Patients and methods

During 1990-1996, there were 6 male-to-female transsexual patients enrolled in this study, aged 20-27 years (mean 23). All patients were subjected to complete physical and psychological evaluation preoperatively. Five of them had undergone sex organ conversion, and all had been using estrogen and progesterone regularly either orally or intramuscularly for many years. Their general physical appearance was uniformly masculine except for the complexion, which appeared smooth and fine, similar to females. The anterior thyroid cartilage prominence (Adam¡¯s apple) of all patients was high and pointed as typical of men. The internal laryngeal structure were particularly false and the true vocal cords were voluminous and male-like. Most notably, their voices were male-like in spite of voluntary female voice imitation. This was most obvious during coughing or sneezing. All patients were psychologically stable as assessed by a psychiatrist.

Objective voice assessments included pre-and postoperative tape recording, spectrography, maximum phonation time and determination fundamental frequency, jitter and shimmer using VISIPITCH M 3300 (U.S.A.). Stroboscopic examination was not included in the assessments since it was not available in our institute at the time of study. Informed consent was obtained from all patients.