Changing my voice was something I started working on within hours of learning transition was possible and more importantly, that changing my voice was possible. This was before I started HRT and even before I was 100% sure I was transgender.

If I had to rank my dysphoria, my voice might be at the top. I spent untold amounts of time training my voice and I am very happy with what I was able to do. After changing my voice I have been misgendered on the phone one time (early morning call). I have played video games with voice chat and had men stick up for me when some boy inevitably hits on me. It is not a forced voice, but a natural voice that I spoke and used 24/7. I used this voice so much that I was unable to duplicate a male sounding rainbow passage I recorded near the start of my training. It isn't an overly feminine voice, but it is a woman's voice. There are definitely others who are able to train their voice better than I did and I knew of areas I could work on, but all around I was very happy with my voice.

But around once a day or so I would drop my pitch and I die a little inside. No one but me noticed. I have tried and tried, but I wasn't able to keep my pitch up consistently especially first thing in the morning. For me this is a big deal and daily dysphoria invoking moments that are heartbreaking. Getting VFS is 100% to deal with my own dysphoria, not for anyone else. I know I have a passing voice and there is a chance this could permanently harm my voice, but eliminating this dysphoria was worth the risk.

What I wanted

A feminine voice, but at a technical level, I was looking to get a Wendler Glottoplasty to get a reduction of mass and a shortening of my vocal folds. This seems to have the least risk. Even if I still had to use a trained voice when not "on point" it would be closer to androgynous rather than male.

I was also interested in a thyrohyoid elevation, but I can hold my larynx high pretty continuously so this would only a bonus if I could get it and some, not all surgeons do this.

Picking where to go

I put together a list, did some consultations. Rather than duplicating that, this other VFS post has a very good overview of current VFS surgeon's: VFS: My Process, Experience, and Results

In the end, I went with Dr. Spiegel outside Boston, MA. Similar to Yeson, but more expensive, isn't high touch, has no marketing, the pre-op/post-op paperwork isn't so great, nothing in the way of voice lessons.

Dr. Spiegel does a modified Wendler Glottoplasty. He has been doing this surgery for many years (decades?). Starting around the beginning of 2020 he switched from laser back to using a micro scalpel and has done about a dozen of these since before mine. He used to do it this way before but has found that the laser wasn't working as consistently as he wanted. This is stitched with two resorbable sutures at ~35% in, not permanent ones (he sees no need). He also rarely does Botox and said by listening to my voice (my trained feminine that I didn't need it (he didn't look to confirm). The sutures stay in a variable amount of time depending on the person, but by 3 months it is expected they would have dissolved and be gone.

The fact that he no longer does laser is probably the most significant piece of information given that I have read some bad scaring results from the use of laser.

After COVID-19 Dr. Spiegel no longer does the surgery at a Boston hospital, but has new equipment and does them in the Newton surgery center located above his office.

After my surgery I found a single post of someone else who went had VFS with Dr. Spiegel and the results from the laser scaring turning out really bad.

He told me after surgery that in the past he has performed thyrohyoid elevation's and could have done it also, but never mentioned it in the conversations we had before surgery and it isn't on his website.

Suture at 1/3 in

Dr. Spiegel told me at the post-op that he uses the size of the tool to figure out where 35% is. Like my vocal cords are X tool long so 35% is about "here".

Asking Yeson I got back the following: According to Dr. Kim at Yeson "we're using the microscopic scissor with a ruler on the side to measure the surgical portion."

Dr. Yung said the following: “I don’t necessarily aim for 35%. There is no definitive measurement tool that surgeons use to determine how much to shorten the vocal folds and there is no way to predict how much the pitch will elevate based on how short you make the vocal folds. I base my decision on where to place the sutures on each patient’s individual attributes, like baseline pitch, larynx size, vocal fold mass. On average, the vocal fold length is shortened about 1/3 and this length is measured using landmarks such as the anterior commissure of the vocal folds, the location of the vocal process, and the posterior aspect of the vocal folds.”

