Voice Pitch Surgery: Detailed Guide

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 06.10.2026

How is the pitch of the voice produced?

The voice is produced when air coming from the lungs makes the two vocal folds in the larynx vibrate; the number of these vibrations per second (the fundamental frequency) determines the pitch of the voice. In adult men the average frequency of the speaking voice is about 100–130 hertz, and in women 190–220 hertz; the range between 145 and 165 hertz is a transitional zone that listeners may attribute to either sex. The longer, thicker and slacker the vocal folds are, the slower the vibration and the deeper the voice; during puberty, the growth of the larynx and the lengthening and thickening of the vocal folds under the effect of testosterone are the reason the male voice deepens. This change is irreversible: oestrogen does not raise a voice that has deepened.

Although pitch is the strongest factor in whether a listener perceives a voice as “female” or “male”, it is not the only one. Resonance (the shaping of the voice in the mouth and throat), intonation, speaking rate, emphasis and choice of words also determine perception. Surgery changes only the pitch; the other features depend on the person’s speaking habits.

Who is a candidate?

Raising the voice: The largest group is transgender women in the process of gender affirmation; because hormone treatment does not change the voice, a voice that remains out of step with appearance is a significant problem in daily life. Less commonly, women whose voice has deepened for hormonal reasons or as a result of long-term androgen use also seek treatment.

Lowering the voice: The main reason is a voice that remains at a childlike high pitch even though puberty is complete (puberphonia or mutational falsetto); in these patients the first-line treatment is generally non-surgical, such as voice therapy, and surgery comes into consideration for selected patients who do not benefit from it. Other candidates are adults who find their voice too high for professional or personal reasons and a small proportion of transgender men in the process of gender affirmation (testosterone usually provides sufficient deepening).

Who is not suitable: People with untreated nodules, polyps, cysts or paralysis of the vocal folds; those with uncontrolled reflux; those who cannot stop smoking; those who will not be able to keep to voice rest after surgery; and those whose expectations go beyond what surgery can provide. Accompanying vocal fold diseases are treated first.

Assessment before surgery

The assessment begins with a detailed discussion of how the voice is used and of expectations. At the examination the vocal folds are viewed directly with a thin camera passed through the nose or mouth (endoscopic laryngoscopy); their structure, movement and closure are assessed. A voice recording is made and the average pitch of the speaking voice and the vocal range are measured; these measurements are kept for comparison after surgery. Reflux symptoms are asked about and, if necessary, treatment is started before surgery. Smoking should be stopped at least a few weeks before surgery.

Methods for raising the voice

Glottoplasty (Wendler glottoplasty)

This is the most widely used method today and the one with the most predictable results. Under general anaesthesia the vocal folds are reached with a laryngoscope inserted through the mouth; there is no incision on the neck. The surface covering (mucosa) of the front third of both vocal folds is removed under the microscope, and the vocal folds are stitched together in this area with dissolvable stitches. During healing the two vocal folds join at the front to form a small web; because the vibrating length becomes shorter, the voice becomes higher. The procedure takes about 45–60 minutes; the patient is discharged the same day or the next day. In published series the average pitch of the speaking voice usually rises by about 40–80 hertz, that is roughly a third to half an octave; in the great majority of patients the voice is moved into the female range or to the upper part of the transitional zone.

Cricothyroid approximation (type 4 thyroplasty)

Through a small incision in the neck, two cartilages of the larynx are stitched together to tighten the vocal folds; this makes permanent the mechanism that is naturally used when producing a high-pitched sound. It requires an external incision, the lowest notes of the voice are not preserved, and part of the pitch gain can be lost over the years as the stitches loosen with time. For these reasons it is no longer the first choice in most centres and has come to be used in selected cases or in addition to glottoplasty.

Laser-assisted methods

Thinning the front part of the vocal folds with a laser to reduce their mass and increase their tension (laser reduction glottoplasty) can be performed on its own or together with sutured glottoplasty; the aim is to increase the pitch gain.

