Trachea shave and vocal chords

[Naomi]

I have a question: not too long ago, I completed the hormonal and "real life test" phase of my transition process, the next step will be the operations. I'm a candidate for a trachea shave and adjustment of my vocal chords, will get FFS and GCS.  But first my throat: the insurance has this weird rule in The Netherlands, that they only pay for it if your adam's apple sticks out half a centimeter or more, mine doesn't. My ENT doctor agrees it's very clearly visible and should be gone, so they were looking for ways to circumvent this insurance rule. They also did a voice test and I'm already passably female when I read out a text, but forget when I'm in a conversation. They believe there would be merit in a vocal chord operation and some more voice therapy, in which I try to talk from my throat rather than my chest.

So their proposal is, that they perform a very specific vocal chord operation in which my larynx will be pushed forward. A trachea shave is standard part of that procedure. This way they can help me with my adam's apple, while billing it to the insurance as a vocal chord operation.

But my question is: what kind of vocal chord operation necessitates pushing the larynx forward? What other kinds of vocal chord procedures exist and what are the advantages/ disadvantages of those? My doctor told me that if this operation on my vocal chords wasn't sufficient yet, they could do an extra operation on my vocal chords after that. Is that advisable? Am i right in supposing that the operation they propose is a cricothyroid approximation and that I could still have a anterior glottal web formation?

[Jani]

Hi Naomi.  I can't answer you last question as I don't understand the medical terminology.  I can say that any vocal chord surgery has risks.  From others I've spoken with you also have to do a fair amount of therapy to train your vocal chords after they've healed.  It's not like other surgeries where after it's finished, it's finished.  It seems like you are trying to get vocal chord surgery in order to have the trachea shave done.  As you note that your voice passes well I would find a different way to get this done. 

Jani

[Naomi]

Hey Jani,

Both procedures are explained here (the first two): https://en.wikipedia.org/wiki/Voice_therapy_(transgender)#Vocal_surgeries in one of them the vocal chords are elongated, in the other they are shortened. My doctor told me she could give me the first one and include a trachea shave with that. But she considers the second one to be more effective and told me the chords could still be shortened if the first surgery wasn't doing enough. But I also feel that one shouldn't toy too much with one's vocal chords and having two operations is twice the risk of things going wrong.

I'm not trying to get vocal chord surgery in order to get my trachea done,  really want both. But the insurance wouldn't pay for my adam's apple as a separate operation, because it doesn't stick out enough to constitute a "medical necessity". So the doctors were looking for ways to make the trachea shave part of the vocal chord procedure. I'm very bothered by that thing and consider it a branding of masculinity on my throat. They're just trying to help me out

I gave it long consideration, it was the gender clinic that recommended vocal chord surggery. I've already been seeing a voice therapist for about a year, who didn't believe it was necessary to have them operated, but when I had my voice tested by the voice therapist in the hospital, she did believe it was necessary.  I sound passably feminine if I make an effort and am constantly aware of my voice, but there are too many occasions when I slip: have a lot of daily meetings and after my fourth meetings I get tired, my voice goes down. I do project management, sometimes have to raise my voice to exercise authority and subconsciously end up in this male voice pattern. My voice goes down. Also when I get mad.  It's weird, but I mostly have problems in a professional setting and can't stop myself from doing it.

the hospital also gave instructions to my voice therapist. What they can't solve with surgery, is that I often speak from my chest instead of my throat, which adds volume to my voice. Regardless of surgery, which is just about the pitch, I need to practice with that too.