The Ultimate Trans Guide to the Adam's Apple
May 07, 2026
Whether you want to shrink your Adam's apple, grow it, or just finally understand what it actually is, this is the guide for you.
As a gender-affirming voice teacher, I find the Adam's apple comes up a lot. It's visible, it's culturally loaded, and for many trans and nonbinary people, it can be a real source of dysphoria. But it's also one of the most misunderstood parts of the body when it comes to gender and transition.
So I did a proper deep dive: the anatomy, the research, the surgery options, and what all of it means for the voice. I also brought in two expert guests: speech-language pathologist Tallulah Breslin and fellow Canadian trans voice teacher Voice By Kylie to add their expertise to this subject.
There's a lot to cover, so let's get into it.
Watch the Full Video
Prefer to read? Keep scrolling for a complete breakdown of everything you need to know about the Adam's apple: what it actually is, how puberty shapes it, what you can and can't change, and what it all means for your voice.
What Is the Adam's Apple, Actually?
Before we get into the trans-specific questions, let's get grounded in some anatomy because understanding what the Adam's apple actually is makes everything else make a lot more sense.
The Adam's apple goes by several names: the laryngeal prominence, the thyroid notch, or the more official-sounding Pomus Adamus. Whatever you call it, it's part of the larynx so we need to talk about the larynx first.1
The larynx is a tube-like structure you can feel in your neck. Its primary job is to act as a valve, preventing food, water, and saliva from entering your lower airway. Its secondary but equally important function is that it houses your vocal folds, which allow you to speak. If you place your hand gently on your neck and hum right now, you might feel them vibrating.
The larynx is a composite organ, meaning it's composed of several types of tissue: cartilage, ligaments, muscles, joints, and more. There are actually six (or nine, depending on how you count) separate pieces of cartilage in the larynx. For our purposes today, we're focusing on one: the thyroid cartilage.
The thyroid cartilage acts as a shield that protects your vocal folds, which are anchored to the back of it. It's made of two plates with small horns at the back, and crucially, those two plates meet at the front and form a point. That point is the laryngeal prominence. Everybody with a larynx has one.
It's typically only called an "Adam's apple" when that point is visible as a bump in the neck, and that's where individual variation (and puberty) comes into play.
Want to learn more about vocal anatomy? Check out the related posts below!
Gender-Affirming Voice 101: Vocal Anatomy
Vocal Anatomy: Understanding Your Voice
Degendering Vocal Anatomy
Who Has an Adam's Apple?
Here's something that gets lost in most conversations about this: anyone of any gender and any hormone configuration can have, or not have, a visible laryngeal prominence.
This isn't a political statement, just anatomy! There are cisgender women with very visible thyroid cartilage, and cisgender men whose laryngeal prominence is barely noticeable at all. While puberty can play a role in the size, shape, and position of your thyroid cartilage, like all things related to sexual dimorphism, it exists on a spectrum and ultimately comes down to individual genetics.
So before we go any further: a visible Adam's apple has never belonged exclusively to any one gender.
Puberty and the Larynx
That said, puberty does affect your larynx, and understanding what it does (and doesn't) is genuinely useful.2, 3
During endogenous puberty, the larynx's diameter almost doubles in size, and the angle of the thyroid cartilage changes. This happens whether your puberty was testosterone-driven or estrogen-driven. However, testosterone-driven puberty typically results in a thyroid cartilage that is slightly larger and with a sharper angle, and that larger size and sharper angle are what can produce a more visible bump in the neck.
That's the anatomy covered. Now, let's get into the questions people actually come here to ask.
Transfemme Concerns
Can HRT Reduce the Appearance of Your Adam's Apple?
Unfortunately, the effects of testosterone on the thyroid cartilage are permanent, and taking estrogen cannot reverse them. The cartilage that grew during a testosterone-driven puberty stays the size it grew to.
There is one small caveat worth mentioning: a study of 105 cisgender men and 105 cisgender women found that thyroid cartilage continued to grow throughout the lifespan in the men but not in the women.4 It's reasonable to wonder whether androgen blockers might prevent further growth for trans women. That said, the observed growth was very small (less than 1% per decade), and the sample size is modest, so this should be taken lightly until more research becomes available.
