Notes on Gender Role Transition

Anne Vitale Ph.D. Editor

Going Full Time

by Annette Gallo


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May 17, 1997

Editor's Note:

This letter was written to me by a male-to-female client who just had voice and minor face surgery prior to starting to live full time as a woman. The letter goes beyond the surgery and discusses how starting to live as a woman has effected her family and her work place.

I have received her permission to share it with the readership of this site. I also should note that Annette lives some distance from the Bay Area and routinely augments her visits to my office via e-mail. I think you will find it informative. Annette can be reached at

Anne Vitale PhD

May 14, 1997

Dear Anne;

Two weeks ago today, I had voice surgery , a trach shave, and a lip lift as well. My throat is still a bit sore, kind of like having a lump in my throat. It hurts mainly when I talk. It seems to be getting better, but very slowly.

The incision for my lip lift that is right in the crease between my nose and upper lip will probably need make-up for a few months to cover the redness. But after it smoothes out (I hope in another week or so), it will be virtually unnoticeable. It already looks all right.

I like the way my lip looks. I won't have any reason to over-paint my upper lip with lip liner anymore. (I'm really happy about that). Also the over all length of my upper lip is a good bit shorter now. I actually have some teeth showing now. I think my upper lip was about as long as they come. And the actual upper lip itself, (the part that gets the lipstick), as thin as they get. It is still a rather small looking mouth (Nothing for Cindy Crawford to envy), but I am a great deal more comfortable and confident about passing with it now.

The main thing of course was the cricoid surgery. So, let me start out by telling you about the voice evaluation that was performed on me the day before the surgery (Monday). It was mainly done by a speech therapist. After she did her part. She passed the results on to Dr. Cohen, who finished the assessment.

I talked to her a little about the voice training required after the surgery. She said it depends on the individual. The sound will be somewhat higher than it is supposed to be at first. She said that I should expect my voice to settle in to a lower more female sound naturally since I already have some female qualities in my tone. She said that they have only had one patient whose pitch did not drop after surgery. She said that after they had her come back in, all she had to do was learn to relax her voice a bit and it then dropped and sounded feminine, not mouse-like.

During the first part of the voice evaluation, the speech therapist had me do a few things, just speaking into a microphone. As I spoke, there were responses on two different screens that I could see. One was a computer display, the other looked more like an Oscilloscope. First, the speech therapist had me read a passage in a "comfortable, normal" speaking voice. I used my voice that I use when working as Don. Then I read a passage in a "medium high" speaking voice. That one was sort of like my "Momma Bear" voice in Goldilocks.

After that, She had me sing an "easy" note and hold it, "aaaaahhhh", then, a higher note and hold it. Then, I sang starting from the easy note and raising the pitch to as high as I could go until my voice cracked. Finally, I sang starting at the easy note and dropping to as low a note as possible.

I assume that all of this was digitized and recorded as data for Dr. Cohen's research. I was then moved to another device. A topical anaesthetic was then applied to the rear of my mouth to reduce my gag reflex. I made a bunch of other sounds while holding a microphone against my throat, pulling my tongue forward with my hand, and having a video camera inserted down my throat. This really seemed awkward as you might imagine. The interesting part was watching the video played back and actually seeing my own vocal chords at work.

When I went in to see Dr. Cohen after that, He said that I was a good candidate for having excellent results from the surgery. I asked him what kind of factors would make someone not be a good candidate for the surgery. Basically, he said that someone who already had a voice that measured in a female range or someone who made a living with their voice, like a singer, are people that he would not work on. If someone was a heavy smoker, and had polyps on their vocal chords from it, he would advise them that the surgery would probably help significantly, but the results would not be as good as they would have been if they were a non-smoker. He also added that anyone with an extremely masculine sounding voice must not have "unrealistic expectations" that the surgery will make their voices more feminine.

