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Literature about Voice Feminization and Voice Masculinization (Voice Deepening)

A. Voice Feminization

Laryngeal framework surgery

 1. Cricothyroid approximation (CTA)

    • Brown M, Perry A, Cheesman AD, Pring T. “Pitch change in male-to-female transsexuals: has phonosurgery a role to play?” International Journal of Language & Communication Disorders 35.1 (2000): 129-136.
    • Debruyne F, De Jong F, and Oosterlinck K. “Changes in fundamental frequency and spectrum of the voice after surgical cricothyroid approximation.” Scandinavian Journal of Logopedics and Phoniatrics 20.2-3 (1995): 103-106.
    • Isshiki N, Morita H, Okamura H, Hiramoto M. Thyroplasty as a new phonosurgical technique. Acta Otolaryngol 1974;78(5-6):451–457.
    • Isshiki, Nobuhiko, Tatsuzo Taira, and Masahiro Tanabe. “Surgical alteration of the vocal pitch.” The Journal of otolaryngology 12.5 (1983): 335-340.
    • Kanagalingam, Jeeve, et al. “Cricothyroid approximation and subluxation in 21 male‐to‐female transsexuals.” The Laryngoscope 115.4 (2005): 611-618.
    • Kitajima, Kazutomo, Masahiro Tanabe, and Nobuhiko Isshiki. “Cricothyroid distance and vocal pitch: experimental surgical study to elevate the vocal pitch.” Annals of Otology, Rhinology & Laryngology 88.1 (1979): 52-55.
    • Matai, Vandana, Anthony D. Cheesman, and Peter M. Clarke. “Cricothyroid approximation and thyroid chondroplasty: a patient survey.” Otolaryngology—Head and Neck Surgery 128.6 (2003): 841-847.
    • Neumann, K., C. Welzel, and A. Berghaus. “Operative voice pitch raising in male-to-female transsexuals.” European Journal of Plastic Surgery 25 (2002): 209-214.
    • Tschan, Sarina, Flurin Honegger, and Claudio Storck. “Cricothyroid joint anatomy as a predicting factor for success of cricoid‐thyroid approximation in transwomen.” The Laryngoscope 126.6 (2016): 1380-1384.
    • Van Borsel, John, et al. “Feminine after cricothyroid approximation?” Journal of Voice 22.3 (2008): 379-384.
    • Welzel, Cornelia, et al. “Einfluss der Cricothyroidopexie auf geschlechtsspezifische Stimmqualitäten bei Transsexualismus.” Sprache· Stimme· Gehör 26.03 (2002): 125-133.
    • Yang, Caroline Y., et al. “Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: results of surgery.” Annals of Otology, Rhinology & Laryngology 111.6 (2002): 477-485.

2. Feminization laryngoplasty and modified approaches

    • Kunachak, Somyos, Supawadee Prakunhungsit, and Kanjalak Sujjalak. “Thyroid cartilage and vocal fold reduction: a new phonosurgical method for male-to-female transsexuals.” Annals of Otology, Rhinology & Laryngology 109.11 (2000): 1082-1086.
    • Nuyen, Brian A., et al. “Feminization laryngoplasty: 17-year review on long-term outcomes, safety, and technique.” Otolaryngology–Head and Neck Surgery 167.1 (2022): 112-117.
    • Thomas, James P., and MacMillan C. “Feminization laryngoplasty: assessment of surgical pitch elevation.” European Archives of Oto-Rhino-Laryngology 270 (2013): 2695-2700.
    • Thomas, James P. “Feminization Laryngoplasty-A Comprehensive Approach to Reducing the Size of the Larynx and Pharynx.” Otolaryngologic Clinics of North America 55.4 (2022): 739-748.
    • Tucker, Harvey M. “Anterior commissure laryngoplasty for adjustment of vocal fold tension.” Annals of Otology, Rhinology & Laryngology 94.6 (1985): 547-549.
    • Wagner, Isabelle, et al. “Pitch‐raising surgery in fourteen male‐to‐female transsexuals.” The Laryngoscope 113.7 (2003): 1157-1165.

