title: Pitch Elevation in Male-to-female Transgender Persons-the Würzburg Approach.
abstract: OBJECTIVE
  The present study reports objective and subjective voice results of Wendler's glottoplasty modified by Hagen.
  
  
  METHODS
  This is an outcomes research study.
  
  
  METHODS
  A total of 21 patients underwent Wendler's glottoplasty modified by Hagen. Parameters in the follow-up session were laryngoscopy, voice range profile, Voice Handicap Index, Life Satisfaction Questionnaire, and a visual analog scale for individual satisfaction with the voice.
  
  
  RESULTS
  The fundamental frequency was elevated into the typical female fundamental frequency range. Furthermore, an elevation of the lower frequency limit was shown without a reduction of the frequency range. About one third of the population feels affected by the restricted dynamic range. This change of the vocal pitch is seen as part of the voice feminization by some of the patients. The Dysphonia Severity Index as a marker for voice quality was unchanged. Subjective satisfaction with the voice showed a strong correlation with the individual elevation of the pitch.
  
  
  CONCLUSIONS
  Wendler's glottoplasty modified by Hagen is an effective and low-risk method of raising the vocal pitch of male-to-female transgender persons. However, elevated Scores of the Voice Handicap Index indicated that in everyday life, transgender persons continue to feel handicapped because of their voice. Another indicator for the lack of social acceptance and integration is the reduced general life satisfaction in the Life Satisfaction Questionnaire especially in the domain "friends, acquaintances, relatives." Therefore, a better multidisciplinary therapy concept for voice feminization is necessary.
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Meister
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hagen
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Shehata-Dieler
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Kühn
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Kraus
authors.affiliation: Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Würzburg, Germany. Electronic address: Kleinsasser_n@ukw.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Kleinsasser
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005783:Gender Identity; D005931:Glottis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010898:Pitch Perception; D011237:Predictive Value of Tests; D011788:Quality of Life; D012649:Self Concept; D012737:Sex Factors; D057830:Gender-Affirming Surgery / Q000009:adverse effects; D013061:Speech Acoustics; D013067:Speech Perception; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology*; D014189:Transsexualism / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D014741:Video Recording; D014833:Voice Quality; D055815:Young Adult
keywords: Glottoplasty; Phonosurgery; Pitch elevation; Transgender voice; Voice feminization