Reasoning

I didn't want to fly because of COVID-19 and so if I wanted VFS I could either drive to Dr. Spiegel's office or wait years to go somewhere else. I had a consultation about VFS and I was told there was an opening in the schedule if I wanted it, so I took it.

In retrospect choosing to go somewhere based upon circumstances and not technical results is stupid. All I can say is dysphoria sucks and the opportunity to maybe suddenly have this feeling go away is really powerful. I now personally understand what goes on in someone's head and why someone might have SRS with say Kathy Rumer even with all of the results that people keep posting. It can be very tempting to keep taking the next step after having a consultation.

When choosing where to go, you want to be able to evaluate them against each other on factors related to the results, not life circumstances. When in doubt, you can always delay the choice. They will always be there and happy to take your money.

No matter how my results turned a lot of the reasoning for choosing to go to Dr. Spiegel was an error on my part.

pre-op

The day before at my pre-op was, without doubt, the worst random experience of my transition. A person I never met before (even though I had been working with someone else) told me "this is their favorite part" and handed me a passage to read in my best male voice while recording me. I know the instant they hear my male voice their brain will gender me male and their comment really hurt. To make this an even more "special moment" this was right after signing paperwork saying that this surgery won't make me "pass". Never have I felt so othered.

The pre-op/post-op paperwork were copies of his FFS post-op paperwork with modification and some errors. There was no mention of avoiding dairy, spicy foods, etc. It did say to eat soft foods but included yogurt (dairy) in the shortlist of examples. No advice about how to start using your voice again. No documentation to give future anesthesiologist about my vocal cords for my medical files. Asking about this they prefer to answer questions when you have them rather than giving you a bunch of information which may or may not apply to you.

I was given a prescription for antibiotics, but nothing else. Nothing to prevent coughing or anything else. When asking about cough drops etc Dr. Spiegel shrugged and said I could if they would work for me. My recovery was entirely on me.

He never scoped my throat to look at my vocal cords before surgery . His reasoning was that he could hear my voice, it sounded fine, and looking wouldn't change anything he would do. He never even asked to listen to my natural voice, but only ever heard my trained feminine voice.

My overall impression is that he is not there to judge my voice or help me improve my voice, he is there to literally be a surgeon that can perform a very specific operation. It is not for him to give you advice, you already need to know that. The same goes for recovery, further vocal lessons, etc, that is not what he does. If you have any existing issues with your vocal cords he is not for you. If you need voice lessons or can't explain what he is doing, why, how the recovery works, and what you need to do he is not the person to go to.

I am guessing his ideal scenario would be if you already had a relationship with a vocal coach, already done training, they have seen your vocal cords, and will continue working with you after the surgery and they recommend you go to him for the surgery.

No one asked if I am working with a vocal coach.

LipLift

Since I was going under and wouldn't be talking something I had thought about doing at my FFS, but didn't was a lip lift. I wanted to do this because my upper lip is more masculine, the distance from my upper lip to the nose is long and my upper lip is very thin.

I scheduled to do this, but my consultation for it was at the pre-op. I had been doing a lot of research and was unsure if this would even look good on me at this point. I was showing a tiny bit of upper teeth when my mouth was open and didn't want him taking a large amount of skin which would look horrible if it showed all of my front teeth. Asking for his option as a surgeon who has does a lot of these he shrugged and said it was up to me and he could take a minimal amount that would still look good. Using some q-tops to move some skin around he showed me something that looked okay. Asking how much skin he would reduce he pondered and said 5mm. He didn't get out a ruler to measure the distance. Ultimately he left me guessing if I should do this or cancel.

