Episode 29 - Voice Feminization and Tracheal Shave Surgeries with Dr Abie Mendelsohn

Watch Episode 29 here!

Listen to full episode :

If you've been thinking about receiving vocal feminization and/or tracheal shave surgeries, this episode is for you!

Vanessa is joined by the wonderful Dr Abie Mendelsohn of the Los Angeles Center for Ear, Nose, Throat and Allergy.

Amongst his many skills, he specializes in vocal feminization, as well as a newly developed NO SCAR tracheal shave!

If you're like Vanessa and are looking to have these surgeries, we hope you find this informative!

You can find Dr Mendelsohn on the web at:

https://www.trachealshave.com/

https://www.laent.com/

Additionally, you can follow him on Instagram @abie_mendelsohn_md

To find the Yeson Voice Center mentioned by Dr. Mendelsohn, check out this link: https://us.yesonvc.com/

Episode Transcript:

Vanessa: 0:00

Hello, everybody, welcome back to transcending humanity. This is episode 29. Already, it's kind of hard to believe. I am joined today by a special guest, Dr. It's Abie, right? Or Dr. Abie Mendelsohn,

Dr Mendelsohn: 0:14

AB - like the alphabet!

Vanessa: 0:15

Thank you. I might bring no worky I, I have a three and a half year old and he's just constantly sick and sleep just doesn't happen. So. But Dr. Madison, could you introduce yourself and let us know who you are? Let the listeners know who you are.

Dr Mendelsohn: 0:36

Thank you so much for having me. Hi, my name is Abie Mendelsohn. As you had mentioned, I have a number of potential titles, I am an otolaryngologist, I'm a head and neck surgeon, I'm a laryngologist, they all basically mean the same thing, which is, I'm a doctor, I do subspecialty in Ear, Nose, and Throat, but really, as a sub sub specialty, really just chosen to focus on the throat, all things related to throat any type of disorders is kind of where we're at concert. And certainly I have a plenty of singers and vocalist, I treat, unfortunately, plenty of cancer patients as well, that affects the throat. But what I've really been able to enjoy over the past, I would say, four to six years, as we continue to increase the ability to provide important gender affirming care is that aspect of my practice has really become such not only important aspect, just in terms of percentage, but really what it means to me emotionally and the rewarding aspect of that part of my practice. And so that's, that's who I am. That's where I am. Awesome.

Vanessa: 1:46

I'm did a little teaser this before we started recording, but this is actually very topical for me. Because pending insurance approval on December, I'm getting vocal feminization surgery. And so this is so exciting. Yeah, that's the time yeah, this couldn't be better. Oh, wow.

Dr Mendelsohn: 2:04

Okay, fantastic. Congratulations, obviously. But, well, no, no, there are some really, really fantastic and we all are learning from each other. And the fact of matter is, is really well, you know, I'm just saying in terms of my numbers are really being able to really collect a large group of our trans individuals who are getting the care that they need and deserve. Before that really was medical tourism. All our patients had to go outside United States and pay a hefty sum. And so when you look at kind of where all the other experiences, it's really centered, just in a few locations throughout the world, I would say for vocal feminization, for instance, South Korea, obviously really an incredible sight. And really, that's the technique that I use, because the main surgeon over there, Dr. Tam, he has a massive like 500, both feminization surgeries, that's something that us in the States, I mean, maybe a select few can can can bail us, but I certainly am not there, hopefully will be there. But now, again, to your point, Vanessa is just the confined so many really reliably excellent centers throughout the country. And that is something that I think is just so many different reasons to celebrate what the kind of where we're going. We're not there yet, but I think there's a lot to celebrate of, of how we're, how we're moving along.

Vanessa: 3:36

I mean, the very fact that insurance companies will even entertain it. I mean, I'm sure I'm gonna have a fight, but they covered my capacity three months ago, so I'm hoping they'll cover this.

Dr Mendelsohn: 3:46

I'll tell you, I had a patient legitimately Vanessa, like two weeks ago, and they were scheduled for bottom surgery orchiectomy. And we were hoping to do a combination that I can come in there also do a trick shave at the same time. Obviously, one recovery, I mean, the the benefits are obvious, we don't have to spend them out. But insurance said okay to the archy ectomy but like refuse the trach shape. And I'm just like, like, logically that makes no sense. Like what is happening right now. I'm thankfully at the last second literally 11th hour and it's because so many of our trans patients are true warriors in the best sense. She got that reversed and got the care that that that she needed, and ultimately were successful. But again, you just can't ever predict what they're going to say because I don't get

Vanessa: 4:43

it. The best prediction you can give when it comes to insurance companies is for them to say no, like they said no to my vaginal plasti. And it turns out it's because my surgeon's office just they just send over like the same like coats for everything. And the orchiectomy is on there and I they'd already had an orchiectomy done. So the insurance company threw it all out. And yeah,

Dr Mendelsohn: 5:06

if one things off, it's all about. And again,

Vanessa: 5:11

but I'm so sorry. It's insurance companies are the absolute ruin of I'm preaching to the choir here. But the absolute ruin of the medical profession.

