Multidimensional Voice Outcomes in Cisgender Women Following Exogenous Testosterone Therapy.

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.