The post-op documentation for lip lift had zero mention of scaring and how to reduce it. The assistant I was working with told me that he has a technique that has no scaring. I knew this to be a lie (and it was a lie), but didn't bother asking to get this "in writing". Further, the post-op documentation said to apply something that contains Vitamin E which can cause scaring to end up worse.

pre-op recordings

I did a number of recordings in the days leading up to the surgery. This was very dysphoric, but I am glad I did because I knew I would never be able to do these again.

• The rainbow passage in the best version of my default neutral voice (aka male)
• The rainbow passage in my daily voice
• The rainbow passage in the best female voice I could do.
• Neutral pitch 'ah' for 10 seconds
• Daily (higher) pitch 'ah' for 10 seconds

Some other random recordings I did:

• Talking about my life for five minutes so I would have what I sound like when I am not reading something.
• I played with my voice completely showing off the crazy ability I had learned how to do, from how masculine to how feminine I could go and alternating between the two while talking. This last one I sort of wish I had actually done this in person with someone equally skilled because it was absolutely silly and awesome.
• When my daughter is an adult if she wants to hear what I sounded like before I transitioned. My old voice is in the background of her baby videos so this is a recording for her using that voice.

Not talking for ... 3 weeks?

Dr. Spiegel specifies that you not talk for three weeks. Discussing it further with him he said he has experimented with other durations, but that seemed to work the best (or at least wasn't causing major issues after that point). This is probably why his website (at the time of this writing) contradicts and says he requires only two weeks.

Some other examples:

Yeson has no talking the first week and then maybe a word or two until the first month.

Dr. Yung has the following:

• Weeks One-Two: Complete voice rest-no talking, whispering, or mouthing
• Week Three: 5-10 minutes of speaking per hour
• Week Four: 15 minutes of speaking per hour
• Week Five: 30 minutes of speaking per hour
• Week Six: Follow up at week 6 will adjust the schedule for the next 6 weeks

Rather than thinking about different durations different surgeons have, think about it in terms of how long it takes for scars to form and their strength during that time.

• At the end of the first week anywhere from 3-10% strength
• After a month a scar strength increases to about 30–50% of normal skin
• After several months it is up to 80%

So just because you can talk you don't want to yell, sing or talk a ton until a few months after surgery. Even if your surgeon says you can talk after a few weeks, you want to do it as little as possible. People have had their surgery fail at six weeks for example.

While it is called "no talking", it really is "No using your vocal cords". You can't mouth words, whisper, no watching or reading anything funny that could cause you to laugh, and no watching sad movies that could make you cry.

Ultimately luck is also involved. You could get unlucky and the stitch breaks or the vocal folds open and you have to have a second surgery. But you do the best you can to prevent that.

Going off HRT for surgery

Dr. Spiegel requires everyone to go off all HRT (explicitly including Spiro) for any of his surgeries. Rather than argue about how I was taking a bioidentical E2 via injection I decided to turn it into an experiment and document what I would go through going off HRT for surgery .

tl;dr I was miserable at the end, but if I had shortened the time from the last dose to the first dose post-surgery I would have been much more okay.

Surgery Day

I was dropped off at 6:30 am for my 7:30 surgery and picked up a few hours later. Dr. Spiegel stopped by after surgery to tell me everything went well and that he had not chipped any of my teeth. They use a mouth guard, but with a big metal thing in your mouth, it is a possible risk. Later looking in the mirror I did find two tiny cosmetic chips on my right front tooth which my dentist can fix.

I already had nausea from lack of HRT, but the anesthesia really gave me brain fog.

At home, I had ice chips and small ice cubes for the first few hours so there was always a little bit of water running down my throat. Then Italian ice pops or sherbet which is wet, cool, slushy, and able to clear my throat of any phlegm. I stuck to this diet on the first day.

Across the day I kept ice on my throat (20 minutes on/off) to help reduce any swelling.

By the end of the first day, my throat was a lot less sore and the major discomfort rapidly went away, leaving me only with a dull ache. My tongue felt pinched and was very numb which took a month to go away.

