Healing goes – I think – faster than I had expected. The degree of sense of obstruction lessens and the sensation of the throat is rapidly approaching normal/neutral in most situations. This is also frightening in its own way (“what if it breaks?”). I dreamt I sang high and wide and I dreamt that I coughed hard, but so far thinking perhaps it holds.

I was speaking with people quite a lot in meetings. For auditorium contexts, having microphones solved most. I feel less tired when speaking, but I also notice when recording that when I speak without thinking, I sound more or less the way I did before when I paid attention to keep the voice not too low. This now holds also when just waking up from sleep. So I have sealed away the lowest register (which makes sense) but I am not automatically speaking much higher than how I usually did in the past. That is a little scary also.

However, I do notice I can go higher than that now, and it feels less breathless and uncomfortable to. So what I suspect I must do is to finally engage with voice training regularly, which I can now do easier; it feels less psychologically impossible to perform the training, and less physically difficult to use a higher register. Noting also a hardness to my voice unless I harmonize explicitly.

Thus all in all, basic feeling is, I will still need voice training (as planned), but I approach it from a perspective where it is going to be less difficult and more applicable. The feeling of _how_ I generate a certain voice is same as before and requires same action. The difference may be whether or not I can easily train and habitualize, mostly because the obstacle/challenge in generating a good outcome has moved to “running out of strength” rather than “running out of breath” and for a string of other partially-felt reasonings. Like with any other medical transition step, how we train to reshape ourselves synergize with how medicine reshapes us to make that easier.

More to come. Tiredness encroaching.

My partner wrote that to some extent, voice surgery gave her something like what she could have gained theoretically from voice training, but was unable to gain in practice, by making it impossible to speak without using the techniques offered through voice training. I think I am seeing how that works now, it matches my experience. Also this forces me to train in a way I otherwise would fail to.

Other interesting lesson from the voice training session I had – how to breathe in fully, using diaphragm, not pulling up shoulders or pulling in belly. So in a way, I also need to learn better posture now. There will be some challenges in carrying this out, but just like I could to thrice daily dilation when that was a bodily need, so I can do this now when it similarly is one.

I wrote a lot on all channels leading up to my vaginoplasty, and a lot on its recovery, and some on the revision surgery too. Enough that I branched out to a second twitter account so as not to impose my genitals on all the Internet without consent. But I have been largely quiet on the second gender confirming surgery I had now in 2021, the glottoplasty. This is a conspicuous absence, and I think it largely reflects how the vaginoplasty changed me, made me less anxious, more confident, and more prone to action than regurgitated reflection. Still this is important to document, also because others may be interested in this experience. So I’ll summarize here.

After the revision vaginoplasty (vulvaplasty, really, just adjusted the labial definition a little), I looked into myself and found no hesitancy any more. I hadn’t learned anything new about the glottoplasty or its risks, but I had learned more about myself, including that if I think I want something, I can decide I am certain enough and then do whatever I need to have it. Some experiences of misgendering and the ubiquituous Zooms making me hear my own voice in meetings made the point clear, if I could rid my voice of gravel, or even have a chance to, then of course I would take it. Last straw was listening to myself on a podcast and hating every second of it. If I knew I would eventually, then no reason to wait. So I researched a bit, concluded easiest was to go to the well-renowned surgeon in my country of residence rather than go abroad in a pandemic, and went to consult. Being able to have the procedure done during the mad times of COVID also reduces FOMO during recovery, so there was that too.

I went to the clinic to ask my questions, and was impressed overall. While different providers do things a little differently it was clear I wanted glottoplasty as first line treatment; no point in trying the far more invasive alternatives if this would work as well as it had for my partner. Thus the decision of where to go simplified further – more a matter of how well they do the same technique than radically different such. Outcome varies widely on recordings, but from the discussion it seemed clear that the main challenge was to ensure the shortening would hold – the basic technique is, open up skin on the vocal folds (vocal cords, in lay terms) and stitch them together so they heal forming a smaller opening, thus providing a shorter wavelength of resonant sound. This surgeon uses permanent stitches. I was assured that if they break, they can be made again. Additionally hyaluron fillers are injected to take pressure off the cords as they heal, and the same outcome further provided by botox injections into the musculature.

I was told that one determinant of good outcome is symmetrical vocal fold; mine were. Unfortunately, I also have a throat configuration where the tongue bone (?) made it questionable if it would be possible to position the laryngoscope deep enough to place the stitches, simply for reasons of access. Still I knew without a doubt, I would need to try. All in all, the procedure is ca 6k EUR. I scheduled, then had to reschedule to me a really good science queer and help my collaborators shine together at a meeting with a science funding body. Something within me broke with that rescheduling, but I am fine being broken and I am still alive. A cancellation opened up on a week’s notice and I knew I had to.

The surgery is outpatient, but with full anaesthesia, so I was asked to stay around with a companion to watch over me for 24h. There is a nice affordable hotel just on the hospital campus, and the clinic itself is welcoming, clean and calming. The staff largely spoke English, and made a point consistently to talk of those they perform the surgery on always just as “women”, rather than “patients” or any less savory term. It felt like conscious affirmation and was appreciated. I was asked to come the day before to sign consent forms, assess anaesthesia safety and so on; there were some issues where I needed a negative MRSA and COVID test both which took time, but all in all no problem not overcome. No eating or drinking for six hours before surgery.

