Edit: Added clears/coughs graphs which starts the day after surgery (surgery on 8/19/20)

What? Why?

So here’s the thing: I have a totally passable feminine voice. It almost never fails to pass, and it was the very first thing that caused a stranger to use the correct pronouns for me. The problem is that it’s effortful. Unlike the effects of HRT, losing weight, or FFS, maintaining my voice felt like a constant low-stakes balancing act.

The idea is to get one of the basic vocal parameters (there’s a bunch) into a nicely fixed effortless place. From there, I can build and play and feel free to use my voice however I please, like a normal person.

There appears to be some controversy about VFS in the trans community. On one side, there are people who say that the risks of surgery outweigh the benefits because a satisfactory voice can be had by voice training alone. Others say that VFS is the only possible way they can get a feminine voice despite their best efforts at training. I don’t feel like any of those opinions describe my feeling: I just wanna exist and not get surprise vocal dysphoria ¯_(ツ)_/¯. For me, this is very clearly a “want” and not a “need.” I could exist without VFS, but why do so when I’ve saved up enough to get this surgery?

The Process

Wow, there’s a lot here to get through. I did a massive amount of research on the procedures available. The thing with trans medicine in the US is that individuals really have to be expert patients, or maybe the better description is “self-advocating patient.” That is, it’s really up to us to put things together and chart a path and then review the plan with a host of health professionals. That’s not an okay state of the world since it requires a ton of privilege to pull off. At multiple times in this process, I put the whole thing down and didn’t think about it for days. I needed this to be a thing that I could abandon, and not regret abandoning. There was a lot that went into this, and doing this on top of everything else in life is a whole lot. However, this is exactly what I did:

First, I did a basic review of what options were available. I looked at patient testimonials, youtube videos, and surgeon’s websites. There’s a bunch, and they’re diverse and hard to compare but that got me building a mental model of this decision.

Second, I focused in on a very few surgical options. I was interested in vocal cord shortening only (that’s VFSRAC [Yeson] and Wendler Glottoplasty & variations.) I read lots of papers on the surgeries, failed to understand them, re-read them, then read other stuff, then re-read them again.

Third, I discussed this over and over with my gender therapist and primary care physician. My PCP is totally awesome and even took part in exchanging papers 🙂 With both of them on board, I started to interview surgeons.

My criteria for interviewing surgeons were low. I wanted to talk to the full spectrum of people providing this surgery. I’m not gonna lie, every time I talked to a new person I was like: “Wow! They were so great. I could definitely go to them for this ♥” And every time, the next surgeon felt like an even better fit… So it was either recency bias or luck of the order… I gonna go with luck ’cause it makes me feel better ;-P

Below are the surgeons I consulted with, in the order that I contacted them:

  1. Yeson Voice Center ($0 consultation, $7,380 total)

This happened completely by email. Jessie was absolutely amazing (you hear this online, and it’s true.)

Pros: A huge online presence, good ties to other trusted surgeons (I had FFS @ FacialTeam), they are high throughput (read: very experienced with all things trans), and specializes only in voice.

Cons: A flight to South Korea meant an extra 2 weeks for self-quarantine (nbd)

2) Dr. Spiegel ($200 consultation [I didn’t do this though], unknown total)

I emailed his office but decided not to proceed with a consultation. The stories online gave me a bad feeling so I decided not to proceed.

3) Dr. Mardirossian ($75 consultation, $9065 total)

I emailed the office and set up a consultation with Dr. Mardirossian.

Pros: I have friends that live near him so I could potentially stay for free, a good reputation with patients online, very personable and an easy consultation

Cons: Florida still had the two-week quarantine so it may as well have been South Korea, Dr. Mardirossian is a plastic surgeon, not a voice specialist

4) Dr. Thomas ($600 in-person consultation, $15,550 total)

I emailed the office and set up an in-office visit after an at-home isolation period. I live in Seattle, so the drive was very reasonable.

Pros: Dr. Thomas is a voice specialist, he is very transparent with his data, he did an excellent job at expectation setting

Cons: Expectation for a completely effortless feminine voice (both pitch and resonance) without voice therapy seemed unreasonable. Did I misunderstand or was this what was being proposed? It didn’t seem to match the results that I heard on his website…

5) Dr. Yung ($ 250 consultation [$600 – $150 SLP – $200 not in person], $7,500 quoted, $10,275 actual)

I emailed the office and asked for a consultation. The consultation was really wonderful. Dr. Yung really wanted to understand my goals and how she could help, which was unique.

Pros: She earned my trust, is a vocal specialist, has integrated voice therapy that already had contact with my voice therapist, she has trans people on staff, and has tons of experience with trans people

Cons: Minimal content on the website, but there’s more on Facebook

At this point, I had spent a total of $925 in consultation fees and ~$200 in academic papers. I could only do this because of where I’m at in life. I decided to stop here and go with Dr. Yung, even though there were plenty more doctors to consult.

