he laryngeal prominence, or Adam's apple, is formed by fusion of the anterior borders of the thyroid cartilage laminae. [1][2][3] Until puberty, the male and female larynxes are equal in size. 1,2,[4][5][6] During puberty, however, increased testosterone levels stimulate growth of the male larynx, 2,4-7 most prominently the thyroid cartilage. 7 In addition, the male thyroid cartilage laminae fuse in the midline at an approximately 90-degree angle, while fusion of the female thyroid cartilage laminae occurs at an approximately 120-degree angle. 3,5,[8][9][10] As a result, a more pronounced laryngeal prominence is formed in males. 3,8 Therefore, the laryngeal prominence is perceived as a distinctly masculine secondary sexual characteristic. 2,8,10 Chondrolaryngoplasty, also known as Adam's apple reduction or tracheal shaving, was first described in 1975. 1 (Tracheal shaving is a widely
Volume 149, Number 4 • Letters 829e adults to provide normative data on laryngeal prominence size in the general population, because these data were lacking. In addition, we aimed to define the recommended maximum laryngeal prominence size in adult females to propose an adequate laryngeal prominence size standard for chondrolaryngoplasty in male-to-female transgender individuals, because evidence-based guidelines for gender affirmative facial surgery, including chondrolaryngoplasty, were lacking. We have not intended to use the 2 mm in absolute terms to evaluate chondrolaryngoplasty results.We agree that patient satisfaction is the most important factor in evaluating surgery results. Regarding patient satisfaction, both passability (a transgender individual's ability to be perceived as their self-affirmed gender) 2 and patient expectations play an important role. Therefore, one of our currently ongoing research projects focuses on the satisfaction with facial appearance and the quality of life in trans women with and without a history of gender affirmative facial surgery.In conclusion, our study was a first step to assess the laryngeal prominence size in the general population and to propose a laryngeal prominence size standard for the indication for chondrolaryngoplasty. The results provided in this study certainly give direction to future research. By further investigating laryngeal prominence size and volume in relation to the surrounding structures and assessing patient satisfaction and quality of life in relation to gender affirmative facial surgery, we can move toward a standardized yet individualized approach to chondrolaryngoplasty in male-to-female transgender individuals.
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