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

## TL;DR

This paper provides the first Brazilian consensus on glottoplasty for transgender women, offering guidance on surgical indications, techniques, and care.

## Contribution

The paper presents the first Brazilian consensus on glottoplasty for vocal feminization using a modified Delphi method.

## Key findings

- Glottoplasty is indicated for transgender women with vocal gender incongruence, regardless of baseline fundamental frequency.
- Most recommendations are based on low-grade evidence, such as case series and expert opinion.
- Comprehensive preoperative and postoperative care protocols were established, including voice therapy and medication.

## Abstract

•Consensus-based recommendations using modified Delphi methodology.•Clear surgical indications and contraindications were established.•Comprehensive perioperative care recommendations are provided.•Surgical indication prioritizes vocal gender incongruence, not acoustic measures.•Most recommendations rely on low-grade evidence (case series and expert opinion).

Consensus-based recommendations using modified Delphi methodology.

Clear surgical indications and contraindications were established.

Comprehensive perioperative care recommendations are provided.

Surgical indication prioritizes vocal gender incongruence, not acoustic measures.

Most recommendations rely on low-grade evidence (case series and expert opinion).

To establish consensus-based recommendations for the indication, surgical technique, and perioperative care in glottoplasty for transgender women seeking vocal feminization.

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.

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.

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.