Dr Mendelsohn: 5:21

Yes. But I think, particularly for for everybody who who's tuning in, I think it's important to realize sometimes we can feel like the world's like, stacked up against us. And it's like, coming right after us. I include us because I feel I'm in battle. Listen, I'm, I'm a sis man. But I still feel like I can say us, because we are all trying to achieve the goals and feels like it's stacked up against us. But it's having to do these fights with insurance for so many non gender affirming causes. It's just there. It's just how they operate. They just try to make our lives miserable. And so I think it's important for for anybody, either having undergone what we might say is close to emotional abuse, sometimes by by some of these last minute denials, or worried about what might come you know, it's, I think you give great advice, which is just like have really low expectations. So you don't have those, you don't fall down. But also understand that sis individuals also need to go through some of this sometimes. Yeah. So it's, it's just, it's a bad.

Vanessa: 6:34

It's like a stupid thing. You don't have it with medications to like, I have some toenail fungus right now. And my insurance denied one of the creams. It's like, you spent$160,000 to give me a pussy. But you won't spend 30 bucks to give me a cream? Yeah, I don't get it. Yeah, it's

Dr Mendelsohn: 6:54

Well, I think and then, as you can tell, we're gonna be able, we're gonna go off topic a lot. But my main gripe, listen, insurance companies need to stay in business, right? They can't just paid for everything.

Vanessa: 7:07

They have to make profit.

Dr Mendelsohn: 7:09

But here's what they don't do. They deny without providing an alternative solution. So do you can it's so easy to say no. But they you know, for the creaming, for example. They'll just tell you know, without saying, but here are three other things that wouldn't be acceptable. And so the lack of direction just leaving people at float, which at some times in their lives is catastrophic. It is. And that is not an exaggeration at all. No question about it. I absolutely. They're just like, sorry, not my problem. Like it is your problem? Yeah.

Vanessa: 7:48

It's, I just don't think, call me crazy. I just don't think insurance companies should be able to allow to override doctors. So yeah, because

Dr Mendelsohn: 7:57

like I said, we can guide us like sometimes we're just like, we won the, you know, the Rolls Royce of whatever. And they're like, well, we can't afford it. But you know, you can take the the Prius, and we're like, fine, but they'll just be like, No, you, you don't get to have anything. That doesn't really work that way.

Vanessa: 8:13

I know. There's I can't even remember the name of the doctor. He's a ticker talker. But most of his videos are about his conversations with insurance companies just like back and forth on the cell. It's better when you're watching some idea who it is, but colors, sorry, my dog is probably going to be making noise cameos, because listeners are used to it. She's jealous of the other dog who's upstairs, and whatever. But yeah, it's my advice. As someone who's been navigating the entire insurance thing. I use the Affordable Care Act and re sign up with Oscar insurance, which is the Cleveland Clinic insurance, which is where I'm getting everything done. But it's just stick with it, and your doctors will fight with you. So like, when I had problems, my doctors like, Oh, hell no. And, you know, they fix things. So. Yeah.

Dr Mendelsohn: 9:15

And yeah, I think wonderful advice. And I'd also say the doctor's office who are unwilling to fight and maybe are not in it for, like, the entire breadth reasons. You know, obviously, there are there are people who are just like, oh, you know, take those wackos out of my office. I don't want anything. You know, obviously, there's a lot to say like, you know, to offer gender affirming care. I think that that is celebrated and we need to appreciate. But you know, we need to be in this fight because the more we do, the better. And specifically, Vanessa, to your example about Oscar, I think a lot of people, particularly when deciding with insurance come Bernie's, specifically toward transgender care, feel this need to go to the top line like the blue shield's or signals or head. And as I'm actually in California, I got my honestly, we have a lot easier time with Affordable Care Act's and medical groups a lot easier time achieving gender affirming care than the quote unquote good insurance. Oh, yeah. So you know, you know, this, that's not necessarily reason to, to feel like, Oh, I'm gonna get the best insurance, and then I'll get the best care. We think about gender affirming care, that doesn't always match up. So it does take a little research

Vanessa: 10:37

it Well, yeah. And it's different state by state. I live in Ohio. And even though insurance carriers aren't technically allowed to discriminate against trans people, they do because they can get they can afford to get away with it.

Dr Mendelsohn: 10:49

Right, you just make your life miserable, miserable, that you're just not gonna get the care that you need. Yeah.

Vanessa: 10:53

So you have to do tons of research in advance. And Oscar honestly, was the only one that was that would cover my bachelor plasti. So that's why it's expensive, and I spent intuited. I only make $20,000 a year and then spend $200 a month on insurance. But yeah, it's what you have to do so. And, yeah, it's do your research. Do it very carefully. Anyone that might know what they're talking about, because it's hard, but it is the rewards are sitting right there. So someone that can fix your fix your issues? Absolutely. I can't wait for mine. I've I've done a lot of vocal training. Yeah. And like

Dr Mendelsohn: 11:36

I just I'm listening to your voice. I think you're doing so many wonderful things. And importantly, some of the things that we cannot address from a surgical vocal feminization surgical standpoint. Now there's, we can't just magically wave our surgical magic wand and just create a feminine voice. Now we can adjust pitch, we can do things to the vocal cords. But there are so many things and sometimes when our patients don't fully grasp it, and they think, Oh, just tweak my pitch, and then all of a sudden, I'm gonna go, man, woman is like, it doesn't really work that well. I love what you're doing. You have a softness to your voice. You're, you're speaking up in your face and really into the nose. Your cadence. Also, many of the things that you're doing vocally just screams screams. Woman to me. This is so it's fantastic.

