When a person speaks, 他们的声音, 他们的手势和说话风格有助于传达他们的性别. 针对变性男性和变性女性, specialized therapy and vocal cord surgery can help them communicate in a way that is more aligned with their gender identities.

耳鼻喉外科医生Lee Akst, M.D., and Simon Best, M.D.语音语言病理学家阿什利·戴维斯(Ashley Davis)博士.S., 耳鼻喉头颈外科助理, 回顾性别确认护理的这一重要方面. 

什么是跨性别声音治疗和声音手术?

Gender-affirming voice treatment is designed to help transgender people who feel 他们的声音s or their ways of speaking do not align with their gender identity.

For some people, 他们的声音 can aggravate gender dysphoria: the feeling of distress caused by physical traits not matching a person’s gender identity. 性别歧视的声音或说话方式可能会使他们面临心理健康问题的风险, 歧视甚至暴力.

跨性别和性别多样化人群的语音治疗

让一个人的声音与他们的性别认同保持一致，首先要从声音疗法开始. 治疗可以包括非手术干预，如锻炼, feedback, recording and practice, 要么找治疗师，要么自己看视频.

治疗可以解决声音和说话风格方面的问题，例如:

• Voice pitch这个人的声音有多高或多低，以及他们说话时声音的变化
• Resonance: how space in the nose, mouth and throat affect the sound of the voice and impart traits often perceived by the listener as masculine or feminine
• Intonation说话时发出的响亮或柔和的声音
• Air flow and breathing这可能会影响一个人声音中的“呼吸”
• Articulation这个人发出不同声音和单词的清晰程度
• Nonverbal cues 比如头和手的手势和习惯

变性人声音护理候选人

“语音疗法几乎适用于任何人, 无论个人的年龄或他们在旅途中的位置,” Davis says. “Voice therapy is a way to explore identity that can be as fluid as the individual as they discover their voice. Unlike surgery, 治疗的改进提供了多种选择, 所以这是一个安全的开始或返回的地方.”

她指出，声音治疗可能具有挑战性, 因为一个人的进步并不总是线性的. “There will be moments where somebody achieves the voice they desire and then struggles to replicate it later, 但有了指导，势头有望一直推荐十大正规网赌平台发展.

“While therapy or surgery cannot automatically ‘fix’ extreme vocal dysphoria [discomfort with one’s voice], having a supportive multidisciplinary team can make the person feel less vulnerable through the process.”

Davis notes that surgery may be an option for people who have been working on their voice and have good intonation, 但是他们可能会注意到他们喜欢的声音偶尔会“下降”,比如当他们在笑的时候, 激动地叫喊或反应. 

First Steps

The initial evaluation of the patient may include a medical history and examination of the vocal cords by the speech language pathologist and the laryngologist. The team can help the patient understand the relationship between the voice box anatomy and what the voice sounds like.

“一个人的音高是由解剖学和功能共同决定的,” explains Best, a laryngeal surgeon. “说话是一个复杂的神经肌肉过程，类似于吞咽. 喉头和声带是由神经和肌肉控制的. 声带越粗越长，音调越低.”

Stroboscopy

医生可能会建议进行频闪镜检查, 哪一种是声带的医学检查. It is a simple test, 在医生的办公室进行，检查声带的解剖结构和功能.

Here is what happens:

• 医生向推荐十大正规网赌平台的鼻子和喉咙喷了一种麻醉药.
• 推荐十大正规网赌平台身体前倾，用纱布捂住舌头.
• 医生将内窥镜(一根狭窄的管子)插入口腔. The endoscope is equipped with a camera and a flashing (strobing) light that helps the practitioner see the vibration of the vocal cords in slow motion.
• The patient follows prompts to make certain vocal sounds so the doctor can see how the vocal cords function.

Determining Goals

下一步是确定患者希望从治疗中获得什么. A candid conversation helps the team get a sense of the person’s ideal voice and its characteristics.

说到音高，165赫兹是性别差异的近似分界线. Voices below this level are most often heard as male; above this level, female. 但这些指标并不适用于所有人，戴维斯和她的团队提供了一系列更灵活的选择.

“一个人可能不想听起来典型的男性化或女性化，”她说. “有更多中性的、非二元的选择. In addition to pitch, other voice qualities, such as lightness, crispness, dialect, 共振和旋律被考虑.”

治疗计划还涉及患者的整体声音健康. “如果推荐十大正规网赌平台花了数年时间来调节声音, it can become strained, weak or raspy,” Davis observes.

确认性别的嗓音手术

Some patients opt for voice surgery ― surgery on the vocal cords ― to help create a voice that is aligned with their gender identity. 贝斯特说，近50%来诊所的推荐十大正规网赌平台选择了外科手术.

这些手术大多是内窥镜手术. Surgeons insert a tube (endoscope) into the patient’s mouth to gain access to the larynx (voice box). 他们使用不同的技术使声带变薄, 收紧或缩短以提高声音的音高. 手术的主要副作用是喉咙、舌头或下巴疼痛.

Other procedures, such as voice deepening, 可能需要一个切口(在颈部皮肤上切开)来进入喉部.

谁能从性别确认嗓音手术中受益?

为希望以女性化声音呈现的跨性别人士而设, procedures can shorten the vocal cords or make them thinner to raise the pitch of the voice so the person does not have to strain to speak at a higher register. 抗雄激素和雌激素治疗不会影响声音, 因此，为了让声音听起来更女性化，手术可能是必要的.