Method for lowering the voice: type 3 thyroplasty

The thyroid cartilage of the larynx is reached through a 3–4 centimetre incision placed in a natural skin crease of the neck. A vertical strip a few millimetres wide is removed from each side of the cartilage, and the front part is moved backwards and fixed. In this way the front end of the vocal folds comes backwards, the folds slacken and vibrate more slowly, producing a deeper voice. The operation is usually performed under light sedation and local anaesthesia, during which the patient remains awake and can speak; the amount of the shift is adjusted by listening to the patient’s voice, which allows the result to be set for the individual. Because it is a permanent cartilage operation, the result is permanent. The external scar is hidden in the crease and fades over months.

The period after surgery

Voice rest: In glottoplasty, 1–2 weeks of complete voice rest are mandatory so that the stitched vocal folds heal without separating; speaking, whispering, coughing, throat clearing and heavy lifting are forbidden. After type 3 thyroplasty the rest period is shorter, but the voice must not be strained in the first week. After the rest period, the voice is used starting with short conversations and increasing over weeks.

The first weeks: The voice may be hoarse, breathy, weak and unsteady; this is the expected state of healing vocal folds. Mild throat pain and discomfort on swallowing last a few days. Reflux medication, plenty of water and a humid environment are recommended; smoking and alcohol clearly impair healing.

The long term: From the third month the voice begins to settle at its new pitch; full maturation is completed between six months and a year. At follow-up examinations the vocal folds are viewed and the voice measurements are compared with those before surgery. Patients return to desk work after 1–2 weeks and to jobs that involve heavy voice use after 4–6 weeks.

Possible problems and risks

In glottoplasty the most important problem is partial or complete opening of the front web during healing and a reduction in pitch gain; not keeping to voice rest, coughing and reflux increase this risk. Healing tissue (granuloma) can develop at the stitch site on the vocal fold; it usually regresses on its own or with a minor intervention. A permanently breathy voice, reduced loudness, narrowing of the vocal range and tiring quickly when speaking may occur. With overcorrection the voice may be higher and weaker than desired, and with undercorrection the pitch may not be high enough; a second correction is performed in some patients. With type 3 thyroplasty, the incision scar, loosening of the cartilage fixation and a voice that is deeper than desired or not deep enough are possible problems. In both operations, temporary pain related to general anaesthesia and the instruments placed in the throat, injury to the teeth and lips, and infection are low-probability risks.

Results and satisfaction

Pooled analyses show that pitch-raising operations raise the speaking pitch significantly and permanently, and that the great majority of patients are satisfied with the result. The main factor that determines satisfaction is setting expectations correctly: the operation raises the voice but does not create “a new voice”; the intonation, resonance and way of speaking that form the character of the voice come with the person themselves. In pitch-lowering surgery, because the voice is adjusted by listening to it during the operation, the result usually reaches the target pitch in the first session.

Frequently asked questions

Can the operation be reversed? Glottoplasty and type 3 thyroplasty are permanent procedures; they cannot reliably be reversed. The decision should be made with this knowledge.

Will I have a scar on my neck? In glottoplasty there is no scar because there is no external incision. In type 3 thyroplasty and cricothyroid approximation a short scar hidden in the neck crease remains and fades over months.

When can I speak? After glottoplasty there is no speaking at all for 1–2 weeks; speaking is then resumed gradually. It usually takes 4–6 weeks for the voice to become comfortably usable in daily life.

Can I sing? The vocal range changes after both operations: with raising, the low notes are lost, and with lowering, the high notes are lost; loudness may decrease. Amateur singing is possible, but for professional singers the decision to have surgery requires a detailed assessment.

Will my voice become completely a female or male voice? The operation moves the pitch into the target range; the intonation, resonance and speaking style that complete the perception depend on the person’s speaking habits and are developed independently of the operation.

Is there an age limit? Development of the larynx must be complete; the operation is usually performed in patients aged 18 and over. There is no upper age limit; general health and the structure of the vocal folds are the deciding factors.

Doesn’t hormone treatment raise the voice? Oestrogen does not raise a voice that has deepened; for this reason, in transgender women there is no permanent way to change the pitch of the voice other than surgery. Testosterone, on the other hand, deepens the voice; in transgender men surgery is usually not needed.

This article is for general information; please consult your physician for diagnosis and treatment.