The use of vocal fold injection augmentation in a transmasculine patient unsatisfied with voice following testosterone therapy and voice training

Introduction
There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training.

Aim
The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery.

Method
A case report and literature review was undertaken.

Results
Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70–344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85–134 Hz across these tasks.

Conclusion
This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function.