This document discusses voice feminization surgery for transgender individuals. It describes the surgery, called cricothyroid approximation (CTA), which raises vocal pitch by stimulating the cricothyroid muscle to contract and approximate the cricoid and thyroid cartilages. The surgery is performed under general anesthesia on an inpatient basis. It involves making an incision in the neck to access the vocal cords, removing part of the vocal cords to shorten them, and potentially elevating the voice box. The goal is to change the voice from a male pitch range of 100-150 Hz to a female pitch range of 200-300 Hz. Follow up includes hormone treatment and suture removal after one week. Before and after photos show the reduction