From Misophonia Through Puberphonia: Window Toward Gender Dysphoria in Autism?

Autism is characterized by distinct patterns of social communication, interests, and behaviors. Gender incongruence involves a mismatch between one's experienced and assigned gender, often accompanied by significant distress (i.e., gender dysphoria). Recent studies revealed that autistic individuals report gender dysphoria more frequently than the general population and are overrepresented in gender clinic settings. Autistic individuals also report hypersensitivity to certain sensory stimuli, which can elicit distress. When this distress is triggered by certain auditory stimuli (e.g., one's or others' biological sounds such as chewing or swallowing) it is categorized as misophonia. Misophonia appears to be highly prevalent in autism. We propose that a lesser-studied phenomenon, puberphonia, could exemplify an attempt to reduce the distress elicited by misophonia in a certain category of individuals. Puberphonia is characterized by an unusually high-pitched voice, predominantly in teenage boys and men, that can occur in the absence of identifiable physical causes. The psychogenic aspects of puberphonia are just beginning to be explored. We hereby propose an exploratory direction, suggesting that puberphonia may be an individual's attempt at diminishing a distressing auditory stimulus (misophonia) due to their deepening voice. This, in turn, may be an indicator of unrecognized gender dysphoria. Given that voice pitch has also been reported to be higher in autistic males compared to controls, we further ask whether autism is more prevalent among cases of psychogenic puberphonia. Finally, we wish to draw attention to the need for research on the epidemiology and overlap of puberphonia, gender dysphoria, misophonia, and autism.