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Updated: Sep 20, 2026
Learning Modern Laryngeal Surgery in a Dissection Laboratory
Published on: March 18, 2020
Timing of Laryngeal Surgery in Gender Affirming Care: A Single Institution Review
Michael R Xiang1, Randy Bach1, Natasha Mirza1
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia.
Objectives:
To understand where laryngeal surgery falls in the order of gender-affirming surgeries (GAS) for transgender and gender diverse (TGD) patients, by analyzing: (1) number and types of GAS pursued, (2) chronological order of GAS pursued, and (3) whether the timing of laryngeal surgery impacts functional voice outcomes METHODS: Retrospective chart review of adult patients undergoing laryngeal surgery within a single institution's Otolaryngology department for a primary diagnosis of "Gender Dysphoria." TGD patients pursuing voice therapy (VT) only were enlisted as controls. Charts were reviewed for all GAS performed and voice-related questionnaires (VHI-10 and TWVQ).
Results:
Seventy-two patients status post laryngeal surgery with an average (standard deviation [SD]) age of 35 (13) years; 62 underwent vocal feminization, and 10 underwent vocal masculinization. On average (SD), patients underwent 2.61 (1.52) GAS, consisting of 1.42 (0.64) laryngeal surgeries, 0.34 (0.70) facial surgeries, 0.43 (0.58) top surgeries, and 0.44 (0.58) bottom surgeries. Twenty-nine pursued laryngeal surgery only. Among the 43 who underwent multiple GAS, seven pursued laryngeal surgery first, seven pursued laryngeal surgery between other GAS, and 29 pursued laryngeal surgery last (P < 0.0001). Patients who pursued laryngeal surgery first had higher preoperative TWVQ scores (P = 0.018). No significant differences in postoperative or delta TWVQ scores by timing of laryngeal surgery were observed. Forty-six patients status post VT were enrolled as controls, consisting of 40 transfeminine and six transmasculine patients. Significant differences were identified in post-intervention (P = 0.0007) and delta (P = 0.0074) TWVQ scores between surgery and VT cohorts.
Conclusion:
Laryngeal surgery is highly effective in treating vocal incongruence. Most patients pursue laryngeal surgery last. However, timing of laryngeal surgery does not affect voice outcomes. There is a need to increase awareness of voice surgery as an effective option for gender dysphoria, especially considering the many barriers to laryngeal surgery (insurance limitations, scarcity of specialized surgeons, geographic disparities, etc).
Level Of Evidence:
Retrospective cohort study, single institution chart review.
