After several speech therapy sessions to re-educate her voice in the gender transition process, in 2023, Sílvia, a trans woman from Barcelona, decided to go one step further. She underwent a Wendler glottoplasty, a surgical technique to make the larynx smaller and increase vocal fold tension, which makes it possible to increase the fundamental frequency of the voice and give it characteristics associated with the female gender.
“The goal, for example, was to avoid being misgendered on the phone. If someone couldn’t see my face and didn’t know me, they would almost always address me as male – and that of course triggered my dysphoria, which I really wanted to avoid. So, I saw that this was the solution,” explains Sílvia.
The Clínic is the only public hospital in Catalonia that performs this procedure and patients are supported on this journey to find a voice they feel comfortable with and identify with. As Sílvia says, “my voice is part of my identity, in fact, sometimes is the only visible or audible part, because there are times when you can only be heard. Before, my voice gave me away, and now it doesn’t.”
A minimally invasive surgical procedure with satisfactory results
The programme is led by a multidisciplinary team made up of Dr Isabel Vilaseca and Dr Eduardo Lehrer, from the Otorhinolaryngology Department, and speech therapists Monica Egea and Ada Cabero, from the Clínic Institute of Medical and Surgical Specialities (ICEMEQ).
The patients who receive care under this programme come from the CAP Manso Transition Unit. The Transition Unit provides care and support from a biopsychosocial perspective to transgender people who request it, and includes medical, surgical, psychological and social care, to enable patients to complete their transition process with guarantees.
Dr Isabel Vilaseca, otorhinolaryngologist and director of the Surgical Department, explains that “voice feminization is a multidisciplinary process that requires initial specific speech therapy; after the surgical procedure these results are consolidated and, finally, more speech therapy rehabilitation is needed to recover the voice timbre. We shouldn't think that this is just voice surgery, it’s a whole process and, when it's done well, the results are very satisfactory”.
Meanwhile, Dr Eduardo Lehrer states that “of the surgical procedures available for the feminization of the voice, the one that is most commonly performed today is the Wendler glottoplasty, basically because it is minimally invasive surgery, with a hospital stay of less than 24 hours and we manage to reduce the size of the larynx, and make the vocal folds vibrate more quickly so that they reaches frequencies that are feminine.”
Speech therapy, fundamental for self-esteem
Speech therapy rehabilitation, as described by speech therapist Ada Cabero, aims to “work on the flexibility of the vocal folds, intonation and prosody, do exercises to work on head or cranial resonance, as well as developing softness, speech patterns, facial gestures and expressiveness.”
The speech therapy exercises include vocal gymnastics such as vocal work singing with a piano and spoken voice through the reading of texts, as well as body exercises. Speech therapy rehabilitation after surgery is key to reducing risks and vocal damage and allows patients to better adjust their expectations in relation to changes in their voice.
“After this whole process, they feel much more confident, their self-esteem increases, and they have greater self-assurance, because their overall communication improves,” says speech therapist Mònica Egea, who stresses that speech therapy support is key to consolidating the change.
“Voice feminization is the latest technique to be incorporated into the Catalan Health Service’s portfolio of services, after vaginoplasty and other gender transition interventions,” recalls Dr Vilaseca. With this addition, the Clínic strengthens its position as a leader in the comprehensive care of transgender people and consolidates a pioneering programme in Catalonia.
