The transgender is who has persistent discomfort with his of her sex or sense of inappropriateness in the gender role of that sex. Many transgenders have been undergone trans-sex operations after 1980′s. But there were not so much experience of voice surgery for transgenders. Vocal pitch can be elevated by various surgical techniques. Type Ⅳ thryoplasty, which one of the cricothyroid approximation methods, increases tension to the vocal folds, thus increasing fundamental frequency and upper pitch range. We treated a transgender (MTF, Male to female) using this technique. Acoustic and aerodynamic measures were obtained both pre- and post-operatively. Clinically significant improvement was achieved in both study; increasing of vocal pitch, widening of pitch range, and improvement of vocal efficiency.