The anatomical structure colloquially known as the “Adam’s Apple” is present in all people, regardless of biological sex. This structure, properly termed the laryngeal prominence, is the external feature of the largest cartilage in the throat. While the structure exists in everyone, its size and visibility vary significantly. This variation is why the laryngeal prominence is far more commonly associated with men.
The Anatomy Behind the Prominence
The laryngeal prominence is not a separate organ but a protrusion of the thyroid cartilage, the largest cartilage of the larynx, or voice box. The thyroid cartilage is shield-shaped, composed of two plates of hyaline cartilage, called laminae, that meet at the front of the throat. This junction point creates the visible laryngeal prominence.
The primary function of the larynx is to house and protect the vocal cords, which are located directly behind the thyroid cartilage. The cartilage also plays a role in the pitch of the voice, as its movement changes the tension of the vocal cords. Everyone has the underlying structure, but the degree of its outward projection determines its visibility.
Why Size Matters in Biological Sex
The difference in the visibility of the laryngeal prominence between sexes is primarily due to the effects of hormones during puberty. In males, the surge of testosterone causes a significant growth spurt in the entire larynx, including the thyroid cartilage. This growth results in the two cartilage plates joining at a more acute, or sharper, angle.
The sharper angle pushes the laryngeal prominence outward, making it distinctly visible and palpable beneath the skin. This growth also lengthens and thickens the vocal cords, causing the characteristic deepening of the voice during male puberty. Females also experience laryngeal growth, but due to lower levels of testosterone, the thyroid cartilage plates meet at a wider angle. This wider angle causes the prominence to remain relatively smooth and less noticeable.
Factors Causing Female Prominence
While a prominent laryngeal feature is not typical in women, its appearance can be attributed to genetic variation and hormonal factors. Some women naturally have a less obtuse angle to their thyroid cartilage. Furthermore, a slender neck or lower body fat percentage can make even a typical-sized prominence more visually apparent, as there is less soft tissue to obscure the cartilage.
Hormonal conditions that cause elevated androgen levels can also lead to a more noticeable laryngeal prominence. Conditions like Polycystic Ovary Syndrome (PCOS) or congenital adrenal hyperplasia may result in higher testosterone production, which can stimulate laryngeal growth. Women who have undergone hormone replacement therapy using testosterone, such as trans men, will develop a significantly larger and more visible prominence due to the direct effect of the hormone.
Medical and Surgical Considerations
Surgical modification is an available option for individuals with a laryngeal prominence that causes distress, whether for aesthetic reasons or gender affirmation. The procedure is called a chondrolaryngoplasty, commonly referred to as a “tracheal shave” or “Adam’s Apple reduction.” This surgery involves carefully shaving down the excess thyroid cartilage to create a smoother contour in the neck.
The goal of chondrolaryngoplasty is to reduce the prominence without compromising the integrity of the larynx or damaging the vocal cords, which sit directly behind the cartilage. The procedure is typically performed on an outpatient basis, often involving a small incision hidden in a natural skin crease beneath the chin. Non-surgical methods, such as using specific makeup techniques or wearing clothing that covers the neck area, can help camouflage the feature.