Can Puberty Blockers Prevent the Formation of an Adam's Apple?
Absolutely, yes. Preventing testosterone-driven laryngeal changes is far easier than correcting them after they've happened, which is one of the many reasons puberty blockers are genuinely life-saving care for trans teens.
Can Voice Training Reduce the Appearance of Your Adam's Apple?
This one is more nuanced and a bit interesting.
If your approach to voice feminization involves raising the larynx to create a brighter resonance, you may notice the bump in your neck becomes less noticeable when the larynx is in that higher position. This makes anatomical sense: when the larynx moves up, the prominence shifts with it.
However, it's not a good idea to hold your larynx in a raised position all the time for the purpose of concealing the prominence. Your muscles need to rest and stretch — keeping any muscle in a sustained contracted position leads to tension, discomfort, and fatigue over time.
There's also another wrinkle: not every approach to voice feminization involves larynx raising at all. Many people find it overly taxing and instead achieve a brighter resonance by modifying the shape of the mouth. In those cases, voice training would have no visible effect on the Adam's apple, and that's completely fine.
Voice training is for your voice, not for your neck. These are worth keeping separate. If you're interested in learning more about voice feminization, check out these popular posts below.
How to Achieve a Deep, Low, Dark Feminine Voice: A Complete Guide
How to Shout, Cough, and Laugh with a Feminine Voice: A Guide for Trans Voice Training
The #1 Exercise for a Lighter, Feminine Voice (Backed by Science!)
Can You Have Your Adam's Apple Surgically Reduced?
Yes! The procedure is called a chondrolaryngoplasty. You may have heard it referred to as a "tracheal shave" or "trache shave," but that's actually a misnomer. The procedure reduces the size of the thyroid cartilage, not the tracheal cartilage. The name just stuck.
Does a Chondrolaryngoplasty Affect Your Voice?
Ideally, no. When the procedure is done correctly with appropriate precautions to protect the voice, a chondrolaryngoplasty should not affect how you sound. I spoke about this with voice-specialized speech-language pathologist Tallulah Breslin in my earlier conversation about voice feminization surgeries. Here's what they explained:
"You can go in through an open surgery — there are now some methods to go under the tongue, but most of the time it's open — and shave down the top part of the thyroid cartilage. The issue comes up because the vocal folds insert right below. If you shave too low, you can damage the anterior commissure — the place where the vocal folds connect.
There's a really easy fix to protect the voice: you go in with a camera, look at the vocal folds, and put a needle where they insert into the cartilage. That allows you to do two things: maximize how much you can remove because you know exactly how far is too far, and keep you from shaving too low so you don't damage the voice. The surgery is inherently not a voice surgery — but if it isn't done safely, it has the potential to damage the voice."
— Tallulah Breslin, speech-language pathologist
If you're considering a chondrolaryngoplasty, Tallulah's guidance is simple: ask your surgeon directly what they plan to do to protect your voice. That single question can tell you a great deal about whether you're in good hands.
If you haven't seen my full conversation with Tallulah about voice feminization surgeries, it's well worth your time. You can find it here: Voice Feminization Surgery Explained with Tallulah Breslin.
Voice Feminization Surgery, Explained (with Tallulah Breslin)
Interview with Voice By Kylie: What Can Go Wrong?
While researching this video, I came across a post by fellow Canadian trans voice teacher Voice By Kylie about the complications of chondrolaryngoplasty that can affect the voice, specifically, things she has observed in her own teaching practice. She very generously agreed to come on the channel to discuss it.5, 6, 7
Below is an edited summary of our conversation. Please watch the video above for the full exchange.
What voice-related effects have you seen after chondrolaryngoplasty?
Kylie described a range of effects she's observed in students who have had the procedure:
- Loss of upper pitch range — difficulty reaching higher pitches, sometimes accompanied by warbling or instability at the top of the range
- Loss of power or projection — not necessarily a quieter voice, but a reduction in the fullness or carrying quality
- Compensatory tension — some people end up recruiting neck muscles and jaw tension to try to pull the larynx up, because the mechanism that used to do that job no longer has the same leverage
- A chronic-cold quality — a voice that sounds like there's always mild swelling happening
Why does the loss of upper pitch range happen?