Vanessa: 12:26

Thank you. I appreciate it. Especially coming from you. Someone knows what they're talking about. Yeah, it's because the surgery, it changes your pitch. And for me, I start falling down later, long throughout the day, and it starts going like this. And I started talking about my throat a little bit. Luckily, I don't go all the way down to my dead. Hate that sound so much. So but yeah, it's the surgery is it fixes pitch, but you still need to do training? Oh, yeah, no question about it. A lot of a lot of offices offer training as well. My surgeon's office, I found out about the surgeon through my through my doctor training. He was in the same office. So that's so great. Okay, well, I have a few questions if you would like to do a quick Oh, yeah. I

Dr Mendelsohn: 13:13

mean, I feel like we can just chit chat for like three hours. Yeah, like Yeah,

Vanessa: 13:17

it's, it's it's just kind of how we I work with this podcast, but perfect. Yeah. But basically, I

Dr Mendelsohn: 13:25

do some questions. It's great. Yeah, guide me. Otherwise, we'll be we'll get lost.

Vanessa: 13:30

But I'll start off with how did you get into the field of all this of bringing the end and I don't even know that. I can't remember the correct words for it.

Dr Mendelsohn: 13:42

Yeah, it's so long. It's almost Yeah, it's otolaryngology, which is actually a misnomer, because it stands for oto is for ears, and Laron is the throat, you know, so otolaryngology, but we're missing because ENTs actually oto Rhino laryngology that just Yeah, exactly. But that for some reason thought that that was too long. So we just went for the otolaryngology, but you know, I don't come from a medical family. I had no idea what hospital rounds were. I got most of my expectations of what med school was going to be like from watching er and George Clooney and seeing Dr. Carter go from medical student to attending physician and that was really kind of how I was figuring out what to do with my life. And it was actually quite by accident that I found this rotations Oh to learn how to end I didn't even it wasn't even on my my sights but I hadn't was kind of fell in love with surgery. Go into the operating room. Getting in there with my hands. Fixing a clear and obvious problems obviously doesn't always fix everything but you're you're accomplishing a singular goal with without surgery, and you work hard, then you go home. And then you come back and do it again. And what I loved about what I do head and neck specifically was it was such a tightly packed mess of anatomy that nerves and blood vessels and all this all this complexity, which I figured I can spend the rest of my life, just studying and getting better and getting better and really never achieving that goal. And that's something beautiful because we just want to continue to grow real lives, which with whatever we're doing. And then once I was like, Okay, I remember coming home to my wife and tell her that's it. I know, I'm gonna do with the rest of my life. And that was an exciting moment, because, you know, it only took me into my 30s but at least I got there.

Vanessa: 15:44

I'm 42 I don't know

Dr Mendelsohn: 15:46

exactly just what am I gonna do and I grew up. Then once I started getting more experienced within this field, really, the throat really the voice box in and of itself, for me was the most magical area. And the reason is, is because a we have no concept of how it all works. So when we think about the mystery, and being able to really study and, and continue to increase our knowledge, the voicebox is really kind of where it's at. As well as it's really what makes us human. You know, obviously the brain keeps us alive and we need a heart you know, you liver is very important. I'm not gonna say who's more less important than the lungs? I mean, come on, I You gotta you gotta breathe. When we talk about humanity, what do we do we communicate, we sing, we talk we eat, you know, we breathe. These are all the activities that the voicebox controls. I thought that that's really kind of defines us as who we are as people. And I thought, you know, what can be more beautiful if I can help people either preserve those functions or regain them after they go through something horrific. And so, for me, it was just, it was just, I knew this was what I wanted to do. It's,

Vanessa: 17:02

it's magical, really. So and as you said, it's such a complex area, that it's like a puzzle. It's a challenge. It's it keeps things interesting. I imagine. It's like playing operation, I guess,

Dr Mendelsohn: 17:13

it legitimately is, you know, it's I, you know, when we have trainees or students, I make that joke sometimes, like, I'll just pretend like you're playing the game operation. Unfortunately, I've dated myself a little bit, because not everybody knows about like, actual physical board games anymore. But

Vanessa: 17:28

you know, it's weird. I am. I'm raising. I'm a I'm an example raising and Shan alpha. And right, like, the kids they have in his daycare, they have like, office phones, that kids are like, what is this?

Dr Mendelsohn: 17:48

What is that antique is? Yeah, it has

Vanessa: 17:50

a cord on it. But what I feel sorry. So how did you get into the whole trans healthcare thing? How did you kind of jump into this whole part of the community? Right?

