Voice changes after androgen therapy for hypogonadotrophic hypogonadism

Polycystic Ovary Syndrome and Alteration of Vocal Function: A Systematic Review and Meta-Analysis

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among young women, correlated with hyperandrogenism. Among the symptoms of PCOS, vocal alterations are quite unknown. Dysphonia may be related to hyperandrogenism, and there is no consensus about its prevalence and the severity of vocal disorders, which can cause noticeable discomfort.

METHODS

A systematic review of the literature was conducted. Four studies on PCOS that evaluated the phonatory system were included for a total of 174 patients (96 PCOS, 78 controls), and a meta-analysis on comparable data was performed.

RESULTS

Four studies evaluated parameters related to vocal symptomatology, altered audiometric examination, and findings at the laryngoscopy in patients affected by PCOS versus controls. Although the individual studies showed increased incidence of alterations and a tendency to develop speech fatigue in women with PCOS, when the results of studies were pulled in meta-analysis, the overall difference was not statistically significant. The studies themselves were very different from each other; therefore, it is hard to draw any firm conclusions.

DISCUSSION

The aim of this study was to assess the prevalence of vocal alterations, the correlation with hyperandrogenism, the quality of life, and the voice changes after starting a therapy for PCOS. The present meta-analysis failed to find any difference in terms of PCOS and control cohort. However, the lack of high-quality studies makes it difficult to draw firm conclusions. New and larger studies or big population program data are therefore warranted.

Androgenic induction of penile features in postnatal female mouse external genitalia from birth to adulthood: Is the female sexual phenotype ever irreversibly determined?

Female mice were treated for 35 days from birth to 60 days postnatal (P0, [birth], P5, P10, P20 and adult [∼P60]) with dihydrotestosterone (DHT). Such treatment elicited profound masculinization the female external genitalia and development of penile features (penile spines, male urogenital mating protuberance (MUMP) cartilage, corpus cavernosum glandis, corporal body, MUMP-corpora cavernosa, a large preputial space, internal preputial space, os penis). Time course studies demonstrated that DHT elicited canalization of the U-shaped clitoral lamina to create a U-shaped preputial space, preputial lining epithelium and penile epithelium adorned with spines. The effect of DHT was likely due to signaling through androgen receptors normally present postnatally in the clitoral lamina and associated mesenchyme. This study highlights a remarkable male/female difference in specification and determination of urogenital organ identity. Urogenital organ identity in male mice is irreversibly specified and determined prenatally (prostate, penis, and seminal vesicle), whereas many aspects of the female urogenital organogenesis are not irreversibly determined at birth and in the case of external genitalia are not irreversibly determined even into adulthood, the exception being positioning of the female urethra, which is determined prenatally.

Effects of Infertility on Voice in male patients

Purpose

In this study, we aimed to determine the differences in normospermic, oligospermic and azoospermic infertile men by performing voice analysis and to discuss this in the light of the literature.

Methods

71 male patients who applied to the urology clinic due to infertility and were then referred to us were included in the study. Hormone analysis and spermiogram were requested from the patients for routine infertility tests. Testosterone, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Prolactin levels of the patients were recorded. Age and spermiogram results were recorded. According to the spermiogram results, the patients were categorized as Group 1 (azoospermic), Group 2 (oligospermic), Group 3 (normospermic). Voice Handicap Index-10 Turkish version (VHI-10) was applied to the patients and the results were recorded.

Results

The age of the infertile patients ranged from 20 to 37. The mean age was 28.23. The distribution of the patients was 21 patients in Group 1, 40 patients in Group 2, and 10 patients in Group 3. The mean Testosterone level of the patients was 2.78; mean FSH level 12.14; mean LH level 7.26; mean Prolactin level was 8.1. The mean VHI-10 scores of the patients were 10.52. The fundamental frequency F0 Hz (mean pitch) values of the patients were 176,468; jitter % (frequency perturbation jitter) values average 0.25; shimmer % (amplitude perturbation shimmer) values average 2,322; HNR dB values averaged 24,862.

Conclusions

Testosterone is more effective on the voice, especially in male individuals.It would be more logical to think that many hormones, growth factors and local factors are effective instead of a single hormone.