The first time you need to cough is scary and took me around 10 minutes to work through, trying different things, sip water, anything slushy, juice, look up, look straight ahead etc. To prevent a cough the best solution I found was holding my head between my legs and letting gravity help.

When moving from lying down to sitting up nearly every time I had to cough and always had water nearby.

First week

Even if VFS is a short surgery, Anesthesia takes a week to get out of your system and the first two or three days you will be not the most alert person in the world. By the end of the week I felt much more back to my old self.

Food

My diet the first week was simple and anything to not irritate my throat. Eggs, sherbet, mashed potatoes, warm (not hot) soup, apple sauce, jello, fish, etc. Water, honey water and pineapple juice (which could help suppress inflammation) were mostly what I drank.

The first three months I avoided or kept to a minimum anything that would dry out my or irritate my vocal cords. Anything that had dairy in it would cause phlegm to build up and cause me to want to cough. The few times I had anything dairy I immediately followed it up with some sherbet or honey water to try to clear my throat. Beyond dairy, no chocolate, no caffeine, nothing spicy, no alcohol, no candy. Bonus; Between the surgery and the diet change I lost 6lbs across the first two weeks.

Not talking

In theory

Learn how to say in sign language a number of core words: thank you, repeat, happy, okay, more, all done, yes, no.

Practice not talking for 24 hours before surgery to see where you mess up. For me when I first wake up I have a hard time remembering to not talk. Also hitting your toe or similar times where you swear "instinctively" you want to practice doing something else instead.

When whoever you live with talks to you the first few days immediately hold out your hand to signal thumbs up or thumbs down. Then you are not tempted to answer with words. They will also quickly learn to ask you one yes/no question one at a time.

We had a few clipboards with paper around the house that was handy to write on. On my phone, there are apps to display words in big letters and an easy way to have the system speak any words you highlight.

In practice

When others were talking it sometimes felt like I wasn't there because I couldn't really join in conversations. This took time to get used to.

Recovering from surgery, moving slowly, and not talking I would walk up behind my spouse and startle her. I wore some Christmas earrings with bells a few times but switched to a neckless with a bell so I would stop surprising her.

By the end of the first week we had figured out a handful of ways to communicate without talking and it wasn't so bad.

Your throat rapidly feels pretty normal after a few days and you start to worry that the surgery didn't do anything and on more than a few occasions it was super tempting to say something, anything because it felt fine.

Waking up was always very disorientating. I think I was always talking in my dreams, but sometimes I thought I might have said a word or two when I first woke up before remembering that I can't talk.

Across the three weeks, I spoke eight words. Each time was very unconscious, but they were all said very softly. Pinching a finger one time, talking to my cat, etc. Each time it happens you are both horrified that you spoke and at the same time trying to remember what it sounded like, but it happens so quickly can't really tell. Meanwhile you are worried that maybe you re-opened your vocal cords. You can't check, all you can do is keep quiet.

While I was able to stop the majority of times, I sneezed once and coughed twice, but both times were well past the first week, and both times I tried my best to make them as minimal as possible by keeping my mouth open and not letting any pressure build. Various tricks really helped prevent sneezing.

By far the worst was over the three weeks a few times I wanted to cry and I had to sit there and be sad, but not let myself get to the point of getting the release of a good cry. About a week and a half in the LipLift looked like it was going to turn out really bad. I couldn't talk and refused to write down anything. Stuck alone in my head I had to work through it without the help of crying using every trick I have learned from my dealing with hard things from my transition.

Around two weeks I noticed I stopped talking in my dreams too.

The anticipation of getting to talk is a lot and someone else put it best:

I'm caught between the opposing forces of uncertainty and building excitement for my voice

I am not going to sugar coat it, not talking for weeks straight is hard emotionally/mentally. In the past when traveling alone I still would talk to people such as a Lyft driver, hotel checking in, or at least sing to myself or talk back to the tv or stuff like that. You can't do any of that with this surgery and it gets to you.

