Dr. Karen Kost, an otolaryngologist at the McGill University Health Centre, is one of the few surgeons worldwide who perform voice feminization surgery.Andrej Ivanov/The Globe and Mail
Sarah-Lily Faucher keeps a recording on her cellphone that she captured on Nov. 7, 2023, to document the sound of her baritone voice for the very last time.
Hours later, in a Montreal operating room, Ms. Faucher underwent voice feminization surgery that changed her voice entirely. It now has a much higher pitch than before.
The 33-year-old said the new sound of her voice aligns with her gender identity as a transgender woman. The procedure has also been emotionally grounding, offering her peace of mind.
“It’s not something that I will ever worry about,” she said in a recent interview.
Transgender medical experts say the sound of a person’s voice can be a source of gender dysphoria: They may experience shame, anxiety and fear when they are misgendered. Many transgender people report they fear for their safety during a time of heightened political scrutiny in North America.
While voice alteration procedures are in more demand globally as part of gender-affirming medical care, access barriers persist for patients. A review released this year in the Laryngoscope, a peer-reviewed medical journal, noted a high demand for feminization voice surgery but said barriers are exacerbated by limited training for otolaryngologists, known as ENT doctors, to offer gender-affirming care.
Additionally, some transgender individuals are not aware voice alteration procedures are available.
A study published in 2025 in the International Journal of Transgender Health, which examined the health care experiences of transgender and non-binary young people in Alberta, found several participants were dissatisfied with their voice or would want to change its sound. However, it said “they did not know that there was even a service available or where to access such services.”
The surgeon who performed Ms. Faucher’s procedure, Karen Kost, is regarded as a pioneer in her work, including innovative surgical approaches focused on underserved medical needs, such as for transgender patients.
Based at the McGill University Health Centre, or MUHC, Dr. Kost is seeing more requests coming in for surgery to make the pitch of patients’ voices higher or lower. Patients, however, cannot contact MUHC directly. They must be referred to the academic health centre for this specialized care.
Voice feminization surgery involves shortening the vocal cords and making them more stiff to bring up the pitch.
By contrast, lowering the voice involves allowing more laxity in the vocal cords. Usually, this involves pushing back the Adam’s Apple area while a patient is sedated, Dr. Kost said.
Sarah-Lily Faucher, a patient of the McGill University Health Centre, and Dr. Kost, pose for a portrait at the MUHC in Montreal on July 23. Dr. Kost performed a gender-affirming voice feminization surgery on Ms. Faucher.Andrej Ivanov/The Globe and Mail
Another new but not commonly available approach involves testosterone injections in the vocal cords, she added.
Dr. Kost is among a small number of otolaryngologists who do this type of work in Canada.
She said she is part of a group of about 70 surgeons from around the world who perform these technically challenging procedures. They require specialized equipment and higher levels of training.
A fellowship program at the MUHC offers specialized training on vocal surgery procedures, Dr. Kost added. “There is a learning process for sure,” she said.
Part of this work involves meeting with patients and explaining the surgery, as well as seeing them work with a speech language pathologist.
Maia Masuda is a speech language pathologist at the MUHC who specializes in working with patients with voice disorders, which can include trauma and damage.
She also works with members of the trans and gender non-conforming population who wish to align their voice with their gender identity, including patients referred by Dr. Kost.
Ms. Masuda said that she has seen patients at different points in their journey, including after surgery to work on voice resonance – the way a voice reverberates.
Most often, she said, she meets with patients before surgery. During this meeting, patient history is shared. The care team then works with patients to determine if they would like to pursue surgery or not.
Ms. Masuda said a person’s voice is a very personal part of them. It communicates much to the world about who a person is, as well as their emotions, personality, thoughts and beliefs, she said.
Members of the trans and gender non-conforming population tend to be underserved and can be vulnerable, Ms. Masuda added.
“To be able to be allowed into their world to try to help them perhaps get some tools to improve their overall well-being and happiness is really a privilege,” she said.
Nearly three years after voice feminization surgery, Ms. Faucher says she no longer worries about the sound of her voice.Andrej Ivanov/The Globe and Mail
Ms. Faucher, who also worked with a speech language pathologist, is evidence of a patient who has benefited from the medical supports at MUHC.
Before surgery, she said she was frequently misgendered, despite taking estrogen since age 28 that altered her physique. The hormone does not change the sound of the voice.
As a result, she often had to correct people on the phone who thought they were talking to the wrong person when they heard a deep voice on the other end.
While she understood why the other person reached this conclusion, it was still painful for her.
Thinking about her voice was time-consuming: She was always aware of its sound and worked on it constantly.
“That was extremely difficult for me to live with,” Ms. Faucher said. “It was exhausting.”
Nearly three years after surgery, she no longer has this worry. Instead, people have difficulty believing she is transgender.
Ms. Faucher said she is not making a political statement by sharing her story.
Instead, she said she is speaking publicly about medical care and what she has drawn from her surgical experience.
“It sounds like my natural voice that I wish I had by birth,” she said. “It is nice to finally be aligned.”