Voice changes in reproductive disorders, thyroid disorders and diabetes: a review

The subject of vocal changes accompanying pathological conditions, although still not well explored, seems to be promising. The discovery of laryngeal receptors for sex hormones and thyroid hormones can strongly support the hypothesis of changes in voice due to various endocrinopathies. On the other hand, the impairment of the proper function of the vocal apparatus can also be caused in the process of the microvasculature complications of diabetes mellitus. This review was a comprehensive summary of the accessible literature concerning the influence of selected endocrinopathies on subjective and objective voice parameters. We analysed a total number of 16 English-language research papers from the PubMed database, released between 2008 and 2021, describing vocal changes in reproductive disorders such as polycystic ovary syndrome and congenital adrenal hyperplasia, thyroid disorders in shape of hypo- or hyperthyroidism and type 2 diabetes mellitus. The vast majority of the analysed articles proved some changes in voice in all mentioned conditions, although the detailed affected vocal parameters frequently differed between research. We assume that the main cause of the observed conflicting results might stem from non-homogeneous methodology designs of the analysed studies.

Adapted version of the Pubertal Development Scale for use in Brazil

OBJECTIVE

To determine whether scores in an adapted version of the self-assessment Pubertal Development Scale into Portuguese match those from the gold standard in pubertal development (Tanner scale).

METHODS

This was a cross-sectional study with a convenience sample of 133 children and adolescents aged nine to 17 years (59 males; mean age of 13 years and six months, with standard deviation = 25 months). Youngsters completed the Pubertal Development Scale and were then examined by specialists in adolescent medicine.

RESULTS

Exact absolute agreement of pubertal stages were modest, but significant associations between measures (correlation; intra-class correlation coefficients of consistency) showed that the Pubertal Development Scale adequately measures changes that map onto pubertal development determined by physical examination, on par with international publications. Furthermore, scores obtained from each Pubertal Development Scale question reflected adequate gonadal and adrenal events assessed by clinical ratings, mostly with medium/high effect sizes. Latent factors obtained from scores on all Pubertal Development Scale questions had excellent fit indices in Confirmatory Factor Analyses and correlated with Tanner staging.

CONCLUSIONS

We conclude that self-assessment of body changes by youngsters using the Portuguese version of the Pubertal Development Scale is useful when estimates of pubertal progression are sufficient, and exact agreement with clinical staging is not necessary. The Pubertal Development Scale is, therefore, a reliable instrument for use in large-scale studies in Brazil that aim at investigating adolescent health related to pubertal developmental. The translated version and scoring systems are provided.

Male Vocal Quality and Its Relation to Females' Preferences

In both correlational and experimental settings, studies on women's vocal preferences have reported negative relationships between perceived attractiveness and men's vocal pitch, emphasizing the idea of an adaptive preference. However, such consensus on vocal attractiveness has been mostly conducted with native English speakers, but a few evidence suggest that it may be culture-dependent. Moreover, other overlooked acoustic components of vocal quality, such as intonation, perceived breathiness and roughness, may influence vocal attractiveness. In this context, the present study aims to contribute to the literature by investigating vocal attractiveness in an underrepresented language (i.e., French) as well as shedding light on its relationship with understudied acoustic components of vocal quality. More specifically, we investigated the relationships between attractiveness ratings as assessed by female raters and male voice pitch, its variation, the formants' dispersion and position, and the harmonics-to-noise and jitter ratios. Results show that women were significantly more attracted to lower vocal pitch and higher intonation patterns. However, they did not show any directional preferences for all the other acoustic features. We discuss our results in light of the adaptive functions of vocal preferences in a mate choice context.

Age- and sex-related variations in vocal-tract morphology and voice acoustics during adolescence

Distinct differences in the human voice emerge during adolescence, with males producing deeper and more resonant voices than females by the end of sexual maturation. Using magnetic resonance images of heads and voice recordings obtained in 532 typically developing adolescents, we investigate what might be the drivers of this change in voice, and the subjective judgment of the voice "maleness" and "femaleness". We show clear sex differences in the morphology of voice-related structures during adolescence, with males displaying strong associations between age (and puberty) and both vocal-fold and vocal-tract length; this was not the case in female adolescents. At the same time, males (compared with females) display stronger associations between age (and puberty) with both fundamental frequency and formant position. In males, vocal morphology was a mediator in the relationship between bioavailable testosterone and acoustic indices. Subjective judgment of the voice sex could be predicted by the morphological and acoustic parameters in males only: the length of vocal folds and its acoustic counterpart, fundamental frequency, is a larger predictor of subjective "maleness" of a voice than vocal-tract length and formant position.

