My Voice Masculinization Surgery & voice dysphoria

First I'd like to start with a roll call of sorts. If you're a trans masc individual who has voice dysphoria and is seeking help with getting a passing voice, could you like this post?

If you're a trans person who is following out of interest, can you also like this post?

I hope you get closure regarding the malpractice of this surgeon. It's heartbreaking to read about your struggle and I wish I could help somehow, but I only have words of encouragement to offer.

Would you say that with the voice training, as short as it might have been yet, your "croaking" is getting better?

Again, I wish you the best!

Firstly, I hope that you’re doing ok. Secondly, I have had a ridiculous five year journey since I finally confronted the fact that I was transgender. (Unfortunately, a little too late in my life to undo much of the damage done to both me and my immediate family as a consequence of failing to deal with it earlier.)

Anyhow, if there’s any way you’d be prepared to exchange just a couple of messages; to be honest I do have a couple of questions, you would really be helping me out. I can relate to a lot of what you’ve been through and I haven’t managed to find anyone else in a similar situation.

If not, I am sincerely sorry for bothering you. Please take care. All the best. Tom.

So now that I know I definitely cannot get Botox injections or surgical alternatives to help my MTD, that’s all my hope out the window. At least I know now that I’m stuck with this voice and nothing can be done about it. 

You’ll either have to settle with voice therapy or hope you’re the first person to get satisfactory results from voice masculinization surgery/type 3 thyroplasty. 

My family doctor referred me to an ENT who later told him they tried to call me and didn't get a response. I got no calls. On Friday (Nov. 5th), I was called twice by the ENT but since I was driving, I could not answer. I called back when I got home and was told that I was e-mailed regarding the scheduled phone call, I was not e-mailed. If I had known I had a scheduled phone call, I would not have been driving at that time.

Again, I don't have high hopes that this will go over well. The clinic has one review by a trans person who was dissatisfied with this ENT, saying "she does not work with trans patients", so that's already worrying.

Source: https://www.themodernvocalistworld.com/articles.html/article/how-to-avoid-vocal-fold-trauma-2-releasing-the-true-vocal-folds-r547/

1. Get to know what Constriction of the False Vocal Folds feels like. Constriction of the FVFs is when the FVFs are squeezing inward. When we are breathing quietly our FVFs are at rest. In Estill terms this condition would be Mid. When we wheeze they are squeezed inward (Constricted). Alternate between breathing quietly and wheezing. Where do you feel the movement in your larynx when you are wheezing? Can you feel it release when you go back to breathing quietly? Now, try it with sound by beginning with breathing quietly then adding tone (without changing anything else in your larynx). Then, wheeze and keep the wheezing feeling while you add tone. This may feel quite uncomfortable*. Don't do it too much or with too much force but just enough to feel and know what it's like to Constrict the FVFs and release the Constriction to Mid.

2. Learn to do the opposite: Retract The False Vocal Folds! The FVFss move out of the way of the true vocal folds when we are about to laugh and cry and when we are breathing absolutely silently (you can stick your fingers in your ears and when the false vocal folds are pulled out of the way you won't hear anything!). This is FVF Retraction. Keep the feeling in your larynx while breathing silently as you add tone. The sound will be a bit fuller, clearer, more resonant and will feel like there is no pressure on the True Vocal Folds at all! Aaaaaaah! Happy vocal folds!

Source: Nicole Gress https://www.undeadvoice.com/

Quick suggestion: when you lower the larynx it’s really common to constrict the “false vocal folds” (flaps of tissue right above your vocal folds). When this happens they get in the way of the airstream and you can hear a raspy/breathy quality in the voice.

To retract the false vocal folds, plug your ears and just breathe in and out. Can you hear the air moving as you breathe? That sound is the air moving past your false vocal folds.

Now lower your larynx but don’t talk, just plug your ears and breathe again. Hear the air even more? You’ve constricted your false vocal folds.

