Start outside: your neck
The Adam's apple is the front of the thyroid cartilage. Behind it sits your larynx: the box of cartilage where your voice is made.
CareInformation checked on 24 October 2026 · next check January 2027
Voice
From speech therapy to voice surgery: the techniques in plain language, coverage conditions and clinics in the Netherlands and abroad.
Not yet reviewed by a healthcare professional. This page was made by volunteers (not doctors), with help from AI and based on the sources below. In doubt? Ask your own gender team or doctor. Something wrong?
Step 1
Start with speech therapy
Feminising hormones do not change your voice. Voice training with a speech therapist experienced with trans voices is therefore the first step: pitch, resonance, intonation and articulation. Speech therapy is covered by basic insurance (deductible applies). Your gender team or GP refers you; the standard mentions a visit to an ENT doctor first.
Interactive
How your voice works, and what surgery changes
Scroll slowly: the drawing follows you, from the outside in. Or tap what you are looking for below. Schematic, not to scale.
The larynx
At the top are the hyoid bone and the epiglottis. In the middle the thyroid cartilage, below it the cricoid cartilage, then your windpipe. Inside, the vocal folds run from the front (behind your Adam's apple) to the back.
The vocal folds, from above
This is how an ENT doctor looks inside with a camera. When you breathe, the vocal folds are open. When you speak, they close and vibrate. How high your voice sounds depends on how long the vibrating part is, how tight it is and how heavy it is. Just like a guitar string.
Wendler glottoplasty
Through the mouth, the surgeon sutures the front parts of the vocal folds together. The vibrating part gets shorter, the voice higher. No scar on your neck. This is now the standard method. Hoarseness for up to about 6 weeks.
Through the mouth · shorter vibrating part
VFS / Yeson method
Also through the mouth (endoscopic): the front part of the vocal folds is shortened and sutured. This is followed by a month of complete voice rest.
The clinic itself reports 135 → 208 Hz after 6 months, not independently verified
Laser reduction (LAVA)
With a laser, the surgeon removes vocal fold mass. Lighter vocal folds vibrate faster. On its own this gives about 10 to 20 Hz; together with Wendler 50 to 100 Hz.
±10–20 Hz · with Wendler 50–100 Hz
Cricothyroid approximation (CTA)
Now from the outside. Through a cut in the neck, the surgeon fixes the thyroid cartilage to the cricoid cartilage. The cartilage tilts and the vocal folds become tighter. Scar of 3 to 5 cm. The effect can fade; the medical literature recommends it less.
Through the neck · tighter
FemLar
Also through the neck, but bigger: the larynx is made narrower, the vocal folds about 40% shorter, part of the false vocal folds is removed and the larynx is moved higher. The aim is also a different sound. Then 2 to 3 weeks of silence. Revisions were common.
Through the neck · smaller and higher
What surgery does not do
Surgery mainly changes pitch. How you sound also comes from the space in your throat and mouth (resonance) and from your speech melody (intonation). You learn that with a speech therapist, before and after. Risks of surgery: hoarseness, less volume, smaller range and voice fatigue. There is no hard evidence which technique is best.
Step 2
Voice surgery: the techniques
| Technique | What happens | Good to know |
|---|---|---|
| Wendler glottoplasty | Through the mouth, the front parts of the vocal folds are stitched together. The vibrating part gets shorter, the voice higher. | No scar; now the standard method. Hoarseness up to ±6 weeks. |
| Cricothyroid approximation (CTA) | Through a neck incision the thyroid cartilage is fixed to the cricoid cartilage, tensing the vocal folds. | 3–5 cm scar. Effect may drop back; literature now recommends it less. |
| Laser reduction (LAVA) | A laser removes vocal fold mass. | Only ±10–20 Hz; 50–100 Hz combined with Wendler. |
| VFS / Yeson method | Endoscopic: the front part of the vocal folds is shortened and sutured. Then a month of complete voice rest. | The clinic reports 135 → 208 Hz after 6 months (not independently verified). |
| FemLar | Through the neck: narrower larynx, folds ±40% shorter, part of the false folds removed, larynx raised. | Also aims at resonance. 2–3 weeks silence. Revisions were common. |
Surgery mainly changes pitch. Resonance and intonation must be learned through speech therapy, before and after. Risks: hoarseness, less volume, smaller range, voice fatigue. There is no hard evidence which technique is best.
Money
Coverage
Covered by basic insurance if you have had at least six months of intensive speech therapy and your speaking voice is still below 160 Hz. Prior authorisation is often needed.
Providers
Where?
Amsterdam UMC (VUmc)
CTA and Wendler. Conditions: six months of therapy, voice below 160 Hz, assessment by ENT and speech therapist, no smoking.
KNO: 020-444 11 40
Meander MC, Amersfoort
ENT department with vocal fold surgery, including glottoplasty and laser treatment (the editor's own experience). Referral via GP.
Polikliniek KNO: 033-850 41 63
Radboudumc / Rijnstate
Pitch-raising surgery for Radboudumc patients is done at Rijnstate (Arnhem).
Mevoc, Hamburg
Medical Voice Center: 60–80 glottoplasties a year, 6–8 weeks wait. Asks for videos of your vocal folds and voice.
+49 40 513 13 007
Yeson Voice Center, Seoul
VFS method. Price indication via third parties $7,500–8,400 (uncertain).
Dr. James Thomas, Portland
FemLar ($15,500) and pitch surgery ($10,000), plus ±$4,000 surgery centre fees.
Voice
Trans men
Testosterone usually lowers the voice from ±4 months, maximum after ±1 year. About 10–20% keep problems; speech therapy then helps. Voice-lowering surgery (type III thyroplasty) is usually not needed.
From experience: voice surgery is not a quick fix. Recovery takes months, hoarseness may remain, and you need speech therapy before and after. Keep your surgical reports and vocal fold images: second-opinion clinics ask for them straight away. Read my story.