Subjective and Objective Effects of Androgen Ablation Therapy on Voice

OBJECTIVES

The aim of present study was to evaluate possible side effects of androgen deprivation therapy (ADT) on voice quality by means of objective and subjective measures.

STUDY DESIGN

Cross-sectional.

METHODS

Thirty-five male patients who had been diagnosed with prostate cancer and who had been using bicalutamide and goserelin acetate combination for at least 12 months were included in the study. Thirty healthy nonsmoker males of similar age and without any laryngeal pathology constituted the control group. Acoustic and aerodynamic voice analyses and voice handicap index-10 were applied to both groups. Maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were determined during acoustic and aerodynamic voice analyses.

RESULTS

Maximum phonation times were 18.86 ± 5.24 and 24.20 ± 3.59 in ADT and control groups, respectively. It was significantly higher in the control group. Fundamental frequencies were 143.73 ± 18.47 and 135.00 ± 13.18 in ADT and control groups, respectively. Jitter values were 2.72 ± 0.62 and 1.99 ± 0.27 in ADT and control groups, respectively. Shimmer values were 11.50 ± 1.81 and 10.48 ± 1.36 in ADT and control groups, respectively. Fundamental frequency, jitter, and shimmer values were significantly higher in the ADT group. Noise-to-harmonic ratio values did not differ between groups. Voice handicap index-10 result was significantly higher in the ADT group.

CONCLUSIONS

ADT has adverse effects on the human voice. Prospective studies with long-term follow-up of a larger cohort are required for more detailed analysis.

Androgen modulation of Foxp1 and Foxp2 in the developing rat brain: impact on sex specific vocalization

Sex differences in vocal communication are prevalent in both the animals and humans. The mechanism(s) mediating gender differences in human language are unknown, although, sex hormones, principally androgens, play a central role in the development of vocalizations in a wide variety of animal species. The discovery of FOXP2 has added an additional avenue for exploring the origins of language and animal communication. The FOXP2 gene is a member of the forkhead box P (FOXP) family of transcription factors. Prior to the prenatal androgen surge in male fetuses, we observed no sex difference for Foxp2 protein levels in cultured cells. In contrast, 24 hours after the onset of the androgen surge, we found a sex difference for Foxp2 protein levels in cultured cortical cells with males having higher levels than females. Furthermore, we observed the potent nonaromatizable androgen dihydrotestosterone altered not only Foxp2 mRNA and protein levels but also Foxp1. Androgen effects on both Foxp2 and Foxp1 were found to occur in the striatum, cerebellar vermis, and cortex. Immunofluorescence microscopy and coimmunoprecipitation demonstrate Foxp2 and the androgen receptor protein interact. Databases for transcription factor binding sites predict a consensus binding motif for androgen receptor on the Foxp2 promoter regions. We also observed a sex difference in rat pup vocalization with males vocalizing more than females and treatment of females with dihydrotestosterone eliminated the sex difference. We propose that androgens might be an upstream regulator of both Foxp2 and Foxp1 expression and signaling. This has important implications for language and communication as well as neuropsychiatric developmental disorders involving impairments in communication.

What makes a voice masculine: physiological and acoustical correlates of women's ratings of men's vocal masculinity

