[Expert phoniatric assessment of voice adaptation in male to female transsexualism].

Sex change surgery for patients with gender identity disorders has been performed successfully during the last decade, especially for males becoming females. A troublesome problem for some of these individuals is the retention of a male voice. Castration and estrogen therapy may produce only minor changes in pitch, with patients requiring further surgical treatment. Techniques used include glottoplasty, crico thyroid approximation and/or anterior commissure advancement. Although the voice is highly gender-specific, the standards of care for transsexuals do not cover guidelines for a diagnostic approach and surgical therapy. For medical jurisprudence, questions concerning specific aspects of German social law are answered in a representative case of a male-to-female transsexual. A review of the literature shows that there is no common thought about whether and when a specific surgical procedure should be performed in a gender-transforming process and which method should be used for long-term results and patient satisfaction. Although worldwide experience with these operations and overall good results are assumed, further reports by phonosurgeons performing these operations are required concerning actual results. We propose that medical scientific societies should offer phonosurgery as an optional treatment for male-to-female transsexuals in their guidelines and standards of care.