Gender-Affirming Feminization Voice Surgery: A Scoping Review of Preoperative Assessments

To identify the preoperative assessments and criteria surgeons use to assess the suitability of transfeminine patients for voice feminization surgery.

Electronic search of Ovid MEDLINE, Ovid Embase, APA PsycINFO, Cochrane Library, CINAHL, and PubMed excluding MEDLINE records was performed on February 11, 2025 for articles that were published from inception to the search date. No language or date limits were applied.

The inclusion criteria were developed using the PICOTS framework. Inclusion criteria included all studies reporting (1) assessments and surgical criteria used in; (2) transfeminine adult patients who; (3) underwent feminization voice surgery. Studies involving transmasculine patients and those addressing nonsurgical interventions for voice were excluded. Non-feminization voice surgeries were excluded.

Screening and extraction followed PRISMA-ScR guidelines by two authors. Extracted data included study type, origin, and intervention. Clinical criteria were emphasized, including voice training, acoustic and perceptual parameters, and patient-reported outcomes. Other factors included medical/psychiatric evaluation and hormonal therapy.

Of 520 studies screened, 42 met inclusion. Most were retrospective case series/reports (2000-2025) with sample sizes from 1 to 506. Acoustic parameters, especially fundamental frequency, were commonly assessed. Perceptual tools included GRBAS, CAPE-V, and clinician judgment by speech-language pathologists. Patient-reported outcomes such as the Voice Handicap Index and Trans Woman Voice Questionnaire were also used. Endoscopic evaluation was frequently performed, and CT imaging was often used for cricothyroid approximation cases.

There is significant variability in preoperative criteria across studies, with limited reporting on key factors like prior voice training or psychological evaluation.