving the head up and down, left to right, etc.

• Blowing through a tube, each exercise 20x: first just air, then O sound, then Oo, then Aa, then “ambulance sound” eee-ooo, etc.
• Neck movements, 10x: take in air through the nose while tilting the head up, then while moving it downward release air through the mouth. Left to center, right to center, at diagonal on left, then right, etc.
• Neck massage using lotion and running fingers along the neck in various ways. Personally I think the efficacy of any neck massage in the cartilage area is limited due to the vocal cords being behind the cartilage. I suspect this varies person to person, but my cartilage area is quite substantial and stiff. I do think lymphatic massage is valuable though.
• Shoulders back while taking in air, then release air and shoulders; shoulders forward, rolled forward, rolled backward, etc. 10x.
• Tongue rolled forward, then pushed forward out of the mouth, then massage the neck, 40x.
• “M” sound 15x; O-Aaa sound 15x; Making a Bhhhh sound with 1 finger against closed lips, then making the same sound again without the finger, 20x; softly making an O-aaa sound with mouth open, then again with O-ooo sound; pushing lips together and pushing air through – like blowing a raspberry without the tongue and making a high pitched Bpbpbpbp kind of sound; I actually can’t do this exercise very well because of a lip lift surgery I had.

Due to language barriers I didn’t ask for elaboration on what each exercise accomplishes. My therapist was often doing other things during our sessions, such as working at a computer, driving, talking to other people, at a salon, etc; and just guiding me roughly between routines. I didn’t exactly find the lax style of the therapy to be problematic – just unexpected.

After 1 month of therapy I was able to talk full time, though still squeaky when starting to talk, and falling into a more normal speech pattern as the talking went on.

Speculations on Efficacy

Overall I think the efficacy of each exercise and what they accomplish is hard to gauge. I think the shoulder work is mostly for relaxation. The throat massage is mostly to aid in healing and reduced swelling. I think making sounds and blowing through the tube with different sounds accomplished the most in terms of regaining flexibility and control of the vocal cords. I am told the tube in water exercises are focused on resonance work, but it’s also a common method for generally recovering from vocal surgery.

Voice Therapy Exercises (2nd month – actually 5 weeks)

I thought the 2nd month of therapy would be more focused on vocal techniques, but it was just more general exercises – more or less the same as the first month. I was told to continue these exercises – particularly focusing on the tube in water exercises for resonance, until 6 months of recovery.

Voice Therapy Exercises (6 months and beyond)

I am often at 140hz average talking after 6 months of healing. When I pointed this out and asked about further therapy on my voice, I was told to continue with the same exercises I’d already been doing… I’m writing this particular paragraph around 7 months of healing. Honestly it’s pretty depressing. Using R1 and forward resonance I can get to around an average talking voice of 160hz… really straining technique I can sometimes get to 180hz on a good day; for anything beyond that I need antihistamines and/or corticosteroids – then I can get up to a 200-220hz average talking voice temporarily. My hope is that maybe after a year or two of healing I will more naturally be in the 180hz or higher average talking range. Note that I can raise my pitch, but it sounds fairly unnatural to do so.

I suppose one of my biggest criticisms is the idea that voice is final at 4-6 months of healing. They cooked portions of my vocal cords with a laser… of course there is going to be long term inflammation and a change in voice quality over years. Why misdirect and stress people out with this 4-6 months timeline? It reminds me of people saying 2 years is the maximum effect for HRT transition when people continue to notice changes well after 10 years. Can all these ‘professionals’ please stop with the misinformation? Y’all are stressing out trans people constantly about their progress.

Overall Thoughts

Would I choose Voicefem again? Probably, unless my final voice is not to my liking – final voice after… 1 year? 2 years?

There was so much questionable faith at every step, but this is true for any medical tourism. I went through Facial Feminization Surgery with FacialTeam EU alone in Spain. Similarly there was so much faith involved. I used my dead name for FFS so it would make it easy to identify my body and inform my family if anything went wrong.

Being trans you get told all the time that you are brave and courageous, etc. Cis people have no idea. We are also desperate to just try to feel OK every day, and surgery is one of the few ways that is possible. It was intimidating to go to Colombia for the first time, but one thing I was sure of, was that any preconceptions I or anyone else might have about the country, were likely unfounded or unfair.

Conclusion: So uhh… do I pass?