Dr Mendelsohn: 18:08

I think it was, you know, my, my kids, we can have kids, we can brag about it. Because my kids always laugh. You know, we all have like, quotable lines we're doing. And I always talk about like, my, my career path professionally is just one big happy accident just kind of fallen into the right place. Like I fell into e and t and then I fell into, you know, throat specialist calm, they're in college. It's just, it's just kind of like just around them always willing to help and say yes when I can. But after I was done with my training, what's called residency at UCLA, made the decision to actually go out to Belgium for some advanced training. Yeah, it was wild. The whole story behind that will take a whole hour. But anyway, I found myself in Belgium, learning laser treatments, and they were just ahead of the curve on so many different aspects in terms of surgical care and really minimally invasive, talking about preservation, particularly after cows. It's, it's, again, it's critical to why we're doing it. Why would you want to be cured of cancer if you can't ever speak or eat or do anything? Again, it's like kind of like, well, what's the point really then? So I was really excited to go out there. And in addition to being advanced in many ways, from a technical standpoint, certainly from I would say, a progressive and societal standpoint. Your was was also lightyears ahead. And so my first really true experience with transgender care specifically with vocal affirming care. Was Was there was in Belgium, and it was just, it was a dream. It was like what we always want, we want to find a way to truly be able to manipulate the vocal cords so that we can achieve this wonderful goal like it's not just for fun, it's not experimenting. And it was just like, oh my god, we this is possible. And for me, that was just incredible. Came back to my training came back to Los Angeles, I will got on faculty at UCLA. And I was like, Okay, I'm ready. And then obviously, the problem is, you know, it's not like we have like a ton of trans individuals with bags of briefcases of cash laying around. No, no, I have a lot of people like, oh, how can I get into this? You know, I'm like, Well, you can believe that you're helping someone. And, you know, if you get paid, that's nice. And, you know, just do your best. But yeah, this is not, shall we say, the Beverly Hills cosmetic practice that we see on you know, this is, this is truly, you know, a labor of love. So it kind of just fell dormant just because the opportunities weren't there. And then all of a sudden, again, about I would say, about six years ago, it really started all of a sudden, just kind of creeping up. Somebody's like, Oh, would you be willing to see someone who wanted, you know, either a trach shaver, or a vocal affirming, I don't remember exactly what, where it all started. But I was like, Yeah, of course. Yeah. This is amazing. And it was just one by one. And then all of a sudden, people like, oh, you know, who's doing that. And then, all of a sudden, next day, I know, it's 200 patients later, 250 pay? Like, what? It's just great. It's just been, it's just been this, you know, self affirming cycle, which is the more and get to do, the more people I get to meet, the more, the more I get to learn about this, the better I get. It's just been almost an obvious outcome where it's like, of course, you can't help but get more involved. Yeah.

Vanessa: 21:43

Oh, I am so happy that there are doctors like you out there. And it's because what a lot of doctors don't seem to have much care about any training on how I'm working with trans people and stuff like that. So like, I took someone like you, or Cecile Fernando, who is my, who's my surgeon for my vaginal plasti true allies to the community that are interested in us and, you know, are cheering, cheering us on? I mean, what you're doing, whether you realize it or not, you probably have saved a life or two, just for now. No

Dr Mendelsohn: 22:19

question about it. So yeah, yeah, a lot of times, I'll either have a chance to speak to someone in the hospital who is either ignorant, or hateful, or maybe a little bit both. And, and they really, you know, to give them as much credit as I can, they're really like downright confused. Like, why would you want to do this? This is like, why would you get involved here? And I, to your point, exactly. It's a very simple process. I save lives. I save lives, I help catch patients. And when I get to perform gender affirming surgery, or just having a gender affirming, therapy conversation, I save a life. And I know for a fact that I have like not like oh, it probably I have obviously, I will not tell you the the persons. But I know for a fact that I have, and it's fantastic.

Vanessa: 23:11

Do you have any, like memorable experiences or success stories from patients that you'd like to share? Anything?

Dr Mendelsohn: 23:17

Yeah. There is. There have been a few transformative, I see. Actually didn't, but I'm glad I did. It's almost like it wasn't meant to be. In when we do the post op visits, they've been a couple times where just we all just kind of like, what either it's vocally and or drink shave where it's just like, what just happened? So from that, that actually happens more often than that, which is again, one of the things like I just need to do this more and more. I would say there's there's really two stories that that stand out for me. One is a story that I tell often, which is as we're getting one of our patients ready for her vocal feminization surgery. Once anesthesia, the next step is to make sure everything's padded and secured, get the pads on the elbows, so there's no sores. As we were moving the arms I saw along the wrist, pretty deep slash marks, which were obviously not accidental. And it was just our point before it was just so reassuring that we are doing so much good in this world. And it was just it was it was crushing because understanding the pain that was involved to create those scars. But also knowing that potentially we were providing this safety blanket that that that can hopefully be just something about their past. Another just a wonderful, beautiful story. We just like just like yourself, and that's what we were able to do. Combined vocal feminization tradesave on a patient from out of state. And she called about six weeks later, and she said, I just I just wanted to call and just share with you a story. And I said, great, I'd love to hear it. Yeah, she said, she said, I just wanted to let you know that. I went to the gym yesterday, and she went into the locker room. And she said it was about 15 minutes before she forgot that she should be nervous. And it was so striking because for her, she she shared with me that that by far, going to the gym and going to locker room was the worst experience of her weekly routine, by far. And again, most of us individuals just don't understand that. Nobody likes the locker room. But it's not downright just panic stricken when you have to do that. So a we don't, we don't understand. But be it was such a beautiful journey that not only was she so secure In now, her her gender, but the fact that she didn't even remember that it was supposed to be anxiety provoking, I was like, and I was like, oh, did it? Yeah,