I asked him about the unfortunate occurrence of some plastic surgeon's re-attachment of the vocal chords at the time of doing a tracheal shave. He said that they have worked on a few patients with that same problem. They can fix it, he said. They may not be able to get as high a pitch as they would have otherwise, but he is confident that they can raise the voice of patients like that, unless their voice dropped significantly lower after the trach shave.

While I was in surgery, and they had me vocalize while they tightened up my vocal chords, I could hardly believe the sounds I was making. It was really strange hearing this high pitch come out of me. As you know, they actually take it up a bit higher than it will end up being. It sounded a bit silly, kind of "pixie-like".

I guess it will be partly up to me, and partly due to the result of stretching that it will settle back down. Now I can focus on a relaxed, sultry female intonation style without having to try to raise the pitch at the same time. It has always seemed rather impossible to me to raise the pitch by consciously tightening your voice muscles and relaxing the tone in a feminine way at the same time. I suppose that if one is determined enough it is possible.

Getting the surgery seems like a more certain method to me though. It seems like it is almost guaranteed to work. That is, as long as I don't break something loose during the healing process. Every time I cough, or have an irresistible urge to clear my throat, I'm afraid that I'm messing it up. Dr. Meltzer's follow up patient care counselor, Fran came to the hospital the evening after the surgery and told me not to worry about those things. Vocalizing is the main problem. So, laughing will do damage. But, it is possible to sneeze, cough, or clear your throat without vocalizing.

There was an older TS who had her SRS done last week and was recovering a few rooms down from mine at the hospital. She came to my room a couple of times and decided to chat with me. I had a very hard time not laughing at some of the stories she was telling me. It was funny and awful at the same time. The harder that I tried not to laugh, the more I wanted to. It was like getting a case of the giggles when I was a kid and was in church with my best friend who was making jokes about the minister. I felt like I was going to explode. Fortunately, I didn't vocalize.

The morning after surgery, a male nurse came in and, waking me up, asked how I was doing. Before I could think I replied: "OK". When I heard the pixie voice, I panicked. Later on that day, I went back over to Oregon Health Sciences University to have my post-op check up with Dr. Cohen. I asked him about my morning accidental vocalization. He said that it would not have damaged anything. I still couldn't help but worry about it though. He stuck a scope down my throat to examine his work. He said that everything looked fine. And, he was very pleased with the sounds that he heard me make the day before in surgery. He thinks that I will have "dramatic" results from the surgery, and wants me to stay in touch with him over the years ahead.

He, together with Dr. Meltzer, have been performing this procedure for about two years only. They have performed it on about 200 patients. So far, the results appear to be permanent. He wants to keep a database on patients that is as complete as possible. So, the next time that I'm in Portland, I'm supposed to go back in so they can re-measure my voice.

I hope this memo isn't too long for you. I can't talk so I guess that I'm just writing to get over it.

* * * * *

Mother's day weekend held a lot of feelings and insight about grieving who I was. It finally hit home on mother's day, talking to my mom on the phone (she lives in southern calif.).

It was the first time she heard my voice since the surgery. She kept saying things about how my voice really just sounded like it used to, except somehow damaged. She used adjectives like strained, hoarse, and sore. She did not notice anything positive about it that was new, like the fact that it is about an octave higher in pitch than it was. What she found comfort in was how I still sounded like I used to somehow in spite of the changes due to surgery.

While these were not the things I would have liked to hear, I was just glad that she was not saying something like what a horrible Mother's Day greeting it was to hear her son's voice in this way. I could tell that she was just trying to hold on to her son. She simply would not allow nor in any way accept the possibility of losing another son. And, I fully honor that. The death of my younger brother over eight years ago is a harsh reality that crippled her in many ways. She has been struggling with that reality ever since, as have all of us who loved him. Still, I have seen her struggle go beyond anything that should ever happen to anyone. If I had any efficacy within my family system, I think I would have done something to help her complete her grief cycle. Yet, without getting off into a major tangent here, my family role, as well as that of my mother would not accommodate that from ever happening. (I tend to apply the perspective of Murray Bowen in trying to understand)

Actually, I am the same person as Annette that I was as Don, only more of her. At the same time, I am also completely transformed. And, in the transformation there is a death and, naturally, a rebirth.