After you are allowed to talk

I talked a bunch the first day but rapidly went back to not talking much. You get sore quickly. Remember just because you are allowed to talk doesn't mean the scar is at full strength. I still used hand signals and my phone whenever possible as well as being super careful around sneezes and coughs for the first two months.

Three weeks: Talking!

To start I said a few words to see how it would come out and found if I talked with zero effort I couldn't do anything, no pitch at all, no vibration. It was a weird whisper. It took me a few minutes of trying things before gently going through the scales I was able to figure out how to talk again. It was the weirdest sensation that is impossible to describe.

My voice sounded croaky, raspy, and very very hoarse. After a minute or two of playing around, I could sort of consistently talk and I recorded a rainbow passage. After having 3 weeks to debate what to say I thought this should be the first thing so I could compare it to my previous recordings. On playback, it sounds so bad. I seemed to have very little control, my voice was cutting in and out and the pitch was all over the place.

Being so sore I only made a few recordings the first day and otherwise kept quiet. In every one, the average pitch Vocular was say was ~130hz. I was completely panicking. At least I finally got to cry.

On "learning how to talk again"

Looking back I don't know if this was me having to re-learn how to use my vocal cords or if there was phlegm or something on my vocal or if it was from the lack of use. The first few days I definitely have had the experience where if I tried to talk "the old way" nothing would come out and switching to "the new way" then I could talk. I feel like this can't be right, but it is my best description of what I felt was happening. Even a week later I still had to switch "modes" once or twice, but it is rapidly decreasing as I now know "how to talk". Talking with someone a bit more knowledgeable in this they say that this was atrophy from lack of use and not re-learning how to talk.

Next day

After sleeping I realized saying the rainbow passage was not the right thing to do. I have so little control right now and it varies so much across the passage it is near impossible to compare yet.

The correct thing to do is the neutral 'ah'. Comparing that is obviously way easier and the first recording was a pretty consistent ~160. More importantly, when I try to do 'ah' at a pitch higher such as above 190hz I could see I had absolute fry all across the spectrum which explains why when using Vocular it was saying I could still hit 112hz and my average was low. Using WASP I can see that my initial recordings where I talk was actually around 150hz and not 130hz.

A huge thank you to a close friend who let me watch him play Heave Ho where he constantly dies in silly ways and I got to laugh for the first time in 3 weeks. After the previous few days, I needed to smile.

My voice definitely has a very whispery, airy, type quality to it right now. Something like a bad cold or laryngitis.

Post-op

The post-op appointment was at 27 days.

I got the impression that Dr. Spiegel wouldn't look at my throat so I explicitly asked to have him do that. It was with a little handheld tool so I don't have a video or photo. Looking he said everything had healed well, but it was very inflamed and has swelling still. He said that would probably go away by 6-8 weeks and he has seen anywhere from 6 weeks to 6 months for that to fully go away depending on how the body responds. Further, as the inflammation and swelling go down a minor pitch improvement is often had, but really it will be the overall quality as the hoarseness goes away. Similar to when one has a cold and your pitch and quality changed. I should expect a similar outcome and duration.

Asking about what to tell any future anesthesiologist he said to simply tell them I had vocal surgery and they will pick the right tube, but when pressed said 6.5mm is probably what they would use. Elsewhere I have seen to tell your anesthesiologist to use a 5.5 mm intubation tube so this seemed in line with that. Asking if this is something they should include in the post-op documents for everyone to include in their medical files he didn't think so.

The office staff didn't do a recording of my new voice to compare against the pre-surgery voice. I got the impression they forgot.

1st week I can talk (aka 1 month)

Across the first week, my voice cleared up a massive amount.

Trying to test an unmodified pitch, it would vary between 160hz and 190hz, but usually seemed to land right around 160hz-170hz. Talking was a lot more inconsistent and seems to be between 140-160hz the first few days but seems to have ended up around ~170 by the end of the week.