Vanessa: 26:27

I can relate with that. Like, that's one of the reasons I'm getting this done is because if I go into the ladies room, like what if I slip with my, with my training, and also I'm talking like this or something like that? And I'm like, Who is this guy in the in the bathroom? I'm like, Well, this guy's busy. I need this, I need to be here. But yeah, it's, it's, that's, that's a worry. And especially since I'm running, I'm running for office. And just to help with the whole, because I'm, I'm one of two trans women in Ohio running for office right now. But it's giving speeches and stuff like that. I might, my vocal modification, I tire out very easily. And with the pitch, so just be able to keep the pitch up. It's gonna help a lot, because I'm already fighting an uphill battle in a very conservative area of questions. So it's, it's a safety thing. So

Dr Mendelsohn: 27:24

yeah, you're exhausted. Let's say you're doing three different events back to back and you're doing nothing but talking shaking hands. Yeah. I have plenty of patients coming in for consideration for the local Femen surgery, who I walk in, and I legitimately have no idea why they're there. I'm like, Hi, what's your name, nice to meet you. And they start talking. I'm like, I have no idea why you're here. And, exactly to your point, either. It's just from mental exhaustion, physical exhaustion, the vocal cords just cannot continue in such effort. And then they'll also say, early in the morning, when you first wake up and roll over whoever is in bed with you. Maybe that's a safe spot. Maybe that's not late at night. And then after a few drinks, so it's just like, to your point, you want to go to the restroom, maybe you're you're having a cocktail, or six or seven. You know, now you have to go to the bathroom after so many drinks. And now you're just like, I don't like it. Am I allowed to talk? Can I talk? That's just yeah, those are, those are, those are thought processes again, that that I never have to do. Like, I had a few beers, I'm allowed to go to the bathroom. That's actually quite normal. So again, it's one of those things where I'm continuing to learn and understand like, what I think is very straightforward is anything but another

Vanessa: 28:57

thing that kind of factors into it, too is a lot of autism and trans and being transgender, there's up pretty heavy overlap between the two. I am autistic myself, a lot of my trans friends are autistic as well, it's become kind of a meme. And but when we're having an episode, it becomes really hard to maintain it maintain a voice as well. So that's I, I have a friend that um, she does amazing. Her vocal training is amazing. Her name is reverse she, she's on a podcast called Trans spotting. And like when I first heard it, I reached out to them because I'm like, reached out to her. Where did you Where did you learn to do that? And it's just how she just does it. She's amazing. But she falls into those times to where it's tired and this that and the other and it starts dropping down a little bit more. So it's, it's, you know, it's a thing. So a little bit of a trigger warning to the listeners and viewers. Hear just say no, you're being recorded for film too. I hope that's okay. Yeah, it goes on YouTube, okay. And I'm getting a little chicken warning, we're gonna be talking about the surgery kind of stuff here. So you for the trans community, you're mainly doing the vocal feminization surgery, which, from what I understand it's an endoscopic surgery. And so you have the, your vocal cords are like this, and you put a band is that the way that you do it, you put the band here between the kind of like, pulls it up a little bit more like a why.

Dr Mendelsohn: 30:39

Exactly, exactly, almost like a V to a y. And that's actually a pretty common medical term and plastic surgery where they try to do scar visions, they will actually make a V shape and they'll turn it into a Y shape. You can think about bringing a PECS down there have been a number of different approaches and techniques described to achieve this goal which is a natural sounding voice which is elevated within at least androgynous stone, but again, ideally within well within to what would be societally recognized as as feminine. The technique, I only offer one technique, because in my hands and mitogen and literature, there's one technique that really not only has the capacity to provide things like ability to sing afterwards, whether it's in the shower or on stage, it doesn't matter. They're both very, very important. But also has long term meaning not reversible, naturally. There's not just something that's going to pull apart. And so that's the technique that has been described out of South Korea, the decent voice clinic, you signed by the way why II SLN has a fantastic website, they got a great Instagram page, they do a much better job, and I mean much better job than I do in terms of getting the pre and post recordings. But again, what he had described his glottal plasti. There's a very long name, it's the vocal folds, shortening and Entercom, Usher retro displacement, which is just a mouthful. I've had to practice that a few times. His surgery basically, from an analogy standpoint, attempts to put a capo on the vocal cords. And a capo is that clip on the end of the guitar, which makes all the guitar sounds a little bit higher. And that's exactly what we tried to do, it effectively shortens the vibrations of the vocal cords. And by doing so, increases the standing or the comfortable pitch that's done through the mouth, like you're saying, under general anesthesia. So when a person is sleeping, were able to go directly through the mouth, bring in the microscope, look at those vocal cords, take off the very cover up the front part, we usually are estimating about 30 to 40% of the front, if you think about front to back the length of the vocal cord, and then through the mouth, which is it's a specialized technique. But with a little bit of practice, we're able to put a stitch down there and then put a second stitch to really try to taper up the vocal cords. And then we come on out, we're all done. Overall, that certainly takes about 45 minutes. So that's it's a really nice, straightforward, overall very limited amount of discomfort, a little bit of a sore throat for a couple of days, but particularly as you're describing, with the gamut of gender affirming care, specifically from from the feminizing standpoint, this would be one of them. More exactly. More mild interventions. However, I've had several patients Tommy, who have gone through several different surgeries, top bottom and face everything. They said emotionally, their vocal folds surgery was the most impactful surgery for them in terms of their own adjustment. I was trying to understand I didn't really fully understand why that shouldn't be so. But again, I think that they just saw, again, their own voice what they're ready to listen to who they are. And whether it was a top surgery that never defined who they are, in fact, quite the opposite. You know, that was they were able to kind of slide into exactly where they're supposed to be. Yeah. And for whatever reason, they felt like that adjustment after the vocal surgery was was was more jarring. Not to say they were not happy, happy, but it was, again, while it might be not as impactful physically in terms of the recovery, we don't discount again what that emotional journey will be. Yeah

