The importance of the voice in male-to-female transsexualism.

Transsexuality is a complex, permanent transposition involving a paradoxical feeling of belonging to the opposite sex. Furthermore, in the case of male-to-female transsexuals, the unchanged male voice, which is at odds with the female outward appearance, poses a serious obstacle to full social integration of the woman. One way of permanently raising the fundamental frequency, requiring little effort, is modified cricothyroidopexy via miniplates, which has been used in our hospital since 1993 following a technique developed by Isshiki (thyroplasty type IV). Until now, this operation has been performed on 67 female patients. To record the anatomical-morphological and functional data, preoperatively, post-operatively, and a year after the operation, a detailed voice diagnosis was made, laryngoscopy was carried out, X-rays were taken, and computer-assisted tomography was used to examine the larynx. Thus far, the functional results have been good. On average, the fundamental frequency has been raised by about one fourth. Whereas none of the female patients had a female-speaking voice before the operation, after the operation, about 30% of the patients' voices were in the female range, and 32% had at least a neutral-sounding voice.