การผ่าตัดเปลี่ยนเสียงในเพศทางเลือก เพิ่มความมั่นใจในการใช้ชีวิต

Voice is something that can indicate a person&#8217;s personality. For example, having a deep, loud, and resonant voice reflects power, authority, and confidence. It is a voice characteristic typically associated with males, while a high-pitched, soft, and light voice tends to be more indicative of females.
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Therefore, for those who wish to change their gender or have undergone gender confirmation surgery, which is surgery to align the external body with the desired gender, voice surgery is one aspect that can help complete the transformation. Having a voice that matches the changed gender will increase confidence and make life easier.
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<h2>Voice Surgery in the LGBTQ+ Community</h2>
Voice surgery is generally divided into 2 cases:
<h3>1. Surgery to change voice from male to female (Feminization laryngoplasty)</h3>
There are 3 main surgical techniques as follows:
<ul>
<li>Open surgery to adjust the external laryngeal structure to tighten the vocal cords (Cricothyroid approximation; CTA). This method leaves a small scar on the neck.</li>
<li>Endoscopic surgery by suturing the anterior vocal cords (Anterior glottis web formation).</li>
<li>Using laser to reduce the size of the vocal cords and create lateral tension (Laser reduction glottoplasty).</li>
</ul>
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<h3>2. Surgery to change voice from female to male (Masculinization laryngoplasty)</h3>
Generally, voice change from female to male is commonly achieved through male hormone therapy, which causes physical changes in the vocal cords, lowering the voice pitch to some extent. Therefore, voice surgery is less popular than voice change from male to female. Male voice surgery is usually open surgery focusing on adjusting the external laryngeal structure.
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Both types of voice surgery have different advantages and disadvantages. Open surgery has the downside of a scar on the front of the neck, which may develop into a keloid scar in the future. Endoscopic surgery has the advantage of no external scar but may cause scarring on the vocal cords.
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<h2>Preparation Before Voice Surgery</h2>
<ul>
<li>Undergo diagnosis by an otolaryngologist, a specialist in the larynx, who will take a history, assess voice use behavior, and the desired voice goal.</li>
<li>Physical examination with endoscopy to observe the laryngeal structure, vocal cords, and overall vocal cord function to detect any abnormalities that may cause voice problems.</li>
<li>Voice quality assessment by a speech therapist, including completing voice questionnaires to analyze problems and needs accurately.</li>
<li>Avoid taking medications, supplements, or health products that may affect platelet function or blood clotting, such as aspirin and fish oil, at least 2 weeks before surgery to reduce the risk of surgical complications, unless necessary. The attending physician will decide on medication details for preparation.</li>
<li>Take care of vocal health by drinking enough water and avoiding substances that dry the vocal cords, such as alcohol, caffeine, or irritants like cigarette smoke.</li>
<li>Avoid behaviors that may injure the vocal cords, such as excessive voice use or shouting.</li>
</ul>
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If factors causing abnormal voice or affecting surgical outcomes are found, explanations and treatment planning will be done with a multidisciplinary team of specialists to achieve the best surgical results.
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<h2>Appropriate Age for Voice Surgery</h2>
<ul>
<li>The patient should be of legal age, 18 years or older, capable of making their own decisions and understanding the risks and outcomes of surgery in both the short and long term.</li>
<li>Since voice surgery may cause scarring on the vocal cords, resulting in permanent voice changes that may not be reversible to the original voice, the patient should have already undergone gender confirmation surgery.</li>
</ul>
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<h2>Voice Surgery Procedure</h2>
<ul>
<li>Voice surgery is performed under general anesthesia to suppress sensation, with an anesthesiologist inserting and managing the breathing tube throughout the surgery.</li>
<li>Endoscopic surgery involves inserting instruments through the mouth and performing surgery with a high-magnification endoscope using specialized laryngeal surgical tools. The vocal cord mucosa is cut and the anterior vocal cords are sutured together, or laser is used to reduce the size of the vocal cords and increase lateral tension.</li>
<li>Open surgery involves altering the cartilage structure of the larynx. The surgical details vary depending on whether the voice is changed from male to female or female to male. The external surgical incision is on the front of the neck, 3-5 cm in length. The laryngeal cartilage is sutured together to raise the pitch or some cartilage is pushed inward. The surgeon then closes the neck incision.</li>
<li>When the patient wakes or regains consciousness, the anesthesiologist removes the breathing tube, marking the end of the voice surgery.</li>
</ul>
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<h2>Postoperative Care After Voice Surgery</h2>
After voice surgery, the patient must rest in a hospital room and can eat and drink normally. The doctor will prescribe pain relief medication. Generally, there may be muscle soreness in the neck or shoulders from lying with the neck extended during surgery, and pain at the surgical site if there is an external wound. There may also be throat irritation or pain from the breathing tube. The doctor will continuously monitor respiratory symptoms for 24 hours after surgery. If no complications are found, the patient can be discharged.
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Voice surgery can be a complex treatment process. Patients should study and understand the procedure carefully and prioritize the treatment steps by consulting a laryngeal specialist. This includes preoperative preparation, selecting the appropriate surgical method, and systematic voice rehabilitation with a speech therapist to achieve the best voice results that meet the patient&#8217;s needs.
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Dr. Purich Praneetwattakul
Otolaryngologist
Subspecialist in Laryngeal Diseases
and Voice Disorders
Phyathai 2 Hospital

Voice is one of the indicators of personality. For those who undergo gender confirmation surgery, voice modification surgery helps to align the speaking voice with the changed gender.

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Voice surgery in transgender individuals increases confidence in life.

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