The term “Adam’s apple” describes the laryngeal prominence, the visible protrusion formed by the thyroid cartilage in the neck. This feature is often associated with men, leading to questions about its appearance in biological females. Everyone possesses the underlying cartilage forming the “voice box,” so the presence of the structure is not determined by sex. The difference lies entirely in the size and angle of this cartilage. Understanding the mechanics of the larynx and the influence of hormones provides a clear answer regarding its potential prominence in women.
Understanding the Laryngeal Cartilage
The thyroid cartilage is the largest piece of cartilage that forms the framework of the larynx, or voice box. It is a shield-shaped structure composed primarily of hyaline cartilage, positioned in the anterior neck. This cartilage protects the delicate vocal folds, or vocal cords, that lie directly behind it. Its two flattened sides, called laminae, meet and join at the front midline of the neck.
The point where these two laminae fuse creates the outward peak, formally known as the laryngeal prominence. Everyone is born with this structure as a fundamental part of the upper respiratory system. The prominence’s size and visibility depend on the angle at which the laminae meet. In females, this angle is typically wider and more obtuse, while in males, it is narrower and more acute, causing a sharper, more distinct protrusion.
Hormonal Influence on Thyroid Cartilage Size
The significant difference in the size and visibility of the laryngeal prominence between sexes is directly linked to hormonal changes during puberty. Before puberty, the size and angle of the thyroid cartilage are similar in both males and females. The onset of male puberty triggers a surge in the production of testosterone, the primary androgen, which acts as a powerful growth signal for the larynx.
Testosterone specifically causes the thyroid cartilage to enlarge significantly, making it taller and increasing its anterior-posterior diameter. This hormonal action changes the meeting angle of the laminae, causing it to become more acute, which creates the noticeable protrusion on the neck. The growth of the cartilage also lengthens the vocal folds, which vibrate more slowly, resulting in the characteristic deepening of the voice.
Factors Leading to Laryngeal Prominence in Women
While the female larynx does not undergo the same testosterone-driven enlargement, women do have a thyroid cartilage, and several factors can lead to a visible laryngeal prominence. The appearance of a noticeable Adam’s apple in a woman can be attributed to natural anatomical variation and genetics. Some women simply possess a slightly larger or more acutely angled thyroid cartilage than the female average.
A prominent larynx can also be a manifestation of conditions involving elevated androgen levels, known as hyperandrogenism or virilization.
Hyperandrogenism and Virilization
Medical conditions such as Polycystic Ovary Syndrome (PCOS) are characterized by an excess production of androgens like testosterone. This can lead to the development of male-like secondary characteristics, including the virilization of laryngeal tissues. The functional result is a deeper voice, which stems from an enlarged thyroid cartilage.
Congenital Adrenal Hyperplasia (CAH) is a genetic disorder where the adrenal glands overproduce androgens due to an enzyme deficiency. High androgen exposure in women with CAH can cause features like a deep voice and excessive hair growth. Cartilage enlargement is typically more pronounced if the condition is treated suboptimally, allowing for prolonged androgen exposure.
Exogenous Hormone Use
The intentional use of exogenous hormones, such as testosterone therapy for gender transition, causes the thyroid cartilage to grow similarly to male puberty. The cartilage enlargement and subsequent voice deepening are permanent effects of this therapy. These diverse factors illustrate that a prominent laryngeal structure in women results from either natural anatomical predisposition or the effects of circulating androgens.
Medical Options for Laryngeal Reduction
For individuals concerned about the cosmetic appearance of a prominent laryngeal cartilage, a surgical procedure is available to reduce its size. This procedure is formally known as Chondrolaryngoplasty, often referred to as a “tracheal shave” or thyroid cartilage reduction. The surgery is commonly sought by transgender women and others who desire a smoother, less angular contour to their neck.
The procedure involves a small horizontal incision made in a discreet location on the neck. The surgeon exposes the thyroid cartilage and uses a specialized tool to shave down the protruding portion. Extreme care is taken not to remove too much cartilage, as this could compromise the structural integrity of the trachea and potentially damage the vocal folds, leading to breathing difficulties or voice changes.
The procedure is typically performed on an outpatient basis under local anesthesia with sedation or general anesthesia. Patients can expect mild swelling and bruising for about one to two weeks, and a short period of vocal rest may be advised. The result is a less noticeable laryngeal prominence, providing a more feminine neck contour.