Adam's Apple: Does It Change My Voice?

Medically Reviewed by Zilpah Sheikh, MD on January 17, 2024
5 min read

‌"Adam's apple" is the common term for what doctors call the laryngeal prominence of the thyroid cartilage. It's the cartilage that wraps around the front of your voice box (larynx) and helps protect your vocal cords from injury. Everyone has thyroid cartilage, even though you may not be able to see it.

The Adam's apple is about the same size in people assigned male at birth (AMAB) and those assigned female at birth (AFAB) until puberty. Once puberty starts, hormones (especially testosterone) in people AMAB may cause their vocal cords to grow bigger than those in people AFAB. The thyroid cartilage may therefore stick out a bit more in people who are AMAB to protect these larger vocal cords.

An obvious Adam's apple is therefore sometimes considered a secondary sex characteristic of males. A secondary sex characteristic is a physical feature that may show up differently based on your sex and that usually becomes obvious at sexual maturity (puberty). However, thyroid cartilage size varies from person to person. Often, people AMAB have larger, more obvious Adam's apples than people AFAB, but not always. For instance, some people AFAB, especially those who are very thin, may have an obvious Adam's apple.

On the outside of your throat, your Adam's apple looks a bit like a small, rounded apple under the skin in the front, and it may stand out a bit. Inside your throat, your thyroid cartilage is made up of two plates that come together to form a V-shaped notch in the center over your vocal cords.

The name "Adam's apple" likely comes from the Judeo-Christian story where Adam ate an apple from the tree of the knowledge of good and evil. God had forbidden Adam from eating the fruit, so as punishment, God caused the apple to become stuck in Adam's throat.

"Adam's apple" may also be a mistranslation of the Hebrew term from the Bible "tappuach ha adam," which means "male bump."

The only known function of the Adam's apple is to protect your voice box and vocal cords from injury.

Some doctors also think that the growth of your vocal cords and Adam's apple at puberty may cause your voice to deepen. This happens in all people, regardless of sex assignment at birth, although there may be more growth in this area in people AMAB. However, no evidence has confirmed this yet.

Having an obvious Adam's apple may cause some people anxiety and distress, as it is popularly thought to be a sign of being male. Therefore, some people may choose to have cosmetic surgery to make their Adam's apple smaller or larger, depending on their personal preferences.

Adam’s apple size

‌The Adam's apple is typically larger and more obvious in people AMAB, as they have larger voice boxes than people AFAB. In general, hormones, mainly testosterone, decide the size of your Adam’s apple. Also, the angle at which the two plates of your thyroid cartilage grow together decides how much it will stand out. People AFAB usually have a much wider angle, meaning that their Adam’s apple sits flush against their voice box, which leads to a less prominent Adam’s apple.

Your Adam’s apple is made up of thyroid cartilage. Cartilage is the same tissue that makes up your nose, ears, and windpipe (trachea). The voice box and windpipe have several types of cartilage, which work together to make sure your airways stay clear and you’re able to speak. Some of these cartilages include:

  • Thyroid cartilage. This cartilage is the largest piece of cartilage in your neck. It makes your Adam’s apple and surrounds the front of the voice box and windpipe, just under your thyroid gland. It works to protect the front of your neck.
  • Cricoid cartilage. This cartilage sits toward the bottom of your neck and is ring-shaped. It wraps around your windpipe. Your thyroid and cricoid cartilages are connected, and the movement between these cartilages helps you change the pitch of your voice.
  • Epiglottic cartilage. It's flap-shaped, and it sits in your throat behind your tongue, just in front of your voice box. right underneath the thyroid cartilage. It opens to allow air to pass into your lungs and closes to stop food from entering your airway when you eat.
  • Arytenoid cartilage. This is made of two pyramid-shaped pieces of cartilage in your voice box. They're attached to the vocal folds and help you move your vocal cords.
  • Corniculate cartilage. This cartilage keeps the arytenoid cartilage from moving out of place.
  • Cuneiform cartilage. This cartilage supports the epiglottic cartilage and vocal folds.‌

Some conditions that affect your Adam's apple may have the following signs:

  • A sore throat
  • Trouble swallowing (dysphagia)
  • Shortness of breath (dyspnea)
  • Coughing
  • Wheezing
  • Fatigue
  • Sweating a lot

Some conditions that may cause swelling in your voice box and around your Adam's apple include:

  • Laryngitis (inflammation in your voice box)
  • Goiter (an enlarged thyroid gland)
  • Thyroid cancer
  • Laryngeal cancer

Pain in your Adam's apple can be caused by:

  • Pharyngitis (inflammation in the back of your throat)
  • Common cold
  • Serious thyroid swelling
  • Inflammation of your esophagus
  • Fungal infection (candida) of your esophagus

In most cases, surgery on your Adam's apple is for cosmetic purposes. For example, a laryngeal shave, also known as a chondrolaryngoplasty, is a procedure used to lessen the size of your Adam’s apple. It may be performed as part of gender-affirming surgery for people AMAB who are uncomfortable with the size of their Adam's Apple. Some people AFAB with larger Adam's apples may also choose to have a laryngeal shave.

While laryngeal shave isn’t a major surgical procedure, you may need some recovery time. You’ll need to rest your voice as much as possible for the few days following surgery. Your surgeon may also advise that you avoid solid foods during this time.

On the other hand, you may want to make your Adam’s apple bigger. This is known as Adam’s apple augmentation and is generally performed by a plastic surgeon. Hormone therapy doesn't always increase the size of your Adam's apple, so some people AFAB may choose this surgery as part of facial masculinization surgery.

During the augmentation surgery, your surgeon will create an implant from your own cartilage (usually taken from your ribcage) and attach it to your thyroid cartilage in the neck. This will increase the size of your Adam’s apple and give you a more masculine appearance.

Another common Adam’s apple surgery is cartilage graft, which is used to treat windpipe defects in young children and infants.

‌"Adam's apple" is the common term for the laryngeal prominence of the thyroid cartilage. This is the cartilage that wraps around your voice box and helps protect your vocal cords from injury. Everyone has this thyroid cartilage, but around puberty, it may grow a bit larger in people AMAB. A laryngeal shave or augmentation may be performed as part of gender-affirming surgery for people AMAB and AFAB who are uncomfortable with the size of their Adam's Apple.