Interview on rtvMarbella

Interview in rtvMarbella, to Dr Juan Carlos Casado, on the occasion of the presentation of the book “FEMINIZACIÓN DE LA VOZ: ABORDAJE MULTIDISCIPLINAR DE LA MUJER TRANSGÉNERO”


We are going to continue speaking about the presentation of a book that has been creating a lot of expectation and interest of a topic that Marbella’s being pioneer. The medical community is doing great progress in this topic and this book collects all this information serving as a guide or as a manual of the voice feminization and the transgender interventions. Today we have with usDr. Juan Carlos Casado, one of the authors of the book and also co-director of the ENT service in Quiron Marbella Hospital.

Welcome Doctor, good morning. A book that collects, or mainly focus as the title says in the voice feminization, but you were commenting before that you are trying to give a more global approach right?

Yes, as an ENT, the main theme of the book is about the voice feminization, but then we gave another secondary title, “A multidisciplinary approach of the transgender women”, I mean that we don’t only talk about the voice feminization aspect, although still remains the central theme, we also talk about sex reassignation surgery called vaginoplasty and facial feminization.

There is a complete chapter of facial feminization, that I have to publicly mention that is masterfully written by the facialteam group of the HC clinic, a group preside by Dr. Luis Capitan and Daniel Simon with all the international prestige that precedes them.

Also a group of endocrinologist explains the hormonal influence in all the transition process of the transgender women. We are also creating another chapter explaining concepts like gender dysphoria, gender identity disorder and all the process of transition including the legal aspect. I think is a summarized and complete guide.

Is it a medical guide? For doctors?

With the purpose of extending our readers, not only focusing in doctors we have tried to write it with a non technical simple common language. But of course is also for medical professionals, like the chapter that describes the surgery of the voice feminization, that maybe it doesn’t creates too much interest in a non medical person.

I’ve tried to explain the different techniques that exists for the feminization of the voice, but is not only for doctors but also for associations, persons interested, speech therapists of course, medical students, phoniatric students and speech pathologists.

A particular issue the voice feminization, but also the facial feminization in which Marbella is also being pioneer, for example, here in Marbella the first intervention was made in 2013, right?

Exactly, the first intervention was made in June of 2012. We performed 3 surgeries, with the special invitation of Dr.Teemu Kinari, of the Central Hospital of Helsinki, my professor in this type of surgeries. A person that I am very grateful and of course I dedicate this book.

An important issue for the transgender women, it seems a minor topic of all the process of sex change , but once this medical, surgical and pharmacological process is over, the voice represents an important factor?

The voice issue is very important, because besides what you just said of the transgender women is correct, hormones doesn’t have influence in the voice. I mean, they can take all the amounts of estrogens and estradiol that you want without modifying the voice tone.

On the contrary, testosterone does have influence in the voice of a transgender man.

Transgender women with hormone therapy can develop mammary growth, they can experience change in the hair growth and fat pattern, but it doesn’t have an influence in the voice, thats why it is important to have a solution for this.

In our book presentation we had a testimony of a patient, already a friend, that had the procedure done a year ago, unfortunately she couldn’t be present but she gave her testimony live from Barcelona via Skype. She explained the effect of the voice feminization in her life, her life changes, and self-esteem in the matter of her voice. A simple action for all of us like speaking on the phone, represents a real problem for them, of course the worst thing is when people answers them: yes sir?

Of course I understand after passing through a process of years to have an image according to your identity, at the end when you speak you ruin all the process.

That’s right Roberto, and even more when the image is not visible or even when the image is visible but the voice doesn’t agree with the external aspect, they usually get shy, don’t participate in some acts or they get out little, it has a high social impact.

And with this intervention do they get a more feminine voice?

We really have spectacular results, the first surprised being me with these results, because this is not a thing we get prepared in our specialty. At first I was cautious.

