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Multidimensional Voice Outcomes in Cisgender Women Following Exogenous Testosterone Therapy
Teresa Procter1, Ashwini Joshi2, Justina Varghese1
1Dept. of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas.
Objectives:
To examine and compare clinical outcomes for cisgender women with voice complaints and a history of exogenous testosterone supplementation to an age-matched nondysphonic control group.
Methods:
Thirty cisgender women who presented to a multidisciplinary voice center with self-reported voice changes and a history of testosterone therapy were identified via retrospective chart review. Auditory-perceptual ratings, laryngeal imaging, and patient-reported outcomes (Voice Handicap Index-10 (VHI-10), Singing VHI-10 (SVHI-10)) were obtained. Acoustic and aerodynamic measures were collected and compared to those of an age-matched, hormone-naive, nondysphonic, cisgender group of women (n = 20).
Results:
Twenty-seven patients (90%) were occupational voice users. Most patients received testosterone subcutaneous pellets (60%) followed by intramuscular injections (30%), topical formulations (6.67%), or a combination of administration routes (3.33%). Mean VHI-10 was 19.12, with 93.3% exceeding the clinical significance threshold of 11. Among those reporting as singers, all patients exceeded the SVHI-10 clinical threshold, with a mean of 34.43. The patient and control groups were significantly different (P < 0.05) for fundamental frequency (F0) of the vowel /a/ and connected speech (Rainbow Passage reading), F0 standard deviation (SD) during speech, cepstral peak prominence SD, subglottal pressure, phonation threshold pressure, and airflow rate for the Rainbow Passage.
Conclusions:
Current evidence on the effects of testosterone on the voice remains limited and excludes domains of a comprehensive voice assessment. Cisgender women on testosterone reporting to a multidisciplinary voice center demonstrate statistically significant findings in acoustic and aerodynamic parameters compared with age-matched, hormone-naive controls. Those using subcutaneous pellets or intramuscular injections may be at a higher risk for dysphonia than other formulations. The emerging clinical presentation of vocal dysfunction in cisgender women following testosterone therapy suggests further investigation is warranted.