Microlaryngoscopic approaches

 3. Wendler Glottoplasty and modifications

    • Aires, Mateus Morais, et al. “Effect of Wendler glottoplasty on voice and quality of life of transgender women.” Brazilian journal of otorhinolaryngology (2021).
    • Aires, Mateus Morais, Camila Barbosa Marinho, and Camila de Santa Cruz Souza. “Effect of endoscopic glottoplasty on acoustic measures and quality of voice: a systematic review and meta-analysis.” Journal of Voice (2020).
    • Anderson, Jennifer A. “Pitch elevation in trangendered patients: anterior glottic web formation assisted by temporary injection augmentation.” Journal of Voice 28.6 (2014): 816-821.
    • Ballestas, Antonio J., Samir A. Ballestas, and Rocio Cuello. “Cirugía de feminización de voz con técnica glotoplastia de Wendler en Barranquilla, Colombia. Voice feminization surgery with Wendler glottoplasty technique in Barranquilla, Colombia.” Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello 45.4 (2017): 247-253.
    • Brown, Sarah K., et al. “Addition of Wendler glottoplasty to voice therapy improves trans female voice outcomes.” The Laryngoscope 131.7 (2021): 1588-1593.
    • Casado, Juan C., María J. Rodríguez-Parra, and José A. Adrián. “Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support.” European Archives of Oto-Rhino-Laryngology 274 (2017): 2049-2058.
    • Donald, Paul J. “Voice change surgery in the transsexual.” Head & neck surgery 4.5 (1982): 433-437.
    • Gross, Manfred. “Pitch-raising surgery in male-to-female transsexuals.” Journal of Voice 13.2 (1999): 246-250.
    • Kim, Hyung‐ “A new conceptual approach for voice feminization: 12 years of experience.” The Laryngoscope 127.5 (2017): 1102-1108
    • Mastronikolis, Nicholas S., et al. “Wendler glottoplasty: an effective pitch raising surgery in male-to-female transsexuals.” Journal of Voice 27.4 (2013): 516-522.
    • Meister, Jonas, et al. “Pitch elevation in male-to-female transgender persons—the Würzburg approach.” Journal of Voice 31.2 (2017): 244-e7.
    • Paltura, Ceki, and Kürşat Yelken. “An examination of vocal tract acoustics following Wendler’s glottoplasty.” Folia Phoniatrica et Logopaedica 71.1 (2019): 24-28.
    • Park, Chris, Sarah Brown, and Mark Courey. “Trans Woman Voice Questionnaire Scores Highlight Specific Benefits of Adjunctive Glottoplasty With Voice Therapy in Treating Voice Feminization.” Journal of Voice (2021).
    • Remacle, Marc, et al. “Glottoplasty for male-to-female transsexualism: voice results.” Journal of Voice 25.1 (2011): 120-123.
    • Wendler J: Vocal pitch elevation after transsexualism male to female. In: Proceedings of the Union of the European Phoniatricians; Salsomaggiore, Italy, 1990. doi: 10.1099/00221287-136-2-327
    • Wendler J (1994). Pitch raising by shortening of the glottis. 3rd Intern. Symp. Phonosurgery, Kyoto, p. 14

4. Laser‐assisted strategies (LAVA, LRP) and combinations

    • Geneid, Ahmed, Heikki Rihkanen, and Teemu J. Kinnari. “Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch.” European Archives of Oto-Rhino-Laryngology 272 (2015): 3751-3756.
    • Koçak, Ismail, et al. “Laser reduction glottoplasty for managing androphonia after failed cricothyroid approximation surgery.” Journal of Voice 24.6 (2010): 758-764.
    • Yılmaz, Taner, Furkan Özer, and Fatma Esen Aydınlı. “Laser reduction glottoplasty for voice feminization: Experience on 28 patients.” Annals of Otology, Rhinology & Laryngology 130.9 (2021): 1057-1063.
    • Orloff, Lisa A., et al. “Laser‐assisted voice adjustment (LAVA) in transsexuals.” The Laryngoscope 116.4 (2006): 655-660.

Comparative studies

    • Mora, Elena, et al. “Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male‐to‐female transsexuals.” The Laryngoscope 128.9 (2018): 2101-2109.
    • Van Damme, Silke, et al. “The effectiveness of pitch-raising surgery in male-to-female transsexuals: a systematic review.” Journal of Voice 31.2 (2017): 244-e1.
    • Casado-Morente, Juan Carlos, et al. “Comparison Between two Surgical Techniques for Increasing Vocal Pitch by Endoscopic Shortening of the Vocal Folds.” Journal of Voice (2022).
    • Schwarz, Karine, et al. “Laryngeal surgical treatment in transgender women: a systematic review and meta‐” The Laryngoscope 127.11 (2017): 2596-2603.