Vanessa: 35:00

And excuse me out the, with the voice saying like for the other things that about, like, getting top surgery bottom surgery is I smacked my mic. It's when you talk, you're noticing that a whole lot more like the changes with your body. It's more like me, I look down I have tense, but like other things like, you don't notice as much. But your voice you hear it all the time, and you quite literally hear in your head and just be able to just talk and have the voice that matches who you are. Come out of your mouth is a huge fucking thing. So it's I kind of like to think what you're doing is you're tuning in organic guitar almost. So yeah, it's like a dream read instrument that you're joining. So that's exactly right. It's pretty wild.

Dr Mendelsohn: 36:00

Oh, I love it. It is so so cool. It's yeah, yeah. It's hard not to get excited about these kinds of things. Yeah, it's. And what it also is cool is a lot of times when we're doing these vocal surgeries, everybody in the operating room, particularly people who a may have zero experience with any type of journaling for me care, or even those who have been on the frontlines have never seen this one. They're like, wow, that one really is something new. Yeah.

Vanessa: 36:28

How often? Like, I know for two weeks after surgery, you can't talk. Yeah, right. That's gonna be interesting. For me as a parent, I actually already I put an app on my phone where I can type in phrases and let my own tell to my kid. Exactly.

Dr Mendelsohn: 36:44

Yeah, that's a good one. What? You can buy some tennis balls and Sharpie them and throw them There you go.

Vanessa: 36:52

Just what you need some more things to throw back. Toddlers know the taters. The kids even started do stepping lately. I'm like, come on. Stop it. They know how to push the button. Yeah, they do. So it's a permanent surgery. Correct? How often do things family?

Dr Mendelsohn: 37:20

A great question. Obviously, it depends on what you mean by fail. When when I when I hear that question the way i i understand that is catastrophic injury to the vocal cords meaning not only do we not achieve our goals for gender affirming care, we've actually destroyed the vocal quality all together. And and I've seen patients come out of surgeries with horribly scarred vocal cords, where they found like 90 year old smokers and is not pleasant to listen to him again, we don't work. We move away from Jennifer McCarron just salvage any type of what we'd consider like a clear sounding voice. Yeah, that is a failure. Thankfully, that's never happened to me. But, you know, I think you do surgeries long enough and really bad stuff may end up happening. Always. Yeah, always a risk. I think that that may happen for two potential causes. One is surgeon who may not be over whelmingly familiar with the techniques and kind of how to make sure to keep the remaining vocal cords safe. Obviously, it's it's important, but even in the best and most experienced surgeons have bad things happen. What I mean by bad things is I had one patient and this was earlier on in my my recent experience. She suffered, I think one of the worst sinus infections that I've ever seen, like within three days after the surgery and she was just pouring down the Quillen of acid which was just thick mucus down onto the vocal cords. And when by the time I got to sorrow, see er, which was like, I think it was like four or five days later. Her vocal cords are all just so beefy read, I was terrified, absolutely terrified that the worst that failure had happened. So sometimes it's just dumb, bad luck, for whatever reasons, and usually it's from an illness. That happens very quickly after surgery. We were able to save that person's voice and the reason why we're able to say but basically what I did was something I do now all the time, was I injected her vocal cords with Botox. Really? Yeah, everybody gets Botox. So now everybody gets vocal Botox about Botox does for our foreheads is it weakens the muscles so that they can't crinkle together and And because those those lines that may not be the most attractive. But so we were looking to weaken the vocal cord muscles so that they can't too strongly and they can't overdo it during the healing phase and fortunate for Beverly Hills, plastic surgeons, Botox wears off, so they have repeat customers. So for us, it's perfect, it allows the two to three months of a healing time to kind of ramp back up. And so earlier on, I was holding it back in terms of just crazy situations like that sinus infection. I just, I just went crazy with the Botox, I'm like, we're just shutting your vocal cords down, and we're gonna hope that they heal and they did. Obviously, we also treated the sinus infection. But now, every single one of my vocal pulled surgery patients before we're ready to wake up, you get a shot of Botox and teach vocal cord, and then we wake up. And so that just really helps that time period after those two weeks, or even I say within those two weeks, the best story and my patients will tell you I say the story all the time, like what happens you're watching an old lady across the street and the bus is about to come. You can't help but yell like and stop, don't walk, but your invoice rest. But hopefully your body reaction just takes over. And so what the Botox does is just prevents you from unwittingly putting too much pressure on those stitches, even within those two weeks, just in case after

Vanessa: 41:32

space surgeon if he does that. It's interesting. So I'll probably send this episode to him. But give me some Botox bearish? Yeah, exactly. Come on. It Well, now it's it sounds like it's a failsafe. So it really

Dr Mendelsohn: 41:47

is. It just allows when we talk about vocal feminization surgery being more of a safety net for so many of our patients who are actually able to achieve a passive voice, for the most part. Yeah. I would say about toxins the same thing. In other words, we I even know for compliant patients. I know they're gonna do exactly what I asked him to do. And then they're ready, good. They've done the vertical training that they're planning to do go back. They even get the Botox for sure. People are like, I don't know.