My mother is unwilling to see the death. And, I don't think that she really "needs" to do that in order for her and me to continue to have a developing relationship. My Father and Sister will be lucky to get even a glimpse of the perspective that my mother has. My younger brother, the twin of the one who died, dances with death. He will see it when he is ready. I really don't know how to predict if my 2 sons and daughter in-law will deal with Don's death. And, as for my granddaughter, I really, really don't know how she will deal with Don. She will have never known him.

I, myself, finally felt Don's death on Sunday evening. You know, I actually cried for him. I miss him. I've got a room full of his clothes that I have been trying to give to my sons. They don't want any of it. And, I know there is at least some of it that they would wear if they bought it off a store shelf. I guess it is part of the thing about not accepting Don's death.

I suppose it is a type of paradox. I mean, I really haven't died. Yet, an expression of me has. A form within which I lived, loved, fought, labored, and tried desperately to find fulfillment is no more. That form, who was called Don, laid himself down to give birth to a new, and hopefully more successful expression of the same self. In his place now stands Annette.

And, I am her. I am confident, yet awkward. I am bashful, yet graceful. I fully remember who I was as Don, yet every day I become more of Annette (Not being forced to have my body physically die for this rebirth has that advantage - no amnesia of the past life!). Every day I walk into the building where I have worked as Don for over eight years. Now, I am in the middle of the third week walking in as Annette. It is so much fun!

My long walk across the parking lot, into the building, and down a long corridor that goes between open area machine shops on the way to my office in the rear of the building has turned into a ritual that is much more enjoyable than I could have possibly imagined. In fact, I was dreading the prospect of walking past all of the machinists and workers who have known me as Don all these years in order to get to my office. It was one of my worst fears.

As I was walking down the corridor, noticing who was watching and who was commenting, all of sudden, sometime during the week before last, I began to realize that my hips really are connected to my legs. And best of all, they began to move in a way that really made sense. It was kind of magic. It felt great. I thought, "wow! I hope I can do this again next time." Well, I did, and it happens all the time now. How cool!

I have been trying to figure out how women walk for what seems like my whole life. More recently, I've been getting rolfed, going to jazz classes, practicing at home, and never with any noticeable success. It seemed the harder that I tried to walk like a woman, the stupider I looked.

I'm certain that being on hormones for over a year, and doing aerobics for the last couple of months has helped my leg muscles to develop in a feminine way. And maybe that has something to do with this little success story about walking. But somehow, it is kind of like a fairy god mother just waved her wand when I was on the spot. It just started happening, and I knew it was right.

I can see my shadow in the mornings walking across the parking lot. And, my walk does look all right. I was whistled at the other day from some guys driving by in a truck whom I've never seen before. What a trip!

Just about everybody I work with knew me as Don. One consultant we interact with in our office only comes in occasionally, and does not interact with people very closely anywhere in the building. Last week he was in, and I could tell he did not recognize me. It made us all smile as he began to flirt with me. Nobody said anything to disappoint him. How funny!

As Annette, I'm just having these great experiences every day. I almost feel guilty. It is kind of like it is just going too smoothly. I told the two neighbors that I have in this older small apartment building in Fair Oaks that I am Don's sister and I am just house-sitting for him while he is out of town. They both bought it. Doing stuff like that really helps build my confidence.

My real sister hates Annette. She hasn't used these words but her attitude says that she regards her as the bitch who did away with her brother. OH well ! You can't please everyone.

I guess, I better stop before I bore you too much. Thank You a lot for your ongoing support. There are still times that I wish you were handy to talk to. But I seem to get through it OK. I have a sort of support circle of a few TS friends. I talk with one or another of them on the phone every few days. Overall, things are really going pretty well. Amazing!

I will stay in touch. Thanks again for all of your help.