My voice mostly sounds hoarse now. As long as this clears up over the next few months I'll be able to deal with this result.

1-3 months misc

It was weird having a hoarse voice that wasn't also 100hz. In the past when I have had a cold I knew it would be really low and I would talk as little as possible and give it time to heal. It took some time to re-adjust that having a hoarse voice doesn't instantly mean it sounds like an old man.

The first month of talking I had maybe 1 longer conversation a day in me, after which it is too sore to use and the rest of the time I needed to keep as silent as possible.

Once I could talk, my voice is best at midday, first thing in the morning, and in the evening I am definitely more hoarse.

My laughing, coughing and sneezing all sound different. The first time laughing caught me off guard. Laughing was never something I really feminized much so that was a big change. Something I have not heard mentioned elsewhere, but any unconscious noise I make during sex also changed and it is so validating.

One day my mom came over and we hung out in the backyard chatting (covid social distancing). My spouse overheard us talking from in the house and told me later that for a moment she had to figure out who was who.

By six weeks I was really missed being able to talk without it getting sore. I also miss being able to do things like yelling, but above all, I miss being able to talk with a clear voice that doesn't sound like someone with a cold most of the time. At three months I still felt this way but to a lesser extent. The recovery really does take a year.

My voice was much softer in the first three months. I don't know how much this is permanent and how much it was from recovery. I was frequently asked to repeat myself early on especially wearing a mask.

Starting at around six weeks I began doing some short and basic vocal warm ups each day and at 2 months I started doing basic daily vocal exercises.

Emotional Roller Coaster

Post-op Depression

Going off HRT, the week prior to surgery was miserable. The first week after surgery I was not all there from the anesthesia, 2nd and 3rd week you are stuck in your head worrying about everything. 4th week I had 6 hours of electrolysis and now had that to recover from that while also trying to gauge how my voice turned out and realizing that you really have another month of talking very little. And even if your vocal cords are "at their final distance" like with other surgeries I had to accepted that I don't know how it will turn out until swelling and inflammation goes away. Combine with the results from my lip lift I was having a hard time. To say every week for six weeks straight I was miserable would be an accurate statement. I was much happier before surgery and I missed being that happy.

Given how little information is included with the pre and post paperwork I really had to go on what I could find online. Some minor little thing that I either didn't ask or didn't write down the answer to would cause me to spin for hours. Even when I emailed and asked a few questions I was told to wait until the post-op appointment to get them answered. This can be emotionally draining when you are wondering if something is okay (usually it super common and fine) and including common questions and answers would have been really helpful both from getting answers, but also feeling like yes this is what everyone goes through and you will be okay.

I absolutely had post-op depression from this surgery. For such a quick and minor surgery compared to FFS I ended up being more suicidal than I had been when dealing with my FFS post-op depression. I should have dealt with it better, but it wasn't until around 6 weeks that I gave myself a routine, made sure to eat well, move and exercise every single day even if I absolutely didn't want to.

Initially Upset

By six weeks it was clear that while it is changed, it is firmly an androgynous pitch. Honestly, it was only slightly higher in pitch than I would do every day pre-vfs and certainly not the 220hz female average and less than even the average of 74hz that Yeson says they get. Mad, depressed, denial, bargaining. All of those fun feelings were what I felt initially.

At a month a good friend gave me the honest truth: "That is a good base to start from, in a year when it heals combined with what you already can do with your voice you will be happy".

Accepting

I went into this knowing that the primary change is that my pitch is shifted. But leading up to it you start imagining that I could stop using all my other voice skills, but of course, that is silly. I won't lie, part of me really wanted to be done having to think about my voice. Just because my default pitch is higher and I have less vocal mass doesn't mean that I wouldn't use all of the skills that I used before the surgery. There is a reason why every surgeon says you have to have vocal lessons. With only a raised pitch you can still sound male, just with a higher pitch. You can't even apply much of your training until the hoarse voice decreases.

