Voice Change as a Result of Androgen Supplementation in Cisgender Women: A Scoping Review.

Abstract

Androgens are increasingly being prescribed as a supplement for cisgender women to combat symptoms such as decreased libido, low energy, dysphoria, and reduced muscle mass. Since testosterone is not FDA-approved specifically for women, it is prescribed off-label with variable dosing and quality, and potential risks such as voice change are still being explored. This scoping review aims to describe existing literature investigating the effects of androgen supplementation on the voice in cisgender women. PubMed, Web of Science, and Scopus databases were searched from inception to October 10^th, 2024. All articles that assessed changes in voice quality in women undergoing androgen supplementation were included. A total of 2191 studies were imported for initial screening. Of these, 1420 articles were screened at the title/abstract level, 78 at the full-text level, and 14 met inclusion criteria. Voice changes in cisgender women using off-label androgen use varied by dose, duration, and delivery route. Transdermal formulations showed minimal effects, while intramuscular injections of testosterone or anabolic steroids were associated with pitch lowering, voice instability, and other undesirable vocal changes. Subjective and objective findings confirmed impaired vocal range, fatigue, and structural alterations, particularly in premenopausal women. Androgens like testosterone have been evidenced to confer a potential risk of subjective and objective voice deepening for cisgender women, in a dose- and duration-dependent manner. There is inadequate consensus for systematic determination of safe dosing and patient selection to avoid this potentially irreversible adverse effect.