Men's voices contain acoustic cues to body size and hormonal status, which have been found to affect women's ratings of speaker size, masculinity and attractiveness. However, the extent to which these voice parameters mediate the relationship between speakers' fitness-related features and listener's judgments of their masculinity has not yet been investigated. We audio-recorded 37 adult heterosexual males performing a range of speech tasks and asked 20 adult heterosexual female listeners to rate speakers' masculinity on the basis of their voices only. We then used a two-level (speaker within listener) path analysis to examine the relationships between the physiological (testosterone, height), acoustic (fundamental frequency or F0, and resonances or ΔF) and perceptual dimensions (listeners' ratings) of speakers' masculinity. Overall, results revealed that male speakers who were taller and had higher salivary testosterone levels also had lower F0 and ΔF, and were in turn rated as more masculine. The relationship between testosterone and perceived masculinity was essentially mediated by F0, while that of height and perceived masculinity was partially mediated by both F0 and ΔF. These observations confirm that women listeners attend to sexually dimorphic voice cues to assess the masculinity of unseen male speakers. In turn, variation in these voice features correlate with speakers' variation in stature and hormonal status, highlighting the interdependence of these physiological, acoustic and perceptual dimensions.

Digit ratio (2D:4D) predicts facial, but not voice or body odour, attractiveness in men

There is growing evidence that human second-to-fourth digit ratio (or 2D:4D) is related to facial features involved in attractiveness, mediated by in utero hormonal effects. The present study extends the investigation to other phenotypic, hormone-related determinants of human attractiveness: voice and body odour. Pictures of faces with a neutral expression, recordings of voices pronouncing vowels and axillary odour samples captured on cotton pads worn for 24 h were provided by 49 adult male donors. These stimuli were rated on attractiveness and masculinity scales by two groups of 49 and 35 females, approximately half of these in each sample using hormonal contraception. Multivariate regression analyses showed that males' lower (more masculine) right 2D:4D and lower right-minus-left 2D:4D (Dr-l) were associated with a more attractive (and in some cases more symmetrical), but not more masculine, face. However, 2D:4D and Dr-l did not predict voice and body odour masculinity or attractiveness. The results were interpreted in terms of differential effects of prenatal and circulating testosterone, male facial shape being supposedly more dependent on foetal levels (reflected by 2D:4D ratio), whereas body odour and vocal characteristics could be more dependent on variation in adult circulating testosterone levels.

Androgens modulate song effort and aggression in Neotropical singing mice

Androgens are an important class of steroid hormones involved in modulating the expression and evolution of male secondary sex characters. Vocalizations used in the context of aggression and mate attraction are among the most elaborate and diverse androgen-dependent animal displays as reflected in a rich tradition of studies on bird song and anuran calls. Male Alston's singing mice (Scotinomys teguina) commonly emit trilled songs that appear to function in male-male aggression. In this study, we experimentally manipulated androgens in singing mice to assess their role in modulating aggression and song effort. Testosterone- and DHT-treated animals retained aggressive and song attributes similarly. However, castrated mice administered empty implants showed more subordinate behavior and sang fewer songs that were shorter, lower in power, higher in frequency, and less stereotyped. The extensive effects of androgens on a suite of phenotypes highlight their role in linking gonadal status with decisions about investment in reproductive behaviors.

Prospective Study of the Impact of Thyroid Hormone Replacement on Objective Voice Parameters

Objectives:

Hypothyroidism has long been considered to have an impact on phonation. In this study, objective evaluation of vocal function in women with hypothyroidism was performed in order to characterize potential dysphonia; their subsequent response to thyroid hormone replacement was prospectively studied. It was hypothesized that thyroid hormone replacement therapy in this cohort would have an objectively measurable impact on vocal function.

Methods:

Prospective evaluation of objective voice parameters and concurrent determination of serum thyroid status was executed both before and after thyroid hormone replacement in a cohort of patients who had had total thyroidectomy. Objective voice parameters before and after treatment were compared.

Results:

Twenty-four female subjects were recruited over an 18-month period. After surgery, all subjects were hypothyroid (mean thyroid-stimulating hormone level, 81.38 mIU/L; range, 25.26 to 100.00 mIU/L) before replacement. After hormone therapy, their mean thyroid-stimulating hormone level dropped to 1.20 mIU/L (range, 0.28 to 3.83 mIU/L). The mean fundamental frequency significantly increased from a pretreatment average of 223.48 ± 36.10 Hz to 237.64 ± 38.81 Hz. Other measured voice parameters (jitter, shimmer, amplitude perturbation quotient, pitch perturbation quotient, noise-to-harmonics ratio, and maximum phonation time) were not affected.

Conclusions:

Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on mean fundamental frequency in female patients. The mechanism of this effect is not known.