B. Voice Masculinization (Voice Deepening)

    • Bultynck, Charlotte, et al. “Thyroplasty type III to lower the vocal pitch in trans men.” Otolaryngology–Head and Neck Surgery 164.1 (2021): 157-159.
    • Haben, C. Michael. “Masculinization Laryngoplasty.” Otolaryngologic Clinics of North America 55.4 (2022): 757-765.
    • Hoffman, Matthew R., et al. “Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension.” European Archives of Oto-Rhino-Laryngology 271 (2014): 1621-1629.
    • Isshiki N, Morita H, Okamura H, Hiramoto M. Thyroplasty as a new phonosurgical technique. Acta Otolaryngol 1974;78(5-6):451–457.
    • Isshiki, Nobuhiko, Tatsuzo Taira, and Masahiro Tanabe. “Surgical alteration of the vocal pitch.” The Journal of otolaryngology 12.5 (1983): 335-340.
    • Slavit, David H., Nicolas E. Maragos, and Richard J. Lipton. “Physiologic assessment of Isshiki type III thyroplasty.” The Laryngoscope 100.8 (1990): 844-848.

C. Chondrolaryngoplasty

    • Conrad, Krzysztof, and Adi Yoskovitch. “Endoscopically facilitated reduction laryngochondroplasty.” Archives of Facial Plastic Surgery (2003).
    • Khafif, Avi, et al. “Scarless neck feminization: transoral transvestibular approach chondrolaryngoplasty.” Facial Plastic Surgery & Aesthetic Medicine3 (2020): 172-180.
    • David, Abel P., et al. “Clinical feasibility and efficacy of the externally scarless transoral chondrolaryngoplasty.” Facial Plastic Surgery & Aesthetic Medicine 24.S2 (2022): S-41.
    • Giraldo, Francisco, Jesús de Grado, and José Montes. “Aesthetic reductive thyroid chondroplasty.” International journal of oral and maxillofacial surgery 26.1 (1997): 20-22.
    • Nuyen, Brian, et al. “Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty.” The Laryngoscope (2022).
    • Spiegel, Jeffrey H., and Gerardo Rodriguez. “Chondrolaryngoplasty under general anesthesia using a flexible fiberoptic laryngoscope and laryngeal mask airway.” Archives of Otolaryngology–Head & Neck Surgery 134.7 (2008): 704-708.
    • Tang, Christopher G., Peter M. Debbaneh, and Andrew J. Kleinberger. “Chondrolaryngoplasty.” Otolaryngologic Clinics of North America 55.4 (2022): 871-884.
    • Wolfort, Francis G., and Richard G. Parry. “Laryngeal chondroplasty for appearance.” Plastic and reconstructive surgery 56.4 (1975): 371-374.
    • Wolfort, Francis G., et al. “Chondrolaryngoplasty for appearance.” Plastic and Reconstructive Surgery 86.3 (1990): 464-469.

D. Voice Therapy

    • Casado, Juan C., María J. Rodríguez-Parra, and José A. Adrián. “Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support.” European Archives of Oto-Rhino-Laryngology 274 (2017): 2049-2058.
    • Carew, Lisa, Georgia Dacakis, and Jennifer Oates. “The effectiveness of oral resonance therapy on the perception of femininity of voice in male-to-female transsexuals.” Journal of voice 21.5 (2007): 591-603.
    • Gallena, Sally JK, Betsy Stickels, and Emily Stickels. “Gender perception after raising vowel fundamental and formant frequencies: Considerations for oral resonance research.” Journal of Voice 32.5 (2018): 592-601.
    • Dacakis G. The role of voice therapy in male-to-female transsexuals. Curr
    • Opin Otolaryngol Head Neck Surg. 2002;10:173–177
    • Hancock, Adrienne B., and Laura M. Garabedian. “Transgender voice and communication treatment: a retrospective chart review of 25 cases.” International Journal of Language & Communication Disorders 48.1 (2013): 54-65.
    • Nolan, Ian T., et al. “The role of voice therapy and phonosurgery in transgender vocal feminization.” Journal of Craniofacial Surgery 30.5 (2019): 1368-1375.
    • Dacakis, Georgia. “Long-term maintenance of fundamental frequency increases in male-to-female transsexuals.” Journal of Voice 14.4 (2000): 549-556.
    • De Bruin, M. D., M. J. Coerts, and A. J. Greven. “Speech therapy in the management of male-to-female transsexuals.” Folia phoniatrica et logopaedica 52.5 (2000): 220-227.
    • Gelfer, Marylou Pausewang, and Ruthanne M. Tice. “Perceptual and acoustic outcomes of voice therapy for male-to-female transgender individuals immediately after therapy and 15 months later.” Journal of Voice 27.3 (2013): 335-347.
    • Loutrari, Ariadne, and Ioanna Georgiadou. “Adapted melodic intonation therapy can help raise trans women’s singing and speaking fundamental frequencies.” Logopedics Phoniatrics Vocology (2022): 1-9.
    • Merrick, Gwen, et al. “Outcomes of gender affirming voice training: A comparison of hybrid and individual training modules.” Journal of Speech, Language, and Hearing Research 65.2 (2022): 501-507.
    • Nolan, Ian T., et al. “The role of voice therapy and phonosurgery in transgender vocal feminization.” Journal of Craniofacial Surgery 30.5 (2019): 1368-1375.
    • Oğuz, Özlem, Beril Ayran, and Kürşat Yelken. “Clinical considerations in speech and language therapy in Turkish transgender population.” Journal of Voice 35.4 (2021): 662-e9.
    • Park, Chris, Sarah Brown, and Mark Courey. “Trans Woman Voice Questionnaire Scores Highlight Specific Benefits of Adjunctive Glottoplasty With Voice Therapy in Treating Voice Feminization.” Journal of Voice (2021).
    • Quinn, Sterling, Jennifer Oates, and Georgia Dacakis. “The Effectiveness of Gender Affirming Voice Training for Transfeminine Clients: A Comparison of Traditional Versus Intensive Delivery Schedules.” Journal of Voice (2022).
    • Rapoport, Sarah K., et al. “Patient Satisfaction and Acoustic Changes in Trans Women after Gender Affirming Voice Training.” The Laryngoscope (2023).