“Since transgender people who wish to present with a masculine voice are likely to achieve voice modification with hormone treatment, 大多数手术患者都希望自己的声音更女性化,” says Akst, a laryngeal surgeon. However, 如果患者在激素治疗后想要声音更低, there are options including therapy and a procedure to loosen the vocal cords to achieve a lower pitch.

声音手术的结果是永久性的. A prospective patient deciding to undergo a procedure can speak with other patients who have undergone the operation. “Connecting with people who have gone through the surgery can help prospective surgery patients understand what to expect,” Davis says. 

嗓音女性化手术

To create a higher, more feminine voice, 手术可以使声带变紧或变薄. “想想吉他弦，”阿克斯特说. 细一点的弦，或者绕得紧一点的弦，振动的音调就会高一些.”

嗓音女性化的温德勒声门成形术

Most patients choose glottoplasty to raise the pitch of the voice so it feels more natural and causes less strain. 这是一种微创内窥镜技术. 内窥镜意味着它是通过一个内视镜来完成的，内视镜是一个插在嘴里的发光的管子.

• 声门成形术在手术室中进行，推荐十大正规网赌平台需要全身麻醉.
• 整个过程大约需要一个半小时.
• 外科医生使用小型器械, 引导通过内窥镜, 到达喉部，在声带前部形成疤痕组织.
• As the scar contracts over time, the vocal cords shorten, resulting in a higher pitch for the voice.
• 患者通常在麻醉恢复后的当天就可以回家.

LAVA for Vocal Cords

A procedure called laser-assisted voice adjustment (LAVA) may be used as a first procedure or a follow-up to a Wendler glottoplasty to further raise the pitch of the voice. 它也可以和声门成形术同时进行.

推荐十大正规网赌平台在麻醉下睡着了, 外科医生用内窥镜从口腔进入喉部, then applies laser beams to the front of the vocal cords to reduce their mass (make them thinner).

环甲近似法(CTA)

is another voice feminization approach to tightening the vocal cords that is no longer commonly used. 在软骨上进行缝合以缩短顶部和底部之间的距离, 缩短声带. 这个手术可以扭曲喉部，让变性女性的喉结更加突出, calling for a 气管剃须或其他面部女性化手术.

Voice-Masculinizing手术

Most transgender people who wish to present with a masculine voice find the hormone therapy that is part of their treatment sufficiently lowers their voices to an acceptable level. But for those patients who desire a deeper voice, a procedure called thyroplasty type III can help. 这是一种罕见的手术，由相对较少的喉外科医生进行, according to Best.

He explains the procedure starts with an incision in the front of the neck in a natural crease where a scar will not be obvious. The surgeon then relaxes the muscle that contracts the vocal cords so it can't raise the pitch of the voice. Changing the position of the voice box cartilage relaxes and shortens the cords and makes them vibrate at a lower frequency. 接受这种手术的患者会注意到他们的声音范围的上限缩小了. 

After Surgery

愈合需要几个星期, and for the first week, the surgeons advise voice rest — using the voice as little as possible while the inflammation goes down. “在第一周让你的声音得到休息是很重要的，”阿克斯特说，“所以不要大喊大叫或耳语.”

• 大多数患者在手术后约三周与外科医生进行随访.
• 如果患者恢复良好，语音治疗可以继续进行.
• 最后一次随访是在6个月时，以评估最终结果.

声音手术的副作用和并发症

手术后，患者可能会出现一些副作用:

• 喉咙痛(用对乙酰氨基酚缓解)
• 在手术过程中由于张嘴而引起的舌头或下颚疼痛
• 在该区域的炎症完全愈合之前，暂时性的声音粗糙

声带手术的性别肯定是安全的，并发症是罕见的. 但是，据报道有一些，包括:

• 麻醉带来的问题
• 声带太紧，导致音高高于预期
• 牙齿因插入内窥镜而破裂或破损的牙齿
• 舌头麻木，可能是暂时的或持续的 

术后护理与治疗

手术会改变推荐十大正规网赌平台声带的结构, 但戴维斯表示，这仅仅是个开始. 该小组建议在手术后进行治疗.

“推荐十大正规网赌平台在手术后立即听到的声音并不是最终的结果,” she says, 注意到可能会有暂时的虚弱或刺耳.

It takes time for patients’ voices to become natural and effortless; practice pays off. “肌肉记忆是恢复的重要组成部分，”戴维斯说，并补充说，心理方面也是如此. “The new voice, over time, 与内心的声音相匹配——一个人在心理上对自己说话的方式.” 

歌手，播音员，演员和声乐艺术家

戴维斯指出，那些把自己的声音作为职业的一部分的推荐十大正规网赌平台, 比如声乐艺术家或画外音专业人士, 你应该明白康复是没有捷径的.

“他们有了一种新乐器，需要了解如何演奏. 一个人可能需要调整气流，学会“打气”，这样声音就足够大了,” she says. “但我们治疗过的几位艺术家已经能够将他们的音乐水平提升到一个新的水平, 用更可靠的音调.” 

畅所欲言:提高生活质量

贝斯特说，声音手术对推荐十大正规网赌平台有积极的影响. He explains, “我们的声音决定了我们如何在世界上展示自己，以及别人如何看待我们. It’s a set of treatment options that may be overlooked in gender affirmation but that can be very beneficial.”

虽然手术后推荐十大正规网赌平台需要一段时间来适应他们的新声音, 戴维斯说，推荐十大正规网赌平台报告说他们感到更快乐、更放松. Transgender and gender-diverse people who have held back speaking up may feel freer to express themselves. “当焦虑缓解的时候, the person’s comfort and willingness to extend themselves and gets reinforced with positive feedback,” she says.

“人们意识到他们有多少话要说.”