Pitch Elevation in Male-to-female Transgender Persons—the Würzburg Approach

Abstract

The present study reports objective and subjective voice results of Wendler's glottoplasty modified by Hagen. This is an outcomes research study. A total of 21 patients underwent Wendler's glottoplasty modified by Hagen. Parameters in the follow-up session were laryngoscopy, voice range profile, Voice Handicap Index, Life Satisfaction Questionnaire, and a visual analog scale for individual satisfaction with the voice. The fundamental frequency was elevated into the typical female fundamental frequency range. Furthermore, an elevation of the lower frequency limit was shown without a reduction of the frequency range. About one third of the population feels affected by the restricted dynamic range. This change of the vocal pitch is seen as part of the voice feminization by some of the patients. The Dysphonia Severity Index as a marker for voice quality was unchanged. Subjective satisfaction with the voice showed a strong correlation with the individual elevation of the pitch. Wendler's glottoplasty modified by Hagen is an effective and low-risk method of raising the vocal pitch of male-to-female transgender persons. However, elevated Scores of the Voice Handicap Index indicated that in everyday life, transgender persons continue to feel handicapped because of their voice. Another indicator for the lack of social acceptance and integration is the reduced general life satisfaction in the Life Satisfaction Questionnaire especially in the domain "friends, acquaintances, relatives." Therefore, a better multidisciplinary therapy concept for voice feminization is necessary.