Introduction: Transsexuality is a complex, permanent transposition involving a paradoxical feeling of belonging to the opposite sex. Furthermore, in the case of male-to-female transsexuals, the unchanged male voice, which is at odds with the, by now, female outward appearance, poses a serious obstacle to full social integration of the woman. Since hormonal treatment or logopedic therapy alone will not achieve a permanent increase in voice pitch, the development of a phonosurgical technique to achieve a permanent elevation of the voice pitch is of great importance. Objective: Based on ISSHIKI's technique type IV we developed a modified cricothyroidopexy via miniplates. In order to avoid the failures caused by avulsion of the cartilages as described by Isshiki, we modified the technique by fixing wire sutures over titanium or absorbable micro-plates. This method prevents damage to the interior of the larynx. and can be expected to produce a lasting rise in the voice pitch of patients. Methods and results: Since 1993, 67 male to female transsexuals have undergone cricothyroidopexy according to Berghaus and Neumann. Increased tension of the vocal cords results in a permanent elevation of the fundamental frequency range by five to six semitones on average. The examination of the voices were carried out pre- and post-operatively and after one year.While pre-operatively none of the patients had a feminine speaking voice pitch, after the surgery, 28 per cent attained a voice pitch within the feminine range, and 38 per cent attained at least a neutral voice pitch. In the long-term the results proved to be of a permanent character.The effect of that voice therapy on the social integration of the transsexuals was assessed by means of a questionnaire. The result shows a better social integation and that they feel more like a woman afte voice therapy.Conclusion: The modified cricothyreoideopexy with miniplates is an adequate surgical method to raise the fundamental frequency permanently. This is confirmed by the comparison of the pre- and post-operative voice parameters and the overwhelming post-operative satisfaction of the patients. Therefore, it is useful to include phonosurgery as an element of the therapeutic concept in sex ressignment.