Pitch Alteration Techniques for Transgender Women: A Systematic Review of Surgical and Nonsurgical Approaches
Bibliographic record
Abstract
OBJECTIVE: To systematically evaluate and compare the effectiveness of surgical and nonsurgical pitch elevation techniques in transgender women using acoustic outcomes and validated patient-reported outcome measures (PROMs). METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive searches of Ovid MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, and gray literature were completed through January 2025. Included studies involved transgender women (≥18 years) undergoing pitch elevation via surgical (Wendler glottoplasty [WG], cricothyroid approximation [CTA], vocal fold shortening and retrodisplacement of the anterior commissure [VFSRAC], and laser-assisted voice adjustment [LAVA]), laser-reduction glottoplasty [LRG], nonsurgical (voice therapy [VT]), or combination approaches. Eligible studies reported both changes in fundamental frequency (F0) and validated PROMs, such as the Voice Handicap Index (VHI) or Trans Woman Voice Questionnaire (TWVQ). Risk of bias was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Data were synthesized narratively with weighted means calculated for key outcomes. RESULTS: Twenty-two studies (N = 977) were included. VFSRAC yielded the highest mean F0 increase (+73.3 Hz), followed by WG (+54.1 Hz), VT (+39.9 Hz), CTA (+30.3 Hz), and LAVA (+26 Hz). WG + VT showed comparable F0 gains (+54.5 Hz) with more consistent outcomes. TWVQ scores improved most with WG + VT (-47.9), followed by WG (-29.0) and VT (-18.7). VHI scores improved most with LAVA (-48.0) and WG (-21.7); VFSRAC and CTA showed modest PROM improvements. Adverse events, including granuloma and vocal fatigue, were more common with surgical combinations. Follow-up ranged from 2 weeks to 4.4 years, with most studies reporting 6-12 months. CONCLUSION: Surgical and nonsurgical interventions both elevate pitch and improve voice-related quality of life. Surgery provides greater F0 gains, while combining VT enhances patient satisfaction. Findings support individualized care and the need for standardized PROMs in future studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.030 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.011 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".