Wendler's Glottoplasty in Italian Transgender Women: A Retrospective Cohort Study on Efficacy and Safety

Objective: This study aims to evaluate the outcomes of Wendler's glottoplasty in an all-Italian cohort of transgender women, focusing on its efficacy, safety, and impact on patient satisfaction. Study design: Retrospective observational study. Methods: The study was conducted on 10 Italian transgender women aged 25-40 years who underwent Wendler's glottoplasty at the University of Salerno from January 2020 to December 2022. Comprehensive preoperative and postoperative assessments included acoustic analysis, laryngostroboscopy, and validated questionnaires such as the Italian versions of the Transsexual Voice Questionnaire for Male-to-Female Transsexuals (I-TVQMtF) and the Voice Handicap Index (I-VHI). Statistical analysis used paired t-tests and effect size calculations to measure changes across key parameters. Results: The mean fundamental frequency (F0) increased significantly from 151.4 Hz (±10.8 Hz) preoperatively to 231.6 Hz (±13.5 Hz) postoperatively (P < 0.001), achieving a range typical of cisgender women. I-TVQMtF scores improved markedly from 71.6 (±9.2) to 24.9 (±5.1), while I-VHI scores decreased significantly from 59.2 (±8.9) to 19.8 (±5.4) (P < 0.001). Perceptual femininity ratings (PA-VAS) also improved, with scores decreasing from 4.4 (±0.3) to 1.9 (±0.4) (P < 0.001). Laryngostroboscopy confirmed 90% glottic closure and 80% symmetrical vocal fold vibration. Minor complications, such as transient dysphonia (10%), resolved with conservative management. Conclusions: Wendler's glottoplasty is a safe and effective procedure for vocal feminization in Italian transgender women, demonstrating substantial improvements in acoustic, perceptual, and self-reported outcomes. These findings highlight the value of integrating surgical and multidisciplinary care to enhance patient satisfaction and quality of life.