‘Everyone Thought It Was a Minor Detail. For Me, It Was the Moment I Became a Woman’

Or Chen before the surgery, on the right, and after it, courtesy of the subjects of the photo. Most of the public discussion of gender transition focuses on hormone treatments or the major surgeries that accompany the process. These are the steps that get the headlines and the attention, but for many transgender women, it is דווקא the things that seem minor to an outside observer that accompany them every moment of the day. A prominent Adam's apple, a voice tone or certain facial features can affect a sense of confidence, the way the environment perceives them and, above all, the way they see themselves. Ahead of Pride Week, Or Chen's story illustrates how the journey to gender transition is not only medical, but also emotional, personal and profound. Sometimes an apparently small change becomes the moment when a person finally feels that the body and identity are speaking the same language. Seven years ago, Or, now 30, married and happy, was the first patient in Israel to undergo surgery to reduce the prominence of the Adam's apple without an external incision in the neck. The innovative procedure, developed by Prof. Avi Hefetz, made it possible to carry out the change through the oral cavity and avoid an external scar that might itself have become an identifying mark. For someone unfamiliar with this world, it may seem like an aesthetic detail only. For Or, it was a real turning point. The first moment she felt she was a woman. 'The goal is not only to change an anatomical structure, but to help the patient feel comfortable with herself and with the way she presents herself to the world.' Prof. Avi Hefetz, Studio Three Photographers, the surgery performed without an external scar. 'I had a very prominent Adam's apple and it bothered me a lot,' she tells Walla Health. 'My initial goal was actually the bottom surgery. That was the thing I knew I wanted to do from the moment I started the gender transition process. I didn't even know there was an option to get rid of the Adam's apple. When I heard about the surgery, I understood it was something that could help me feel more comfortable in my body.' The Adam's apple, which forms as the laryngeal cartilage grows during adolescence under the influence of testosterone, is considered one of the external features most closely associated with a male body structure. For some transgender women, it is a characteristic that can cause discomfort and even gender dysphoria, because it does not match their female identity. For years, surgery to reduce the Adam's apple prominence was performed through an external incision in the neck. But for some patients, the scar itself became a new problem. In response to this need, an innovative approach was developed that makes it possible to perform the procedure through the oral cavity, without an external incision and without a visible scar. 'This surgery became possible thanks to the experience we gained in endoscopic neck surgeries without an external scar,' explains Prof. Avi Hefetz, head of the Head and Neck Surgery and Oncology Unit at A.R.M., the multidisciplinary ENT center at Assuta Ramat Hahayal. 'We were among the first centers in the world to perform thyroid and parathyroid gland removals using an endoscopic approach through the oral cavity, without a neck incision, and in fact the fourth center in the world to perform such surgeries. After we acquired significant expertise in this approach, we realized the same principles could also be applied to transgender women seeking to reduce the prominence of the Adam's apple without leaving an external mark.' According to him, beyond the surgical challenge, the patients' need was also at the forefront. 'We understood that the scar itself could be a source of discomfort. We wanted to allow women to undergo the procedure in a way that would achieve the desired result without leaving external evidence of the surgery. For us, the goal is not only to change an anatomical structure, but to help the patient feel comfortable with herself and with the way she presents herself to the world.'

Or Chen today. 'I wasn't looking for perfection, I was looking to feel at home in my body' / courtesy of the subjects of the photo

'What I was looking for was peace with my body' The surgery was only the beginning of a longer journey for Or. She later underwent hormone treatments, breast surgery and additional procedures to adapt her facial features. But even now, seven years later, she clearly remembers that first step. 'In the end, what I was looking for was peace with my body. The bottom surgery was the main goal, but along the way hormone treatments were added, breast surgery and facial adjustments. Each one contributed something different to the process. For me, anything that helped me feel more comfortable with myself and more connected to who I am was worth doing.' Alongside appearance, the voice also plays a significant role in the gender transition process. While hormone treatments affect a range of physical characteristics, they usually do not change the pitch of the voice in transgender women after puberty. As a result, many women continue to experience a gap between their gender identity and the way they sound to others. At A.R.M., procedures for voice adjustment for transgender women are also performed, led by Prof. Hagit Shapol-Havakuk, an expert in vocal cord surgery, laryngeal diseases, breathing disorders and swallowing. Treatment in this field is tailored individually to each patient and may include a comprehensive assessment of voice characteristics, voice therapy by a speech-language pathologist and, in appropriate cases, also surgical intervention intended to give the voice more feminine characteristics. Voice adjustment is now considered a significant part of the gender transition process for many women, since the voice is one of the first characteristics people encounter in everyday interactions, on a phone call or in a professional setting. For some patients, creating better alignment between the voice and their gender identity contributes to self-confidence, comfort in society and quality of life. During Pride Month, Or Chen's story illustrates how modern medicine can help people create better alignment between the body, the voice and identity. For many in the transgender community, this is not only a physical change, but a significant step on the path to a life in which they can feel whole with who they are. 'I wasn't looking for perfection, I was looking to feel at home in my body. Today, when I look back on the path I went through, I can say that I have reached that place,' Or concludes.