Kylie explained that the cricothyroid muscle (which stretches the vocal folds to increase pitch) can lose leverage after the cartilage is reduced. When those vocal folds can no longer be stretched effectively, instability in the upper range follows. "It's very indicative, very fast — the things I'll hear," she said.
Does this happen to everyone?
Kylie was candid here. In her experience working with clients both before and after the procedure, all of them experienced some degree of change, though the nature and severity varied considerably. The most consistent pattern was difficulty accessing higher pitches. She noted one client who appeared largely unaffected and acknowledged that more research is needed in this area.
What can you do if you want the surgery but also want to protect your voice?
Kylie's practical suggestion: ask for a more conservative approach, meaning less reduction overall. The more cartilage that is removed, the greater the potential impact on the voice. "That super slim profile looks great," she said, "but if you're planning on working with your voice, there can be some consequences." She echoed Tallulah's advice as well: ask your surgeon what they plan to do to protect your voice before agreeing to the procedure.
What if you've already had the surgery and are experiencing these effects?
This was the most encouraging part of the conversation. Kylie's message: not all hope is lost.
If you've had a chondrolaryngoplasty and are experiencing voice changes, the approach simply shifts. Rather than targeting pitch, which may now be harder to work with directly, the emphasis shifts to resonance: modifying the shape of the vocal tract and changing what the tongue and mouth do to create a brighter sound without relying on larynx height. "There are still pathways to get you the voice you want," Kylie said. "It's just going to look a little different for you."
And as both Kylie and I noted, individualized voice training always looks different from person to person, regardless of surgery history. Voice training is not and should not be a one-size-fits-all process.
You can find Kylie at voicebykylie.com.
Transmasc Concerns
Now that we've covered the transfemme concerns, let's move on to transmac concerns!
Can Testosterone Increase the Appearance of Your Adam's Apple?
Maybe. And I mean that sincerely, not as a dodge.
How testosterone affects your thyroid cartilage depends on two things: your genetics and your age. On genetics: if you're on testosterone and wondering how your larynx might respond, looking at the cisgender men in your biological family can give you a rough indication. The same genes shaping their thyroid cartilage are at work in you.
On age, this is where things get more complicated, and it's worth spending a moment on.
Cartilage Mineralization: What It Is and Why It Matters
As we age, the larynx cartilage undergoes a process called mineralization—it begins to harden (calcify) and eventually turns into bone (ossify). Once cartilage has ossified, it becomes less responsive to hormonal signals, including testosterone.
So if you start testosterone after your cartilage has already partially ossified, the potential for visible laryngeal growth may be reduced.
Here's the part that surprises many people: this process can begin earlier than you might expect. One study on laryngeal cartilage calcification found evidence of it in 130 out of 695 participants under the age of 20.8 The same study found that calcification progresses more quickly in cisgender women than in cisgender men overall, reaching 100% by around age 30 versus age 50 in cisgender men. (There's an interesting open question about whether taking testosterone could slow that mineralization process. It would be fascinating to see research on it.)
The honest bottom line: without an X-ray, there's no way to know where your cartilage falls on that spectrum, which makes predicting how much testosterone might change your Adam's apple genuinely difficult.
That said, I want to say something about this, because I've seen it become a real source of anxiety for people considering T. Please don't let the ossification question carry more weight than it deserves. I understand why it feels significant: when you're hoping for a particular outcome, the idea that a process you didn't even know was happening might have already changed what's possible is genuinely frustrating. But zoom out for a second. Testosterone does a great deal for the voice and body. The Adam's apple is just one variable among many, and a visible laryngeal prominence was never guaranteed for anyone, including cisgender men. Whatever your cartilage is doing, it's one piece of a much bigger picture, and even if you don't get every outcome you hoped for, testosterone can still be a wonderful, affirming part of your transition.
If you're exploring what testosterone does and doesn't change about the voice, check out the related posts below.