E. Topic-related physiological and acoustical basics

    • Carew, Lisa, Georgia Dacakis, and Jennifer Oates. “The effectiveness of oral resonance therapy on the perception of femininity of voice in male-to-female transsexuals.” Journal of voice 21.5 (2007): 591-603.
    • Coleman, Ralph O. “A comparison of the contributions of two voice quality characteristics to the perception of maleness and femaleness in the voice.” Journal of speech and hearing research 19.1 (1976): 168-180.
    • Gorham-Rowan, Mary, and Richard Morris. “Aerodynamic analysis of male-to-female transgender voice.” Journal of voice 20.2 (2006): 251-262.
    • Gelfer, Marylou Pausewang, and Victoria A. Mikos. “The relative contributions of speaking fundamental frequency and formant frequencies to gender identification based on isolated vowels.” Journal of voice 19.4 (2005): 544-554.
    • Hillenbrand, James M., and Michael J. Clark. “The role of f 0 and formant frequencies in distinguishing the voices of men and women.” Attention, Perception, & Psychophysics 71 (2009): 1150-1166.
    • Mount, Kay H., and Shirley J. Salmon. “Changing the vocal characteristics of a postoperative transsexual patient: A longitudinal study.” Journal of Communication Disorders 21.3 (1988): 229-238.
    • Mürbe D, Mattheus W. Symptomatic Profile: Pathophysiology of Phonation. In: am Zehnhoff-Dinnesen A, Wiskirska-Woznica B, Neumann K, Nawka T. (Eds.) European Manual of Medicine – Phoniatrics I. Springer-Verlag Berlin Heidelberg 2020, Softcover ISBN978-3-662-46779-4; eBook ISBN978-3-662-46780-0, pp. 230-233
    • Roers, Friederike, Dirk Mürbe, and Johan Sundberg. “Predicted singers’ vocal fold lengths and voice classification—a study of x-ray morphological measures.” Journal of Voice 23.4 (2009): 408-413.