Vanessa: 42:19

That's awesome. So next I want to cover before we run out of time, the tracheal shave, which the other part of it for listeners and viewers tracheal shave is people with Adam's apples, which sis women get Adam's apples to it's, yeah. But like mine, I have too much neck fat right here. So you can't even see my Adam's apple. But I know I have one because my senior photo when I weighed like 80 pounds less than I do now. I have it there. So I guess I'm like, if I can get my insurance to approve these surgeries, I'm just gonna have to do both at once. Because they're already you're already in that area already getting stuff healing there. So that is going to be that one. You have a special technique for that. Am I right? Where he's getting those slides.

Dr Mendelsohn: 43:06

I'm getting engaged. I'm gonna giggly now because this is this is something that that I just, just while the reason is, because it's been about four hours since I did my last one. So yeah, the it's just something I'm just so excited about. And I am very hopeful spell that eventually, it's going to be so the traditional surgery for tracheal shave is again, to reduce that Adam's apple, there's really no part of the body outside of genitalia that is so gender dominant than the Adam's apple. To your point, there are plenty starlets on the red carpet that have very visible voice boxes, you can kind of see every crease and crevice in their neck. But importantly, while you're able to oh, there's a piece of cartilage or none of those bumps are really much more dominant than the rest. That's some scientific studies. three millimeters is like kind of a threshold once you go above three millimeters outside of the neck more than the other contours. That's considered masculine. But obviously, the outside experience of someone is a very small part of what's going on. I think, to your point, I've had many patients who had tracheal shave that externally, I'll never be able to see that. See me that Adam's apple. And I abhor this, this concept where surgeons will say, Oh, you don't need it, because it's not for me to say whether someone needs it or doesn't need it. Yeah, I'd probably patients is I just know it's there. And it's not part of me. Exactly. That's all it is. It's a very simple process. So this idea, again, back to our earlier conversation with so it's like insurance company want pictures like pictures. What are you talking about? What, what, who's who's given the stamp of approval? Anyway, as you can see, I can go off on that. But the point is, is that the Adam's apple is Holy masculine, it needs to come off. And the good news, the Adam's Apple itself, that extra cartilage does really nothing. For us, it provides no purpose. So we can get rid of that pretty quickly. Now, we do need to be careful because just below the Adam's apples where the vocal cords are attaching on the inside. And so if someone's fully concentrating on the aesthetics of how a neck looks, and not remembering so much that the vocal is on inside, then we can get that other type of catastrophic injury again, losing the voice because that the vocal cords have been sheared off, literally. And so. Yeah. So again, looking for someone with experience, understanding how to keep those vocal cords safe is pretty, pretty critical. But again, traditionally, what the surgeries were were described is you either make a cut along the Adam's apple, I'm very fortunate I have a really nice, really nice example I can make out on my patients. Yeah, there was like think thankfully, I'm like, I didn't have to go to the anatomy books I got to write here. Either make a cut directly along where the Adam's apple is, or some surgeons will go just a little higher, underneath that crease under the jaw, go down, find that take down the extra cartilage come out that up really nice. I've, I've always been somewhat conflicted about that surgery because I feel as the surgeon I'm making a person choose between living a life with the Adam's apple, versus the potential of a scar. And sometimes scarring is not too bad. Sometimes scarring is horrific, always catches the eye depends on the person well, and you don't know until it's too late. It's really hard. And some people like oh, I healed very well. And I've seen that and then they don't heal well, next time is a million different factors. So it's just a roll of the dice. And so I was felt somewhat, not guilty, but like, Am I really doing the best I can. So we sought out really about four years ago to change this whole paradigm, saying, Can we do a tracheal shave without any cuts on the skin. And thankfully, now about 185 patients later, I can very much say that we have done so what we do for our tracheal shaves is make a cut on the inside of the lower lip. So hold that out, and then go along the cut right in front of the bottom teeth. soft spot, go underneath the chin. And with the camera called endoscope, we'll use the camera to get down there under the surface. And we can get down to the cartilage. I have this long pincer looks like maybe like a toenail clipper, a little bird to curb down any contour and make sure there's no sharp edges. Come on out with some absorbable stitches on the inside that lower lip. And I would say Good as new. But it's even better than new. It's been really exciting. The first, the first several patients obviously, there was a large discussion, hey, I Oh, you know, we're trying to do this. And a lot of patients came along that journey with us at this point, we got the technique and the instruments down to them to really something that it's it's quite, quite rote. And I'm I'm hopeful that this is not just something unique that one person is doing. I really hope that eventually as we continue to show that gender affirming care is just healthcare. It doesn't require it's just healthcare. It's just, there's someone who I can help. I want to help that person. That's what we do. doctor and nurse. So we all do the same thing, which is we find people that we have skills to help and we need to help that person. That's it. It's as simple as that. I'm hoping as we continue to see that, I would say acceptance and participation. That really tracheal shave is something that never cuts the skin because someone shouldn't have to worry that a scar where the Adam's apple used to be, could be just as outing as Adam's apple.

Vanessa: 49:29

I'm going to have that scar because I know my surgeon does it this way because I transfer the head of done. But that's that's that's what you're describing. That's a pure art is what you created a new art form. So it's so cool.