Voice Training for Transmascs: Before, During, or After T
Singing on Testosterone: What Trans Singers Need to Know (Interview with Eli Conley)
When Testosterone Doesn't Change Your Voice: A Transmasculine Voice Journey
Can Voice Training Increase the Appearance of Your Adam's Apple?
No. Voice training changes how your voice sounds. It doesn't alter the size or shape of your cartilage. A more prominent Adam's apple isn't something that can be trained into existence.
Can You Have Your Adam's Apple Surgically Enhanced?
Yes! And this was one of the more remarkable things I came across while researching this video.
There is a relatively new technique called thyroid cartilage augmentation, in which a small piece of donor cartilage is taken from the rib, carved into an Adam's apple shape, and grafted onto the existing thyroid cartilage.9 The results in the paper I read are genuinely striking! I wish I could show you the before-and-after images directly, but all of my sources are listed below if you'd like to read further and see the pictures yourself.
Does Thyroid Cartilage Augmentation Affect Your Voice?
Honestly, there's no good answer to give here yet. There is essentially no literature on the vocal effects of this procedure, and I haven't encountered anyone in the voice teaching world who has worked with a client who has had it done.
If you have had thyroid cartilage augmentation surgery, I would genuinely love to hear from you. Please leave a comment on the video because I read every single one.
Putting It All Together
Whether you came here wanting to shrink your Adam's apple, grow yours, or just understand what that bump in your neck actually is — I hope this has given you what you were looking for.
The thing that strikes me most about this topic is how much anxiety tends to gather around one small piece of cartilage. And I understand why. It's visible, it's culturally loaded, and for a lot of trans people it can be a genuine source of dysphoria. But I hope this has shown that the Adam's apple is just one variable in a much more complicated picture — and that there are more options available than most people realize, whether that's surgery, hormones, voice training, or simply the reassurance that a visible laryngeal prominence has never belonged to any one gender.
If you have questions I didn't answer, leave them in the comments on the video — I read every single one. And if this post was useful to you, please share it with someone who might need it.
Want to go deeper on gender-affirming voice work? My free one-hour masterclass, Change the Gender of Your Voice: No Hormones or Surgeries Required, is a great place to start whether you're transfeminine, transmasculine, or nonbinary. I'll walk you through the core concepts, and you can see whether working with me feels like a fit.
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Sources
- Brennan, P. A., Mahadevan, V., & Evans, B. T. (Eds.). (2015). Clinical head and neck anatomy for surgeons. CRC Press. (p. 210)
- van Gijn, D. R., & Dunne, J. (2021). Oxford handbook of head and neck anatomy (S. Standring & S. Eccles, Eds.). Oxford University Press. (p. 262)
- Sturm, A., & Chaiet, S. R. (2019). Chondrolaryngoplasty—Thyroid cartilage reduction. Facial Plastic Surgery Clinics of North America, 27(2), 267–272. https://doi.org/10.1016/j.fsc.2019.01.005
- Riede, T., Stein, A., Baab, K. L., & Hoxworth, J. M. (2023). Post-pubertal developmental trajectories of laryngeal shape and size in humans. Scientific Reports, 13, Article 7508. https://doi.org/10.1038/s41598-023-34347-w
- Chondrolaryngoplasty: Vocal considerations, outcomes and effects on acoustic measures of voice. ResearchGate
- Voice feminization surgery outcomes. binasss.sa.cr
- Centre for Surgery: Can a tracheal shave affect your voice? centreforsurgery.com
- Sycińska-Dziarnowska, M., Lindauer, S. J., Szyszka-Sommerfeld, L., Spagnuolo, G., & Woźniak, K. (2024). Laryngeal cartilage calcifications on lateral cephalometric radiographs. Scientific Reports, 14. https://doi.org/10.1038/s41598-024-52968-7
- Deschamps-Braly, J. C., Sacher, C. L., Fick, J., & Ousterhout, D. K. (2017). First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple). Plastic and Reconstructive Surgery, 139(4), 883e. https://doi.org/10.1097/PRS.0000000000003185
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