F. Quality of life and self-assessment

    • Aires, Mateus Morais, et al. “Effect of Wendler glottoplasty on voice and quality of life of transgender women.” Brazilian journal of otorhinolaryngology (2021).
    • Bultynck, Charlotte, et al. “Self‐perception of voice in transgender persons during cross‐sex hormone therapy.” The Laryngoscope 127.12 (2017): 2796-2804.
    • Bultynck, Charlotte, et al. “Organizing the voice questionnaire for transgender persons.” International Journal of Transgender Health1 (2020): 89-97.
    • Casado-Morente, Juan Carlos, et al. “Development and validation of the Spanish abbreviated version of the transsexual voice questionnaire for male-to-female transsexuals.” Acta Otorrinolaringologica (English Edition) 72.1 (2021): 21-26.
    • Dacakis, Georgia, et al. “Development and preliminary evaluation of the transsexual voice questionnaire for male-to-female transsexuals.” Journal of Voice 27.3 (2013): 312-320.
    • Dacakis, Georgia, Jennifer Oates, and Jacinta Douglas. “Associations between the Transsexual Voice Questionnaire (TVQMtF) and self‐report of voice femininity and acoustic voice measures.” International Journal of Language & Communication Disorders 52.6 (2017): 831-838.
    • Hancock, Adrienne B., and Laura M. Garabedian. “Transgender voice and communication treatment: a retrospective chart review of 25 cases.” International Journal of Language & Communication Disorders 48.1 (2013): 54-65.
    • Hancock, Adrienne B., Julianne Krissinger, and Kelly Owen. “Voice perceptions and quality of life of transgender people.” Journal of Voice 25.5 (2011): 553-558.
    • Junior, Cirley Novais Valente, and Adriane Mesquita de Medeiros. “Voice and gender incongruence: relationship between vocal self-perception and mental health of trans women.” Journal of Voice 36.6 (2022): 808-813.
    • McNeill, Emma JM, et al. “Perception of voice in the transgender client.” Journal of voice 22.6 (2008): 727-733.
    • Meister, Jonas, et al. “Perceptual analysis of the male‐to‐female transgender voice after glottoplasty—the telephone test.” The Laryngoscope4 (2017): 875-881.
    • Mora, Elena, et al. “Translation, cultural adaptation, and preliminary evaluation of the Spanish version of the transgender voice questionnaire for male-to-female transsexuals (TVQ MtF).” Journal of Voice 32.4 (2018): 514-e1.
    • Morsomme, Dominique, Joana Revis, and Elisabeth Thomas. “Translation, Adaptation, and Preliminary Validation of Dacakis and Davies’“Transsexual Voice Questionnaire (Male to Female)” in French.” Journal of Voice5 (2019): 807-e13.
    • Robotti, Carlo, et al. “Translation, cross-cultural adaptation, and preliminary validation of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (I-TVQMtF) into Italian.” Journal of Voice 36.4 (2022): 587-e1.
    • Salm, Sandra, et al. “Validation of the German version of the transsexual voice questionnaire for male-to-female transsexuals.” Journal of Voice 34.1 (2020): 68-77.
    • Santos, Heloisa Helena de Almeida Neves Matta dos, et al. “Translation and preliminary evaluation of the Brazilian Portuguese version of the Transgender Voice Questionnaire for male-to-female transsexuals.” Vol. 27. Sociedade Brasileira de Fonoaudiologia, 2015.
    • Schmidt, Jeanne Gabriele, et al. “Voice challenge in transgender women: trans women self-perception of voice handicap as compared to gender perception of naïve listeners.” Revista CEFAC 20 (2018): 79-86.
    • Schwarz, Karine, et al. “Transsexual voice questionnaire for male-to-female Brazilian transsexual people.” Journal of Voice 31.1 (2017): 120-e15.
    • Sirin, Seher, Aslihan Polat, and Firdevs Alioglu. “Psychometric evaluation of adapted transsexual voice questionnaire for Turkish trans male individuals.” Journal of Voice 35.5 (2021): 805-e27.
    • Stewart, Lauryn, Jennifer Oates, and Paul O’Halloran. “My voice is my identity”: the role of voice for trans women’s participation in sport.” Journal of Voice1 (2020): 78-87.
    • Taşkin, Ayşenur, et al. “Investigating validity and reliability of the Turkish version of transsexual voice questionnaire (male to female).” Journal of Voice 36.3 (2022): 434-e25.

G. Surveys

    • Fakhoury, Raja, et al. “Voice Feminization and Masculinization.” Textbook of Surgery of Larynx and Trachea. Cham: Springer International Publishing, 2022. 109-141.
    • Hess, Markus M and Fleischer, Susanne. “Chirurgisch zur höheren Stimmlage.” HNO Nachrichten 48.3 (2018): 24-30.
    • Hess, Markus, and Fleischer, Susanne. “Optionen der Stimmfeminisierung: Mit Stimmübungen und Phonochirurgie zu einem weiblicheren Klang.” HNO Nachrichten 52.6 (2022): 24-29.
    • Kim, Hyung-Tae. “Vocal feminization for transgender women: Current strategies and patient perspectives.” International journal of general medicine (2020): 43-52.
    • Kim, Hyung-Tae. “The Update of Voice Feminization Surgery.” Journal of Clinical Otolaryngology Head and Neck Surgery 21.2 (2010): 184-190.
    • Nerurkar, Nupur & Sarkar, Asitama & Yermalkar, Sameer. (2021). To Web or Not to Web. The Bombay Hospital journal. 63. 42-45. 10.15713/ins.bhj.50.
    • Tang, Christopher G., Peter M. Debbaneh, and Andrew J. Kleinberger. “Chondrolaryngoplasty.” Otolaryngologic Clinics of North America 55.4 (2022): 871-884.