The impact of gender and age on voice related quality of life in children: normative data

OBJECTIVES

Although several instruments are available to measure voice quality in children, their application to a normal population and major demographic subgroups has not been described. It is hypothesized that there is no measurable difference in self-reported voice related quality of life between gender and age groups within a population of normal children as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument.

METHODS

The PVRQOL instrument was used to prospectively survey a cohort of children in series at the Wisconsin State Fair. PVRQOL scores may range from 0 (complete dysfunction) to 100 (no dysfunction). Comparisons were made between age and gender groups in order to test the null hypothesis.

RESULTS

Of the 100 surveys completed by parents of children, 93 were performed correctly and had evaluable data (age range 2-17 years, mean 9.8). The mean PVRQOL score was 97.0+/-5.6. There was no difference between females and males (97.5+/-5.83 versus 96.5+/-5.3, p>0.05, unpaired t-test); however, within the pre-pubescent school age subjects, a diminished PVRQOL was reported for boys (95.5+/-6.37) as compared to girls (98.5+/-3.10, p<0.05, unpaired t-test). Further subgroup analysis revealed no significant difference (p>0.05) between age groups or gender.

CONCLUSIONS

Amongst a random group of children without voice complaints queried outside of a medical center, self-reported PVRQOL showed no significant dysfunction. This is the first report of gender and age-specific normative PVRQOL data in children. A score of 86 or greater on the PVRQOL instrument represents a normal voice related quality of life.

Clinical relevance of ceramide metabolism in the pathogenesis of human head and neck squamous cell carcinoma (HNSCC): attenuation of C(18)-ceramide in HNSCC tumors correlates with lymphovascular invasion and nodal metastasis

It has been documented previously that defects in the generation of C(18)-ceramide, a product of ceramide synthase 1 (CerS1), also known as longevity assurance gene 1 (hLASS1), play important roles in the pathogenesis and/or progression of HNSCC. However, whether altered levels of ceramide generation in HNSCC tumors have any clinical relevance remains unknown. In this study, the levels of endogenous ceramides were measured in tumor tissues of 45 HNSCC patients as compared to their normal tissues using high-pressure liquid chromatography/mass spectrometry (LC/MS), and then possible link between ceramide levels and the clinical parameters of HNSCC were examined. The data showed that the levels of C(16)-, C(24)-, C(24:1)-ceramides were significantly elevated in the majority of tumor tissues compared to their normal tissues, while the levels of only C(18)-ceramide were significantly decreased in HNSCC tumors, especially in tumor tissues of male patients. Importantly, it was also shown here that decreased C(18)-ceramide levels in HNSCC tumor tissues were significantly associated with the higher incidences of lymphovascular invasion, and pathologic nodal metastasis. Importantly, attenuation of C(18)-ceramide was also positively linked to the higher overall stages of the primary HNSCC tumors. Therefore, these data suggest, for the first time, that the defects in the generation/accumulation of C(18)-ceramide might have important clinical roles in HNSCC, especially in lymphovascular invasion and nodal disease.

Nonlinear acoustics in the pant hoots of common chimpanzees (Pan troglodytes): vocalizing at the edge

Common chimpanzee (Pan troglodytes) "pant hoots" are multi-call events that build from quiet, consistently harmonic introductory sounds to loud, screamlike "climax" calls with acoustic irregularities known as "nonlinear phenomena" (NLP). Two possible functions of NLP in climax calls are to increase direct auditory impact on listeners and to signal physical condition. These possibilities were addressed by comparing climax calls from 12 wild chimpanzee males with "screams" and pant hoot "introduction" calls from the same individuals. Climax calls that included NLP were found to have higher fundamental frequencies (F0s) than introduction or climax calls that were purely harmonic. NLP onsets within climax calls were also specifically associated with local F0 maxima, suggesting vocalizers are vibrating their vocal folds at the upper limits of stability. Furthermore, climax calls showed far fewer NLP than did screams recorded from the same individuals, while showing equivalent or higher F0 values. Overall, the results are consistent with the hypothesis that the relative prevalence of NLP is a signal of physical condition, with callers "vocalizing at the edge" of regular, stable production while producing few NLP. The results are discussed in light of the initial hypotheses.