When you watch VFS videos where they show the pre-hz and post-hz on the screen you will be surprised to find out what happens when you turn on your pitch tool and you go from listening to them reading the rainbow passage to talking about their experience. While the video might say 220hz, my pitch analyzer can easily see that it is more like 180hz on average. Further Dr. Thomas's presentation shows an outcome average of around 175hz and Dr. Haben also says an average result of 50 hertz of pitch elevation.

Beyond pitch when watching Some example YouTube Videos the real difference is that someone with very little training can sound better compared to their old voice, but someone with training at the same pitch is night and day better.

Even if I would have preferred 200hz+ for my natural pitch, at least I can say that given my age and height having a pitch on the androgynous side of feminine does not stand out, at all. In fact it is a higher pitch than some other women I regularly interact with.

Results

Emotionally

My everyday voice isn't my unmodified voice. But unlike before I don't have to put in the same amount of effort. My everyday voice feels much more natural. And for the reason I decided to risk having VFS, I no longer worry about having my pitch drop down to a male average pitch and that makes me happy.

My laugh is totally different and I while I love it, it still surprises me at three months. Sometimes I laugh and then laugh at my laugh.

Something I wasn't expecting was that I was sad I lost my "party trick". I have taught countless other people the basics of how to feminize your voice including many doctors. Even when I would feel bad after showing someone I still kept doing it because I was so proud of the skill I had mastered. My voice is now just my voice and even if before I wanted to stop showing it off it is a bit sad I never again can.

Technically

pre-surgery

• My natural unaltered pitch was ~120 (middle of the male range) with a range of around 100hz-390hz
• My trained unconscious speaking voice pitch was ~160 (~145-180) (androgynous)
• I could easily hold a conversation or two at 180-220, but not all day long. (low end of the female range)

post-surgery natural unaltered pitch (range is without going into falsetto)

• 3 weeks - ~150hz talking, 160hz 'ah', whispery, quiet, hoarse, cracking, cutting in and out
• 4 weeks - ~170hz talking, 170hz 'ah', Range 130-320, hoarse, very short conversations at most
• 5 weeks - ~175hz talking, 180hz 'ah', Range 135-330, hoarse, 1 long conversation per day at most
• 6 weeks - 150-200hz talking, 160hz-190hz 'ah', Range 125-360, less hoarse, but still hoarse, a very long conversation will leave me sore for days
• 2 month - 170hz Hoarse talking, non-hoarse voice is ~180. Range 125-390 I can talk all day, it can still get gritty and hoarse the more I talk, but sometimes it is nice and clear for a moment. If I talk all day I will pay for it the next day or two.

In the first week, everything improved dramatically. I really can't emphasize how much things improved in the first week of talking.

Over the first eight weeks, the quality of the voice determines the pitch more than anything. My pitch has increased slightly, but swelling and inflammation are a big part of the reason. Like having a bad cold one minute your voice is okay and the next it is awful.

Honestly trying to document what my pitch was before 2 months while it was still constantly recovering and hoarse felt a bit pointless in the end.

post-surgery (3 months)

• Natural unaltered pitch is ~170hz on average (~150-220 range) Right in the middle of the androgynous range, the low end of the female range.
• Trained speaking voice pitch is ~190hz, but I am not trying to do that full time yet.

My surgical results look to be right at the average for this type of surgery.

My old voice was close enough to my new voice that it isn't noticeable and no one, even those that knew I was having some sort of vocal surgery and couldn't talk for a few weeks have not commented on any change.

At 3 months it is where the constant hoarseness starts leaving and the new voice starts to appear.

At 6 months it doesn't get hoarse as quickly, but I still get horse often enough to notice.

At 9 months I still regularly get hoarse. I miss being able to talk without worrying it will get hoarse. I have a very bad vibration issue that will suddenly appear now and then (first noticed around month 2). Maybe one cord is longer than the other?

