Voice Change Following Testosterone Supplementation in Women: A Multi-Institutional Case Series

Area of Science:

• Endocrinology
• Otolaryngology
• Women's Health

Background:

• Androgen supplementation is increasingly used off-label in women.
• Voice changes are a potential, often overlooked, side effect of hormone therapy.

Purpose of the Study:

• To investigate and describe voice changes in women using androgen supplementation.
• To highlight the risks associated with off-label androgen use in female patients.

Main Methods:

• A multi-institutional retrospective case series of women presenting with voice changes after androgen supplementation.
• Data collected included patient demographics, hormone therapy details, voice assessments (fundamental frequency, pitch range), and Voice Handicap Index-10 scores.

Main Results:

• Nine women experienced voice changes, with symptoms appearing a mean of 15 months after starting hormone therapy.
• The most prominent voice change was a reduction in fundamental frequency (mean 155 Hz).
• Voice therapy and hormone discontinuation were recommended for most patients, with some reporting subjective improvement.

Conclusions:

• Off-label androgen supplementation in women can lead to significant, potentially permanent voice alterations, notably decreased pitch.
• Healthcare providers should exercise caution when prescribing androgens to women due to these risks.
• Further research is needed to understand the long-term vocal impact and management strategies.