Testosterone-Related Voice Change in Cisgender Women: A Survey of Prescribers and Voice Clinicians.

AIMS: To characterize prescribing practices, counseling approaches, and perceptions of testosterone-associated voice change among prescribing providers and examine voice clinician experiences managing presumed testosterone-associated voice changes. METHODS: Cross-sectional study using anonymous REDCap-based surveys distributed through professional society platforms, online forums, and direct outreach to testosterone-prescribing medical providers and voice clinicians (laryngologists and speech-language pathologists [SLPs]). RESULTS: Among 72 medical providers, 55 (76%) prescribed testosterone therapy to cisgender women. Respondents primarily practiced in obstetrics-gynecology (64%), followed by primary care (11%) and endocrinology (10%). Testosterone was largely prescribed during menopause (91%), typically for hypoactive sexual desire disorder (93%). Most providers reported detailed (53%) or brief (37%) voice risk counseling. Management for voice changes included testosterone discontinuation (53%), dose reduction (41%), and specialist referral (12%). Reported barriers from qualitative responses included limited evidence in literature evaluating associations between androgen use and voice risk, patient misinformation from social media, and lack of female-specific testosterone formulations. Among 87 voice clinician respondents, 71% of laryngologists and 83% of SLPs reported treating women with presumed testosterone-associated voice changes. Laryngologists typically relied on clinical judgment (58%) or abnormal laryngeal function studies (eg, videostroboscopy, acoustic and/or aerodynamic voice analysis) (38%) when establishing a diagnosis. Vocal fold thickening (67%) and edema (38%) were the most common laryngeal exam findings, while pitch deepening and loss of vocal range were the most frequent presenting complaints. 83% of laryngologists and 86% of SLPs believed testosterone-associated voice changes are underrecognized. CONCLUSIONS: Our study suggests that prescribing providers and voice clinicians alike recognize voice change as an increasingly common androgenic effect of testosterone therapy, though counseling and management varied. Laryngologists often relied on clinical judgment, including a temporal relationship between testosterone exposure and subsequent voice change, reflecting the absence of standardized diagnostic criteria. These findings underscore the need for voice‑related testosterone research in cisgender women and collaboration between prescribing providers and voice clinicians for informed counseling and timely referral when voice changes occur.