Androphonia (Vocal Feminization)

Androphonia is characterized by an abnormally low pitched voice in women. Some women elect to have a vocal feminization procedure to raise the pitch of their voices and with vocal rehabilitation (speech lessons) sound more feminine.

There is another population that will utilize this procedure; men gender transitioning to women. Let’s have a look at what the experience of taking care of them looks like.

The first time I saw the diagnosis, “Androphonia” I had to go look it up so I didn’t look completely lost when I met the patient. I looked it up, I still didn’t, “get it.” As I’ve mentioned it could have simply been a woman raising the pitch of her voice up a couple of octaves to have a voice that better matches her appearance.

The procedure itself is relatively simple; shortening the vocal chords to raise the pitch of voice. The degree of difficulty in managing this post operative patient is minimal.

  • Assessment of anterior neck incision (often there isn’t one)
  • Strict vocal rest (minimum seven days), patient will communicate with pen and paper, typing on a laptop, sign language, or a mix of these devices.
  • Pain management as needed, although in my experience many have little to no pain.
  • The effects of anesthesia are commonly minimal and patients can usually be made independent shortly after they arrive to the unit.
  • Their diet can be advanced as tolerated, avoid foods that cause reflux (I recommended avoiding carbonation)
  • No smoking after discharge / during recovery (hopefully they are non-smokers)
  • Complications are minimal
  • Arrange for patient to have prescriptions prior to discharge
  • Insure transportation is arranged to their MD follow up the day of discharge

Patient education is a big nursing consideration as the patient will need a handful of prescriptions to manage their post op care.

Common Post Op Medications:

  • Steroids (Medrol Dose Pak) to prevent swelling/closure of the throat
  • PPI (Omeprazole) / H2 Blocker (Famotidine) to prevent acid reflux on the vocal chords
  • Cough suppressant syrup / Pain reliever (Tussionex) to prevent vocal chord injury

The other big nursing consideration for the gender transitioning patient is emotional support and open acceptance. This will be one of the toughest tests for a nurse, insuring they keep their judgements and personal beliefs in check. If for one reason or another (religion, personal beliefs, etc) a nurse feels uncomfortable taking care of a transgender patient, they should speak to their charge nurse and have the patient reassigned to another nurse. Recovering patients deserve to have a nurse that can make them feel comfortable so they can focus on healing.

There are a few key reasons I love these patients. One, I don’t like being judged, so it’s easy for me to get along with others who have been (way more than myself). Two, this is a procedure insurance doesn’t currently cover. The patients pay cash, which leads them to be attentive and compliant with teaching. Three, when shown open acceptance, they are extremely grateful and appreciate the hard work we put in as nurses.

The average length of stay is less than a day, with most patients being discharge the following morning. After discharge they will have a mandatory follow up with their surgeon the same day. The surgeon will strongly recommend voice lessons and patience as it will take weeks to months for the voice to match patient expectations.

As always, thank the patient for letting us care for them and wish them well.

 

-Nurse David

 

Editor’s note: Since this is my first stab at a patient profile, I plan on updating/modifying the content based on new learning experiences. Please let me know your feedback. If there is anything you’d like me to add or touch on, just ask. 

 

 

 

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