Voice development and hormones

Hormones are biochemical messengers that are produced in special cells and transported via the blood. They have specific effects on various organs. During puberty, the larynx and vocal tract grow rapidly and are even more pronounced in boys under the influence of androgens (the male hormones) than in girls, in whom the "voice break" is usually not noticed.

Almost fifteen-year-old Mara has been taking singing lessons for more than a year. She is planning to take a music exam. For the past six months she has not been able to sing at all, her voice has become much deeper. The examination shows at most a slight reddening of the vocal folds. But Mara has not yet had a period, which suggests a hormonal problem. The hormone specialist also found a predominance of male hormones. Mara's voice has therefore broken to a certain extent, although her voice has not dropped by an octave as in boys, but it is lower than the voice of girls of the same age, which physiologically drops by about a third.

The hormonal disorder can be treated, but the voice will not become higher, the virilization of the larynx cannot be reversed. Mara will probably be able to regain access to her singing voice when her larynx gets used to the new situation, and speech therapy is initially indicated for this. However, it is uncertain what range of voice she will be able to sing in and whether she will be able to pass a music exam.

Fourteen-and-a-half-year-old Mike comes to see me because he had caught a cold two months previously and still hasn't found his singing voice again. He sings solo in an ensemble as a mezzo-soprano. He speaks with a somewhat unnaturally high, thin and brittle voice. The examination shows a larynx without irritation, but already significantly larger than that of a child.

What is the problem? Mike has actually already gone through the voice change, i.e. the hormonally stimulated growth of the larynx has taken place. However, due to the cultivation of high-pitched singing, he has also become stuck in a high-pitched voice when speaking. This is not a hormonal disorder, but a faulty adaptation to normal development. What now?

This voice pitch, which has not yet stabilized when the mutation has already largely occurred, is called cambiata. The boy's speaking voice must be lowered into the male register by an experienced speech therapist and stabilized there, because constantly speaking too high strains the voice and leads to vocal fatigue and hoarseness. For this reason, Mike's voice did not recover after the cold. Mike can still sing at a high pitch for the time being. The recording of a concert that Mike was able to sing again a few months later with his high voice sounds perfect.

If the voice remains high despite growth, this is referred to as a mutation disorder. In men, this pathological voice is highly conspicuous, but can be treated well with speech therapy. In girls with a mutation disorder, voice fatigue and hoarseness occur much later and the diagnosis is more difficult to make. Speech therapy is also the treatment of choice here.

Mutational disorders are fairly common. Genuine hormonally induced voice disorders, as described in Mara's case, are much rarer. If an adolescent does not or only partially reach the male vocal range, an examination by a phoniatrist is indicated. If a girl's voice drops noticeably, or if she can no longer sing at all without being under increased strain or having been prone to voice disorders in the past, then this should also be checked medically.