Surgical Interventions for Voice Masculinization: A Scoping Review.

[BACKGROUND] Transmasculine patients generally benefit from medical treatment using hormonal therapy for their transition process. However, up to 20% of transgender men report dissatisfaction with their voice pitch after hormonal therapy. Voice therapy is usually the next appropriate step. Surgical and procedural interventions are a last resort when the pitch remains too elevated for transmasculine patients; however, their effectiveness for voice masculinization is not well characterized.

[OBJECTIVES] To review surgical and procedural options for voice masculinization in the literature.

[METHODS] Two independent reviewers completed a scoping review of literature studying surgical and procedural interventions for voice masculinization. Because of the limited studies available, databases were also searched for surgical and procedural outcomes for puberphonia. Initial fundamental frequency, initial nonprocedural treatment, clinical symptoms, intervention, outcomes, and complications were gathered from included studies.

[RESULTS] The search for surgical and procedural interventions for voice masculinization yielded 34 articles, and 4 articles were included in the study. Regarding puberphonia, 21 articles were screened, and 8 articles were included in the study. Surgical and procedural treatments for voice masculinization included type III laryngoplasty (3 articles) and direct vocal fold injection with testosterone (1 article). For the 12 transmasculine patients, voice deepening ranged from -3 to -67 Hz with an average of -43.75 Hz. Additional treatments described for puberphonia included modifications in the type III laryngoplasty, injection laryngoplasty, and Botox injection. Voice deepening for the 44 puberphonia patients ranged from -12.25 to -175 Hz with an average of -68.61 Hz. Only 6 of the 56 puberphonia patients had complications, all of which were transient.

[CONCLUSION] Conservative measures often succeed in achieving voice masculinization. Our review describes the best results in voice deepening with type III laryngoplasty. Although less effective at voice deepening, less invasive methods like injection laryngoplasty with testosterone or hyaluronic acid also appear promising.