The Hospital Clínic, pioneer in Catalonia in voice surgery for transsexuals

The Hospital Clínic de Barcelona is the only hospital in Catalonia to have an active glottoplasty programme. Glottoplasty is a surgical procedure that allows transgender women to make their voice sound more feminine.   The programme is carried out at the Otorhinolaryngology Service's specialized voice consulting office by Dr. Isabel Vilaseca and Dr. Eduardo Lehrer (otolaryngologists) and the speech therapist, Marta Jordana. The Hospital Clínic is the only hospital in Catalonia to carry out this type of operation within the public health system.  

There is no age limit for voice feminization and each case is individualized.

Four years ago, the Hospital Clínic carried out a pilot study with 8 patients. The programme currently forms part of CatSalut’s portfolio of services, and around twenty patients are operated on every year.  Glottoplasty surgery is accompanied by a reduction in the volume of the vocal chords using laser. The procedure lasts 1.5 hours and there is no need for incisions, since the entire operation is performed through the mouth. 

At present, all the patients who receive care under this programme come from the CAP Manso Transition Unit. (The Transit Unit receives, advises and supports transgender patients who require medical, psychological or social resources to complete their transition process safely). In transgender women, the right voice is essential in order to link the external appearance to their personality coherently.  The female voice has several specific qualities in terms of sharpness, pitch, modulation, intensity, gestures and even vocabulary, which allow us to assign it rapidly to a female gender. Thus, it is essential to work on all aspects in a coordinated way with the help of an expert team. 

Glottoplasty has no absolute contraindications. However, it is preferable to operate on healthy vocal cords with no prior pathology, in order to obtain the best results. There is no age limit for voice feminization and each case is individualized.   

The programme includes a thorough examination of the larynx to rule out any associated pathologies. This is followed by specific speech therapy to feminize the voice, surgery if the speech therapy is not sufficient, and finally the patient receives post-operative voice rehabilitation.  The operation, which is carried out under general anaesthetic, consists of modifying the length of the vocal cords, since the larynx is shorter in women than in men.  Two suture stitches are placed at the commissure and the anterior third of both vocal folds in order to shorten the vocal cords by a few millimetres. And laser is used to increase their tension and reduce their mass, so that the voice sounds higher pitched.   

After the operation, patients usually spend 24 hours in hospital, and can then continue their recovery at home where they need to remain silent for 10 days. The operation is irreversible.