I said I was unfazed, but this is not really true. Because like with all other surgeries, I could not sleep the night before, simply because my body showed signs of anxiety, even if my emotions to that end were all remote and inaccessible. I felt affectively neutral. Still it was clear from an outside view I was in a state of some sort of transitory crisis, just as for other surgeries. I am quite sure this is because the results matter so much, rather than get my hopes up and be disappointed, I just felt nothing consciously. I was still a nervous wreck the days before, which I filled with work and dating, establishing what appears to be two new romantic relationships in the process. One of them accompanied me and I made the somewhat surprising discovery I can be socially and sexually submissive to someone with the right body and mind and attitude, and this did help with the being an anxious mess part – being able to surrender control of what happened in all non-surgery regards helped me stay at least superficially calm.

In the morning I took my piercings out, went to the surgery center, and was sedated. Unlike the clinic, the affiliated surgery center was far less pleasant with staff that were less straightforward to communicate with. That was a short period of time only however. Memories of the time just around the surgery are beginning to fade, but it was like with SRS; IV in hand, feeling of cold, fading out. I believe once more I chanted prayers in thanks and sanctification to Inanna as my last thoughts. As with my other transition surgeries, I give myself in sacrifice to Her, and so all that follows, good or bad, are dedicated to Her virtues.

I had asked to be told when waking whether they could place the stitches, but none understood the question or even knew during wakeup. I had some throat pain, largely to one side. Was given my phone, then eventually could rise and walk with my companion over campus to the voice clinic again, where again an endoscope probe was sent down my nose after a short spray of anaesthesia, and I was shown the view of my new vocal folds. It dawns on me that so far all my transition surgeries have been about giving me womanly folds my karyotype denied me. Through skill and trickery, the surgeon had been able to place the stitches and it already looked surprisingly whole. My main fear resolved, I relaxed some.

I spent the day slowly waking up and sending emails from the bed in the hotel. The challenge during those first days were largely to ensure I did nothing to tear the healing edges apart. While pain faded quickly to mild cold levels in a matter of hours, the buildup of mucus was a major issue. I drank a lot of water and practiced the techniques for clearing the throat safely. The usual way is a major danger, as is sneezing, coughing, speaking or laughing. If any happens, I should hold mouth and nose shut; breathing in and out helped some to prevent sneezing. In the early hours, I felt a need to control my posture completely, since shifting position sometimes caused mucus to shift and risk involuntary coughing to clear it. Thus my newfound sexual submissiveness from the days before quickly submerged in favor of a pragmatic need for perfect self control; my companion was a gentleperson about it and also gave me some needed space to slowly come back to wakefulness and a sense of self after the operation. They still ensured I ate something and cared for me with a remarkable and most appreciated patience, kindness and firmness, and I felt like a safely held prickly but satisfied tsundere. We went out for dinner and walking outside – with a mask – really was good also.

Many asked me how I was able to go without speaking, but the truth was, using laptop or phone text editors, I could just type and show people what I had written, and conversation flowed more or less as usual. I suppose it helps I spent months alone during the pandemic and am an ambivert with a largely online social life. The next day, pain had subsided even more. I had already several times broken the restrictions – coughed or sneezed or laughed a little, by mistake – so of course I was afraid. But endoscopy showed healing according to plan, and we made our way back to my home town by train, life already back to something like normal. The next days challenges largely concerned the same issues – avoiding anything that hurts the stitches. I was given a sign to show saying I could not speak, with a back side saying “Thank you!”, very useful. I took it a little calmer than usual but were quickly working and the week after was seeing people again, including going on a couple hot dates (main issue not speaking was actually during sex, as I had no way of signalling “yes, that is good, please do that more”), and I joined a few videoconferences contributing by chat only, as well as an outdoor party at my institute, breaking the no-alcohol rule.

The latter gave me a cold for a few days, which was an issue because though it was not coughing cold, it meant wet and watery nose mucus running down the throat. I stayed inside and rested and took antihistamins and nose spray, and it faded luckily within a day (though did mean I missed out on a potential hot date with yet another person). All in all, feelings of normalcy came quickly, and it became relatively easier to observe the restrictions, though also harder to avoid some by mistake. Turns out I talk to myself more than I thought I did, for example. Some things began to feel safe just by becoming easier to do carefully. The freedom from talking has felt quite relaxing, in part by creating a mythos around it of being a mermaid transfigured. I set out to forget my old voice, and it might be that I will, and more easily for this fallow period in between. Only challenge in communication has been walking with people because I’d need to stop sometimes to type on the phone when I held their hand with the other as we walked.

Anxiety was still high but calm during waiting, because given no nerves in the vocal folds, there was no way to tell if stitches remained intact after each challenge. So I kept as busy as I could, and then now again traveled to the city of the surgery. They checked me with the endoscope, and sent me also this video so I have it, and it reveals that healing remains intact still, with epithelium now having overgrown the stitches as it should. Then began the voice training sessions. I will have ten appointments with them over Skype, and train myself in between, and now, unlike in the past, I think I can actually make the exercises happen regularly, just as I could dilation, once something in my body made it necessary. To start out what I will do is the same as laxvox, breathing out tonally through a tube that goes underwater, to safely practice vocal fold vibration, thrice daily, five minutes; single tone and rise-and-fall pattern.

More relevant, I can try to speak normally in day to day settings, though I should not overexert either in terms of high or low or loud voice or for too long. I should check for situations where I feel I need to strain to make sound, and then rest instead. As otherwise, having become pain tolerant to the point of literal masochism means I can no longer use pain or discomfort as a guide to what is safe or not. But I can try to communicate normally. I was asked what my first word would be. I chose “Inanna” and vibrated her name tonally as the first I spoke. Purring and growling still works, and are safe. Whispering is safe, and sounds like before. But spoken voice, while still weak and hoarse, sounds different. It will change a lot in the months to come, but already hearing it differently makes me incredibly happy. No matter what is to come, my expectations have been exceeded. More to come.