Lee B. Doe is nearing 50. For the past two years she has noted a cracking in her voice when she tries to sing in her upper range. During the interview I find out that she had been using testosterone cream to improve her sexual energy. When I listen to her voice, she develops a break in her voice at D5, then really cannot reach much higher. Most females can produce a sound at least a half octave higher than this when singing. On stroboscopy, at D5 her vocal cords are stiff enough to stop vibrating at low airflow. This is an atypical amount of stiffness.
Testosterone administered to a female seems to have the same effect that puberty has on a young male — it starts to lower the speaking pitch, perhaps by thickening the vocal cord and also slightly stiffening the vocal cords, gradually impairing the uppermost notes.
This can be put to good use in a transgender female-to-male patient. Over one to two years he will go through a transition in his voice just like puberty. However, if you are a female singer, administering testosterone can markedly impair the upper singing range and probably should not be used if one intends to keep singing in the upper range. While the changes are not reversible even if the medication is stopped, it is possible to retighten the vocal cords with a laser and gain back some of the pitch range.
What you learned
- Testosterone — even in small topical doses — causes the same vocal changes as male puberty in females: gradual thickening and stiffening of the vocal cords, with progressive loss of the upper singing range.
- The voice change from testosterone is not reversible by stopping the medication, though laser tightening of the cords can partially restore upper pitch range.
- For transgender female-to-male patients, this effect is therapeutically useful — a gradual, puberty-like voice transition over one to two years.
- Female singers who require testosterone for medical reasons should be counseled explicitly about the risk of permanent voice change before starting treatment.