Our Early Experience with Testosterone Injection in the Thyroarytenoid Muscle for Lowering the Vocal Pitch
Objectives
A deep, low pitched voice, is often socially perceived as a marker of masculinity and authority. Various conditions are responsible for abnormally high vocal pitch such as puberphonia, vocal fold sulcus, scarring and in the situation where a trans-man does not achieve adequate pitch lowering following systemic testosterone therapy, to name a few. Besides voice modulation, the main intervention that may be used to lower pitch is a relaxation laryngeal framework surgery (RFS). However, this very often decreases the pitch dramatically. Recent studies have shown a drop in the pitch with testosterone injections into the thyroarytenoid muscle (TAM) offering a promising alternative that may mitigate the limitations associated with framework surgery.
Aim
The aim of our study is to audit the outcomes of injecting testosterone into the thyroarytenoid muscle with respect to decreasing the vocal pitch.
Methods
We present a case series of male patients with a high-pitched voice due to various etiologies, such as sulcus, associated puberphonia and vocal fold stiffness. All patients were evaluated pre and post procedure (10 days, 3 months, 6 months) with fundamental frequency (Fo), maximum phonation time (MPT), stroboscopy, patient reported satisfaction score and serum testosterone levels. The patients were injected with a total of 35 to 40 milligrams of testosterone propionate either unilaterally or bilaterally into the TAM either under local or general anesthesia.
Results
Preliminary observations from this ongoing study suggest that direct testosterone injection into the TAM leads to a reduction in pitch. While there is a decrease observed in the vocal pitch, it is not as pronounced as that seen with RFS. As this study is still in progress, final conclusions will be drawn upon completion of data collection and analysis.
Conclusion
Direct testosterone injection into the TAM appears to be a safe, minimally invasive alternative for male patients with persistent high-pitched voices secondary to various aetiologies, thus expanding available treatment options.