Glottoplasty for vocal feminization in transgender women: position paper of the Brazilian Academy of Laryngology and Voice (ABLV)

Abstract

Objective: To establish consensus-based recommendations for the indication, surgical technique, and perioperative care in glottoplasty for transgender women seeking vocal feminization. Methods: Ten otolaryngologists from distinct Brazilian academic institutions, all experienced in transgender voice surgery, contributed to this position paper. A modified Delphi method was applied, supported by a narrative literature review. Recommendations were classified using Oxford Centre for Evidence-Based Medicine levels. Results: Glottoplasty is indicated for transgender women experiencing vocal gender incongruence, regardless of their baseline fundamental frequency. Absolute and relative contraindications were defined, as well as recommended preoperative assessments such as videolaryngoscopy, acoustic voice analysis, and validated quality-of-life questionnaires. Perioperative management includes voice rest, individualized medication protocols, and post-operative voice therapy. Most recommendations are based on level IV and V evidence, reflecting the current paucity of prospective studies. Conclusion: This is the first Brazilian consensus on glottoplasty for transgender women, providing structured clinical guidance for indication, technical execution, and follow-up. Higher-level evidence is needed to strengthen future recommendations.