To retract them, go back to a relaxed larynx (not lowered) and plug the ears. This time see if you can breathe in and out silently without hearing the air. Don’t slow down your breathing or use less air. You’ll feel something shift or widen in your throat, that’s the retraction of the false vocal folds.

Now lower the larynx and do the same thing. Once you get a silent inhale/exhale going, on the next exhale, open the mouth and voice “ahh” and see if you hear a difference in the voice quality.

Source: https://wonderofvoice.com/happy-singing-laughing-larynx/

How do you avoid constriction and use retraction instead? Here comes the laughing larynx! If you think of a silent laugh and feel the neck almost expanding sideways, then you are doing the retraction that makes your voice flow much easier and the need to push with other muscles is not needed. You can do this in any style and it doesn’t mean lowering the larynx unless you want a darker sound.

Found this article here: https://pubmed.ncbi.nlm.nih.gov/19853409/

I've been seeing more trans men expressing their plans to have voice masculinization surgery lately and I want to STRONGLY SUGGEST some points that you NEED TO CONSIDER before getting the procedure done:

1. DO NOT GET THE PROCEDURE DONE BY AVRAHAM MENDELSOHN AT UCLA. HE IS NEGLECTFUL. See my posts in the "Surgery" tag to read about my personal experience dealing with him, the speech therapist he made me work with, and UCLA's billing department. TLDR: It was horrible.

2. You NEED to get a laryngoscopy with an ENT (ear, nose, and throat doctor) BEFORE the surgery. If your surgeon doesn't mention this, bring it up. If they say it's unnecessary, GET ONE DONE ANYWAY. You could have other issues that might be causing your voice problems. You NEED to make sure your throat and vocal folds are healthy and that you're phonating normally before you get any surgery done.

3. Consider that you might have a speech disorder that is causing your voice problems. MTD, or muscle tension dysphonia, can cause someone to speak in an unnecessarily high-pitched voice because of tension in the neck and throat, and sometimes the usage of "false vocal folds" that close your throat up whenever you speak.

4. Working with a speech pathologist or therapist before your surgery can be extremely beneficial. You WILL learn things that you haven't seen on youtube videos.

I realized I’ve been neglecting doing research on muscle tension dysphonia, or MTD, and the usage of false vocal folds so I did some googling and found an article today about different types of MTD. Here it is: https://www.evms.edu/patient_care/specialties/ent_surgeons/services/laryngology/voice_disorders/laryngeal_muscle_tension_disorder/

This part of the article describes the type that I have:

“A second type of MTD occurs when the false vocal folds come together during speech. Normally, the false vocal folds should remain separated as the true vocal folds are adducted. Some individuals develop a speaking pattern in which they ‘bear down’ and the false folds inappropriately contact each other during speech. This is called ‘false vocal fold phonation’ or ‘plicae ventricularis’.”

If we compare the picture of the patient’s larynx provided in the article to mine, they look very similar:

^^ Image provided in the article ^^

^^ My own larynx, demonstrating the usage of “false vocal folds” during phonation ^^

It looks as if my false vocal folds are sharper-edged and more pronounced and purposeful, almost as if I’ve PERFECTED false vocal fold phonation!

I’m still trying to get insurance so I can be seen by an ENT (ear, nose, and throat doctor) and then explore options to treat my MTD. I’d really like to try botox injections, which is one treatment commonly used for MTD. While this treatment is only temporary, I could find out if I really do or do not have a truly masculine voice hiding behind my false vocal folds. I believe that if botox injections work for me to help relax my larynx so I can actually use my true vocal folds, that voice therapy and training will be a lot easier for me since I’ll know what I should be working towards after the botox wears off. My biggest trouble with voice training is that I don’t know what sound or feeling I’m supposed to be producing, because I’ve never known what it sounds and feels like to use my true vocal folds. 

Deep breathing with the diaphragm Inhale through the nose and exhale through the mouth. Remember to keep good posture (always, not just during this exercise)! 10 times, 3 times daily