Dr Mendelsohn: 49:48

I gotta be honest, like I A lot of times I'm like, oh, you know, it's no big deal. I'm like, not this one. I love I love what we do. It's again back to like Give me a chance to have like a new CIRCULATING NURSE in the operating room new anesthesiologist who literally has no idea what they're about to walk into. Yeah, they're just like, I'm like, you're gonna see something really cool today.

Vanessa: 50:13

That is just Oh, that is so cool. Yeah, that. That's that that was one of the things that I know. It's It's like your PTSD results that we saw. So. Yeah.

Dr Mendelsohn: 50:25

But yeah, it's it's what I feel like I can actually say like, I contributed something. Yeah,

Vanessa: 50:31

definitely. And I hope that spreads, use, like conventions and stuff and talk about that, or,

Dr Mendelsohn: 50:37

yeah, absolutely. Yeah, we've been, we've been presenting how we've been a few publications, I think like three different publications in the medical journals. Right now writing a textbook with my amazing friend, Dr. Justin Lee, who was like, an incredible facial femme surgeon at UCLA, she is like the coolest person ever. So she's reading a textbook and gonna get that chapter in there. So again, just making hopefully just standard part of, of gender affirming care.

Vanessa: 51:05

Yeah, that's, that's amazing. This is love it. This is so fun. I really hope that people watching and listening to really find this informative, because just finding information on any sort of gender affirming care, overall, most of the times people just have to go to read it and just hear it from other people. So it's very rare to have I know, my, my, my vaginal plastic surgeon also wants to be on the show, because it's very rare to have a doctor on here that can just have a conversation saying this is what this is, and answering questions that way. And it's educational. So I hope that people find this episode extremely helpful. And, yeah, thank you so much for joining me. Do you have any, like any final thoughts or anything that you want to just kind of spill out there at us?

Dr Mendelsohn: 51:58

Yes, I first of all, wanted to say thank you, Vanessa, for inviting me on your show and allowing me to have the platform to you and your audience. I just enjoyed myself tremendously. I wish I wish you continued success on not only your possible podcasting activities, but in your social services, and hopefully attaining offices and continue to contribute. You are you are you are doing some fantastic things. And I wish you all the success. Yeah, from a from a parting words, I would just say it's very important that anybody who is even within the realm of transitioning, certainly transitioning and then beyond, or having transitioned. Even well before that, understand that there's so much so confusing, and so overwhelming. There's so much mystery and even worst anxiety and even worse than that true hate and violence out there. Please understand, you're not alone. Please understand that just because you come and meet with a surgeon does not mean you're getting surgery, it just means you're collecting information. There are so many times when someone comes in, we have a very long conversation. And they say thank you so much. I'll call you if I need you. And I say fantastic. That is not a waste of my time, I feel really privileged to have been able to contribute in some way. It's not like if you don't want surgery, get on my office. Yeah, it's really something that there's so much out there. Unfortunately, it does take a little bit of effort, takes a little bit of investigation, speak to people, hopefully face to face. As you mentioned, Vanessa, I think there's so much misinformation, just on general searches, even within Reddit. So hopefully speak to actual people understand you're not alone. And there's some good information out there just to let you know that there can be a plan in place. And even when that plan is, hey, we'll check in with you get in a year from now or whatever you need. Or let's get out to your insurance company and gets you all these things that you actually do need, you know, whatever it is they want people have have a preset agenda. Oh no, you need to do top and bottom. But you got to know No, that doesn't work. Everybody's got their own thing. It's got their own path. And it really is for us, the medical community to just be primarily listeners and when we can intervene we will intervene and

Vanessa: 54:41

educate so yeah, but and also now like people have this this episode where it's the a lot of information I'm sure I mean, someone meeting you in person, it's gonna get a whole lot. Go a whole lot more in depth, but this is kind of a good if anything a Cliff's Notes on Alright, so it's So it's amazing. I'm so glad that we were able to get you on here. How can people follow you? Where can people find you have

Dr Mendelsohn: 55:08

it perfect. All all roads lead to the website. Please visit our groups page what you'll find all all things gender and non gender related. If you're having some ringing in the ears, we'd love to see a but certainly I would love to have a chance to speak with you if there's any gender affirming care needs. Our website is www.la Los Angeles, la NT, la e and t.com. That's simple. Yeah, exactly. That one's pretty simple, straightforward. That will kind of lead you everywhere else. But we also have WWW dot tracheal shave.com, which I got to show off some of my scarless outcomes. We love that one. I kind of like like that one school. So that's a website dedicated purely for the scarless approach for the tracheal shave. And then my Instagram where I get to show off some of my outcomes. Again, both from we're doing some great things with the robot and for cancer and HPV but also predominantly from gender for me standpoint, because those are the coolest videos. My Instagram is my first name Abie underscore Mendelson. Underscore MD at Mendelson, MD. Check me out. See if you like it.

Vanessa: 56:28

I just followed you. Thank you as you're talking. Awesome. Yeah. Well, thank you again for joining us. For the listeners, watchers on all that stuff. Remember, like comment, subscribe, follow rate us, donate to our Patreon, all that wonderful stuff to keep the show going. Dr. Mendelsohn, thank you so much for joining me this week. And I can't wait for you to see this episode. So it's usually early on Friday mornings. So once again, I'll wake up early. You have to wake up too early. All right. Good stuff. Thank you so much for joining us. It's been a pleasure. You too. Thank you.