I have to say,all this is a process and a team, you invited me and here I am, but there should be a lot of people here too, beginning with my secretary Isabel Quiñones, she is the one that does the first contact with the patient resolving all the questions and doubts that usually generates this patients. Once this is resolved they come to consultation and the surgery that I perform with the collaboration of another Dr. (Dr. Jeany Wong). After the surgery, speech therapy begins with another important integrant of the team, Soledad Angulo, a speech therapist specialized in voice feminization. I’m sure that if this was only about the surgery (my part) this book wouldn’t exist.

Of course, after surgery they need to learn how to speak with the new vocal folds?

That’s correct, surgery change the larynx original form to a more anatomical feminine larynx. But then we have to change the vocal gesture. Women vocal gesture is different from male vocal gesture in intonation, resonance, articulation and movement. All this is accomplished by the speech therapist.

This means this is work that not only consists of a surgery and thats it. Then it will be months of speech therapy?

Exactly, here I am only a part of the whole process

A process in which not only the feminization but also all the procedure of sex change have an important psychological component and that maybe is not completely approached. That’s why it can be a pain-full process, not only physically speaking.

Totally, we have a lot of anecdotes, for example, we have had girls in the medical consultation that come with their mother saying that they don’t come with their father because “my father still doesn’t accept me”, so imagine the situation.  And then when the voice tone changes, the father comes accepting the situation because now other people doesn’t notice the incongruence.

Of course, unfortunately, all the transgender topic, all the LGTBI has a fight,but of course it can be much more stigma with a physical woman with a masculine voice, they can’t pass unnoticed. Is there a masculinization voice surgery?

Much less frequent because of what I said before, the body responds better to the testosterone hormonal treatment, but in the cases that the results is not sufficient we can perform a type III thyroplasty, that makes voice deeper, making it more stereotypically masculine. We have only made one of these.

Feminization voice surgery, I am sure is not that common of a surgery, but you still do a couple of them per month. Does a lot of people comes from other countries to do this intervention?

The majority, in fact I could say that more of the 50% are from outside Spain. We have also performed surgery in Cis Women, I mean, women with their sex according to their gender but they have an endocrine disorder with excessive androgens that wants a voice feminization surgery.

Are you saying they are women that since childhood have a deep voice and want to change it with surgery?

Exactly, and surgery acts exactly in this cases, we have had girls with Morris syndrome, that is an endocrine disorder and Klinefelter syndrome and its already solved. At the end the main objective of this team is to help the transgender women or at least improve their voice. This emerged because in 2010 an actress came to my consultation because they had to put voice actors or dubbing actors when she acted because she was a transgender woman and she asked me for a solution. At that moment I had no idea what to do to solve her problem as I told her, but I also told her to wait, that I was going to call her in a year. And that was the first surgery of voice feminization made in Marbella.

So I guess she saw in other parts of the world that there was a solution for this problem?

That’s right, I have always been specialized in the voice and voice disorders. Iam the author of three books before, but only of the voice. So thats why she came to me to see if I could help her, and as I say , I told her I couldn’t help her at that moment but in the future, this anecdote made me investigate and study this. I went Finland to learn and then to Colombia to execute it, because in Colombia there is a high demand of this type of surgeries and thank God everything went well and now we can help many people.

Have you been teaching this technique to other surgeons in Spain?

I have been having presentations in many congresses, now I have a course in Madrid on March 16 (Hospital La Paz) about an up to date in the voice, we do this course every 4 years in Spain. We already presented it in Pamplona, Murcia and the American academy.

And are they doing this procedure in other parts of Spain or they don’t dare to do it?

I think is not being made in other parts of Spain, probably because they don’t dare.

Do you think that the “to see what happens” that you felt at the beginning is what they are experiencing now?

Is because it is scary, it’s important to have a team. We, surgeons, are used to do surgeries, do our job and thats it. We don’t see the patient unless there is a complication, but this is different, is not only about surgery but a process to follow to get the desired result. And I think that is the scary part, if you don’t have all the parts of the chain well equipped then there is uncertainty.

Well, I hope they don’t learn that fast, this is a good factor to Quiron Marbella, good for the city because they can presume of having good hospitals, doctors  and professionals. Congratulations and above all for the success of the book