I think I pass with my VFS voice sometimes. I know I don’t pass sometimes because people give me the classic double take when they hear my voice after seeing me. Sometimes the double take seems to turn into a triple or quadruple take. I’m right on the knife edge of passing visually and vocally. Some people misgender me entirely even with a feminine Zoom picture and VFS. Others perhaps cannot even tell I’m trans? At this point (7 months healing) I can’t really tell whether I generally pass or not. Various friends in customer service are amazed when I tell them I don’t pass, because to them I sound like a cis woman with a deep voice.

Well folks, if I sounded like a cis woman with a deep voice, I wouldn’t be getting ‘he’ in a meeting or ‘his’ quickly changed to ‘her’ when they realize their mistake. People like to talk about applying more technique, intonation, upspeak, etc. to sound like a woman, but you know what I have noticed? Cis women who used to be trans men, often get chronically gendered as a man/he based upon their voice. To my ear they sound identical to a cis man and the only thing that changed was the physiology of their vocal cords. They didn’t suddenly drop the habits of talking ‘like a woman’ – they detransitioned and still sound ‘like a man’. Where is all this technique for these AFABs that detransitioned and can’t pass as women by voice anymore?

I feel pretty confident vocal techniques are like wearing a dress so people have an easy gender cue; it certainly helps make it easier to control how people gender you, but it’s not as though every cis woman had vocal training to sound like a woman – it’s very much a physical problem space regardless of habits.

Healing Progress and Recordings

I wanted to record myself doing the Rainbow Reading every week during recovery. I missed a week here and there… mostly due to busy schedule or depression. Honestly this voice recovery has been such a rough ride. I feel like there are days when I have really good / passing voice quality (around 180hz or higher) and others where I’m around 140hz and very male sounding. The cold dry winter is probably to blame… it takes hours of talking to really warm up to my best quality for the day.

Before VFS using Vocal Performance

Before VFS I could perform feminine voice enough to be decently passing, but it was very hard work. Perhaps if I had practiced full time voice I could have done it more easily; however, I found myself constantly falling back into a defensive male sounding voice in many scenarios. It’s possible that VFS isn’t really necessary because apparently the physical structure of the vocal cords won’t change from estradiol, but will from performing voice for a long period of time. Note that VFS is a 1% surgery, so 99% of transfeminine people do not get this surgery. https://www.science.org/content/article/vocal-therapy-changes-voices-transgender-patients-without-need-surgery

After VFS not using Vocal Performance

Here is the 6 month healing mark, when my voice is supposed to be final… but it fluctuates quite a lot even at this point. I did a recording of my voice before VFS, performing a reading of the poem: Do not go gentle into that goodnight. This is one of my favorite poems which I first heard on the movie Interstellar. Dylan Thomas wrote this while his father was dying and I feel a lot of intensity in the writing. https://poets.org/poem/do-not-go-gentle-good-night

For the ‘male’ reading I did no feminine vocal performance – honestly I think the vocal fry is so high because my cords hadn’t been used in this way in a long time… years. I really dug deep and performed it with as much feeling and theatrics as I could at the time.

For the ‘female’ reading I did tighten R1 (resonance chamber 1) and also used forward resonance, but did not raise my pitch. The reading is whatever quality my voice was at the time. Many of my rainbow readings are performed earlier or mid day, when my best voice quality tends to be in the later afternoon or evening. Dr. Antonio told me that doing vocal performance was ‘faking’ feminine voice and that surgery would make it so I wouldn’t have to… all the other surgeons seemed to think vocal performance would still be required after the surgery. So far I tend to agree that to sound really feminine takes a measure of vocal performance beyond the bare results of VFS.

Issues with Chronic Inflammation / Swelling

Because of the rough warm ups I experimented by taking an antihistamine and ibuprofen daily for a couple of weeks and noticed an improvement in my voice quality. I was able to get a prescription for 50mg Prednisone and there is a dramatic improvement in quality – all the way up to an average talking voice of 200-220hz after a few hours. I mentioned this to my vocal therapist and she said I should ask a doctor about investigating allergies impacting voice. She also confirmed for some people healing can take closer to 7-8 months; this makes me feel a bit better about where I’m at while writing this paragraph (around 7 months and still having a lot of fluctuations).

Update 2024-12-19: It’s been 665 days (95 weeks) since VFS and I have to say that the smallness and pitch of my voice has gone up slowly over time, as swelling has gone down. I think the lesson here is that 6 months is not long enough to have a final voice. Even now I have my doubts this is my ‘final voice’. I do not to my knowledge get misgendered based upon voice at all anymore.