In every VFS discussion, it is reported that the voice keeps changing for up to a year.

LipLift

The stitches on the left side under my nose resulted in having a wide scar there. The rhinoplasty scar I got from Facial Team on my nose was practically gone by 3 months. Meanwhile, this is very visible. Even though I have had extensive facial surgery from FFS, this will be the scar on my face.

My upper and lower lip doesn't meet at the corners like in any natural lip, but are slightly in, not at the same distance in, and are asymmetrical. At three months my upper lip and lower nose are still numb.

But those are minor details. The distance Dr. Spiegel removed resulted in when my mouth is closed my lips don't meet and almost all of my top front two teeth and some of my gum is showing. The middle was pulled up extensively. Pretty much exactly what I told him I was worried that it might look like if he took too much. Way more than what he showed me at the pre-op. Every few days I think, maybe it doesn't look so bad, but then I look in a mirror and realize, nope it still looks just as bad. My self confidence was completely destroyed.

At the post op he suggested I constantly lift my lower lip all the way over my upper teeth to the upper lip. Someone else in the office told me not to worry as eventually I will get old and my upper lip will naturally get longer.

At the pre-op a straight on photo was taken without a tripod. The post-op photo was also taken without a tripod, but now at several different angles, but without the matching pre-op photos there is nothing to compare those against.

The assistant who told me I wouldn't have scars stopped by to try to sell me some overpriced anti-scar cream. Utterly amazed and unsure what to say I finally sarcastically told her I would be fine and didn't need it because she said I won't have any scars... as she stared at the massive healing scar. Dr. Spiegel at least said what we all know, that there is some evidence that silicone helps scars, and getting something with that could help.

I am close to the example of when to consider not doing a lip lift. When each individual millimeter makes a big difference the fact that he guessed (badly) how much to remove is infuriating. If he had only grabbed a ruler to measure what he showed me he was going to do.

The best thing I can say is by the third month the swelling had gone down to the point it is less noticeable, I am more used to it now, and less self conscious.

After the swelling went all the way down I got nonpermanent fillers as the first step to try to fix this. Later steroids and probably another surgery with a V-Y upper lip advancement and a lip corner lift will be required. I even considered the insane option of getting a Le Fort 1 Osteotomy. My small bonus surgery turned into a multi-year project to fix.

tl;dr

I had a passing voice and yet I had VFS with Dr. Spiegel. His surgical results brought my default pitch up from male into the low end of the feminine range / androgynous. After 3 months of healing combined with my training prior to surgery, it once again passes, but with a little higher pitch. Ultimately when I do drop my pitch it is now in the lower end of the androgynous range and not in the high male range which was dysphoric for me. I can still hit the upper end of the male range, but day to day I never do. I will never be misgendered with this voice. While I might have wished for a better result, and I lost volume, this was the average result and okay enough to solve the original reason I went.

From the consultations, the pre-op and post-op paperwork, I now fully understand all of the stories that I have heard about Dr. Spiegel's office. The overall process was very informal. From start to finish if I didn't ask a question it wouldn't have been talked about. It is way too easy to not get the information you need and end up with something you don't want. And what you get done might not be precisely what is best for you. Given how long his office has been around and the way he responded to questions about improving their process ("no, we are fine"), or even documenting what they did, I don't expect this will change.

Office paperwork is one thing, when it came to the actual procedures the same attitude seems to be found such as what I should get done, guessing my Lip Lift distance, or where the sutures go in my vocal cords. I have wondered more than a few times how much better both my results would have been if I had gone somewhere else.

On the flip side if you know exactly what you want, believe he can do that, or is the only one that can do that and want near zero input from him or his office then maybe that is indeed what you want.

Post series

This is one entry in a series of posts drawn out of notes and journal entries. A link to all of the posts can be found in my transition journey .