Surgery & Recovery

Day -13: Pre-surgical doubt and reaching out to the trans community for guidance. I’m writing this in retrospect, but this was a scary moment. It was the day I had to fork over the mountain of cash and refunds dropped off the cliff. I reached out to my entire support network and a whole lot of strangers. I feel like the trans community really helped me on this day, and I’m very grateful. https://www.reddit.com/r/transvoice/comments/i4pd7d/presurgical_doubt/

Day -2: Today was my pre-op appointment with Dr. Yung and Wendy Vastine. This was kind of a whirlwind day, which is what I’ve come to expect of pre-op days. We talked about the procedure and expectations for recovery. Dr. Yung was very open to my questions, although I didn’t really have very many. This was mostly because there weren’t any red flags and I was pretty confident in my decision. I felt supported and safe with Dr. Yung. After she had me read the rainbow passage and viewed my vocal folds, I had a short voice therapy session with Wendy. We got to know each other, and they walked me through exercises that I’d be working on during recovery (but not immediately) Wendy will be working with my voice therapist back home (Seattle) since there are restrictions about providing therapy across state lines (yay, US healthcare!). It sounds like information sharing between the two therapists is going very smoothly. After the voice therapy, I was off to hospital outpatient admissions for my COVID test. At admissions, I was surprised by an extra $2150 in hospital costs, and $625 in anesthesia. I’m paying for this surgery out of pocket, so insurance isn’t going to be helping with these costs. This brought the total to:

  • Dr. Yung’s package: $7500

  • Hospital: $2150

  • Anesthesia: $625

  • AirBnB (18 days): $2077 <- this only makes sense during COVID, otherwise flights back and forth would have been the way to go

  • Flights: $196

  • Total: $12,548

Day 0: Surgery went perfectly, and I was out of the hospital 2 hours after surgery started. The total surgery time was just over one hour, which was faster than expected. Waking up took a lot of conscious effort. The nurse didn’t know any sign language at all, but he understood when I pointed at him and gave him the devil horns (he rocked) once he gave me my phone lol. I get a bit of phlegm every now and then that turns into a bubble in my airway. I’m doing a huffing type of maneuver to unblock my airway, but it’s disconcerting… Apparently I wanted croissants after the surgery, so I’m on number three now lol ¯_(ツ)_/¯ My tongue is numb as well and I have a headache, so I took 2 ibuprofen. There are forest fires nearby as well, and we had ash blow into the AirBnB last night. Mom ran out to pick up an air purifier.

Night 0: I forgot that I’d be constipated after surgery… I ate too many croissants, and without anywhere to go, they turned into acid reflux in the middle of the night. I woke up twice with involuntary coughs 😬 My bed is now raised, and I have plenty of medication to handle this. I’ll be eating cherries instead of croissants tomorrow though.

Day 1: Phlegm is my biggest nemesis. It seems to build up every few hours to the point where impedes breathing. I think that laying on my side helps, but I didn’t collect any data to see if that’s true. I downloaded an app to start tracking coughs and voiceless clears over time. Gonna get me some data!

Night 1: Sleep is good. I enjoy sleep. The heartburn problems have been conquered, and I only woke up once with a surprise cough. Dr. Yung reassured me that some unexpected coughing is to be expected ¯_(ツ)_/¯ So I’m just trying not to worry about it too much… But I’m starting to get some nice data 😁

Day 2: A totally normal day, except no talking. I worked on and off for about 6 hours today and napped or watched TV for the rest — quarantine life *sigh*.

Night 2: A totally normal night! I had zero unexpected coughs and slept like normal. My throat is really starting to settle down 😌

Day 3: Getting more and more normal every day. Today there was very little reminder that I had surgery (except for phlegm). Literally no pain, which has started a weird mind game — I’m now worried that the surgery didn’t do anything because nothing feels different. I know that’s totally not right, but it’s clear that it’s going to be hard to wait for this reason… I’ll be good, but I did catch myself thinking a curse word and mouthing it at the same time 😬

Night 3: Last night sucked. All screen time and no exercise made it really hard to get to sleep. It was 2 am before I finally fell asleep. I woke up with a gasp as well, and that’s worrisome.

Day 4: Getting into totally normal days and nights here, so I’ll continue this journal when something interesting happens.

Day 13: I GOT TO HEAR MY VOICE TODAY!!!!!! The recordings attached to this Reddit post are from today. In the after video, I had only said two sentences previously since the surgery and they were both just moments before when they told me I could talk and started asking me questions lol. Some stats:

Range went from 110Hz ->350Hz to 160Hz -> 330Hz (this will continue to change). Humming now at 270 Hz is as effortful as humming at 220 Hz was before. Speaking focal average is a perfect 220Hz ♥

r/Transgender_Surgeries - VFS: My Process, Experience, and Results