Sex hormones and the female voice

In the following, the authors examine the relationship between hormonal cli mate and the female voice through discussion of hormonal biochemistry and p hysiology and informal reporting on a study of 197 women with either premen strual or menopausal voice syndrome. These facts are placed in a larger his torical and cultural context, which is inextricably bound to the understand ing of the female voice. The female voice evolves from childhood to menopause, under the varied infl uences of estrogens, progesterone, and testosterone. These hormones are the dominant factor in determining voice changes throughout life. For example, a woman's voice always develops masculine characteristics after an injecti on of testosterone. Such a change is irreversible. Conversely, male castrat i had feminine voices because they lacked the physiologic changes associate d with testosterone. The vocal instrument is comprised of the vibratory body, the respiratory po wer source and the oropharyngeal resonating chambers. Voice is characterize d by its intensity, frequency, and harmonics. The harmonics are hormonally dependent. This is illustrated by the changes that occur during male and fe male puberty: In the female, the impact of estrogens at puberty, in concert with progesterone, produces the characteristics of the female voice, with a fundamental frequency one third lower than that of a child. In the male, androgens released at puberty are responsible for the male vocal frequency, an octave lower than that of a child. Premenstrual vocal syndrome is characterized by vocal fatigue, decreased ra nge, a loss of power and loss of certain harmonics. The syndrome usually st arts some 4-5 days before menstruation in some 33% of women. Vocal professi onals are particularly affected. Dynamic vocal exploration by televideoendo scopy shows congestion, microvarices, edema of the posterior third of the v ocal folds and a loss of its vibratory amplitude. The authors studied 97 pr emenstrual women who were prescribed a treatment of multivitamins, venous t one stimulants (phlebotonics), and anti-edematous drugs. We obtained sympto matic improvement in 84 patients. The menopausal vocal syndrome is characterized by lowered vocal intensity, vocal fatigue, a decreased range with loss of the high tones and a loss of vocal quality. In a study of 100 menopausal women, 17 presented with a meno pausal vocal syndrome. To rehabilitate their voices, and thus their profess ional lives, patients were prescribed hormone replacement therapy and multi -vitamins. All 97 women showed signs of vocal muscle atrophy, reduction in the thickness of the mucosa and reduced mobility in the cricoarytenoid join t. Multi-factorial therapy (hormone replacement therapy and multi-vitamins) has to be individually adjusted to each case depending on body type, vocal needs, and other factors.