Can testosterone replacement cause the female voice to change?
The Hormones called the “sex-hormones”, estrogen, testosterone, and progesterone all have effects on the female voice throughout a woman’s lifespan. We have all seen this effect in ourselves and others as we age. Most women’s voices are higher before they start having periods, and lower with the beginning of their periods (and estradiol, testosterone production). The deficiency of hormones after menopause changes a woman’s voice as well, making the voice less full, and vibrant, more thin and thready. These changes after menopause progress slowly during the second half of a woman’s life.
There have been many articles that are written about how much Testosterone replacement causes the voice to lower, but they are not based on objective research. This is another “old wives tale” based on the fact that men have lower voices than women, however men have 10 times the concentration of Testosterone that women have. Until now there has not been an objective study to measure voice changes before and after testosterone replacement, but a study done by Rebecca Glaser MD in 2016 specifically measures the changes in pitch secondary to TESTOSTERONE PELLETS.
The female voice deepens with age, menopause, smoking and trauma (acid reflux, and blunt neck trauma), and a few diseases like vocal cord polyps, or HPV. Despite the popular belief that testosterone therapy after menopause lowers the female voice, all studies have failed to support this belief.
The way we measure the voice is a measure of frequency, or a measure of how high or low a voice sounds to the listener. Factors that affect the pitch of the voice include the size of the larynx (voice box) vocal cord length (the part that vibrates) the amount of fluid in the vocal cord and inflammation of the voice box. There are many factors that change the pitch of the voice, so it is difficult to study just the effect of testosterone pellets.
Because women lose testosterone with age over 40, and T pellets are the most physiologic method of replacement, and the one that I use, the issue of voice change comes up periodically, as a reason a woman might be afraid of replacing her Testosterone. This is more significant for people who make a living with their voice like singers.
In the 2016 study Dr Glaser completed, women who had had breast cancer who were taking only T pellets to relieve the symptoms of menopause were studied. This research measured many characteristics of the voice by recording patients as they read specific excerpts that contained all parameters of speaking the English language. These recordings were then measured by standard tests of pitch and quality of voice. The women were tested before being given T pellets, and again while they were on the treatment, and finally after T pellet treatments were discontinued.
The results of the study showed that women on T pellets, had no measurable change in pitch, and the non-significant changes which were identifiable, were minimally HIGHER, not lower in pitch. The women who had this change to higher pitch were the ones with the highest T blood levels.
The most important finding in the study was that if there was a slight increase of the pitch of the voice, or there was some hoarseness, and the voice change was REVERSIBLE after the T dose was lowered or stopped.
The physiology behind raising the pitch of the voice is based on the properties of testosterone in the body:
There are multiple theories for this, it can be explained by testosterone’s immune-modulating
(anti-inflammatory) properties, and its beneficial effect on muscle strength, bone density, pulmonary function and the health of connective tissue, all of which worsen with age as T decline. We can make these assumptions, but the study was not focusing on this aspect. So, these theories remain assumptions.
If your worry about your voice changing is stopping you from trying Testosterone replacement with pellets then, now you know that you can try T without permanent changes in the pitch of your voice, and you may experience a higher pitch, not lower. There is always a balance between side effects and benefits of a treatment. This study helps shift the balance to the beneficial results of Testosterone Pellet Therapy by reassuring women that their voices will not be adversely changed as a result of choosing pellet therapy as a way of replacing lost testosterone!
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.