Implications of Androgenic Steroid Use in Voice Therapy

    Knowledge of how to treat individuals who have experienced the irreversible vocal fold damage of androgenic steroids is sparse.  In fact, I was able to find no published material which addressed this specific issue. I did, however, receive several ideas from some cooperative professionals in the field.  These hints, combined with information from the textbooks provided in my classes comprise the information on this page.  I would love to hear suggestions from other professionals who have worked in this area, or research in this area..

EVALUATION

First and foremost, an evaluation of the voice must be completed.  This will include a laryngoscopy/laryngostroboscopy, to determine vocal fold structure, and to rule out the possibility that the steroids have caused asymmetrical changes in the vocal folds.  Furthermore, the possibility of edema must be eliminated, as virilizing agents, in general, promote the retention of bodily fluids.

The evaluation should also include a comprehensive case history.

Samples of the client's voice should be collected and evaluated evaluated by the clinician's own ears, as well as with instrumentation designed to analyze a voice signal (such as a VISIPITCH - Kay Elemetrics)
 
 

(Click on these links to view helpful tables for voice evaluation:)

Perceptual Tasks vs. Instrumental Evaluations

Normal Data: Fundamental Frequency During Reading for Adults

TREATMENT

Clients exposed to androgenic steroids must understand that the effects the drug(s) have had on their vocal folds are irreversible.  The speech language pathologist may be instrumental in teaching coping techniques, or small ways to change the voice, but ultimately, they will need to come to terms with the fact that they will never have the same voice that they had before androgenic steroids were introduced.
 
 

The SLP must be prepared to counsel clients in regards to the loss of their previous voice.  For some individuals, grieving this loss may be required, at which point the SLP can lend a listening ear, and provide encouragement.  The SLP should be aware of the steps of the grieving process (denial, anger, bargaining, depression, acceptance), and help the client locate themselves within the constraints of this model.  Please note, however, that if a clinically significant emotional problem presents itself, the SLP should refer the client to  professionals trained in the area of counseling.
 
 

The myth of an "optimum pitch" has been refuted (Colton&Casper, 1996).  Though the client will notice that their voice has changed, it is important for them to understand that there is an entire range of pitches which are acceptable for their age and gender.  There is no "perfect pitch".
 
 

Therapy with this class of client should begin with education, wherein the SLP teaches the client the basic anatomy and physiology of the vocal mechanism.  The client should understand what is happening inside the larynx, at which point, you can explain the changes that took place due to the use of androgenic steroids.  This will also include an explanation of realistic goals for voice alteration in therapy.
 
 

Beware of vocal abuse as a reaction to the changed voice, as throat clearing when pitch breaks occur is common.  Teach vocal hygiene (reducing amount of talking, reducing loudness, identifying/reducing/eliminating vocal abuse, environmental manipulation (Colton&Casper, 1996)) as an attempt to curve these behaviors.
 
 

The client should be given information concerning both the musical and physiological limits of their pitch range.  Biofeedback using instrumentation such as the VISI PITCH (Kay Elemetrics) can be useful for this purpose (Andrews, 1999)
 
 

Several professionals I contacted indicated that a singing regiment might be used to raise the habitual pitch for clients exposed to androgenic steroids.  Such a technique is described by Andrews (1999), "Techniques it raise the pitch level are usually most effective when the pitch changes are practiced in relation to the meaning of what is being said.  A pitch pipe, digital metronome, or a keyboard may be used to cue a target pitch and a hum matched to the tome.  The hum may then be shaped into a word beginning with an "m" (e.g., "Mom").  The next step may involve the sentence "Mom, lie down".  A sentence of this kind fits, in terms of meaning, with a downward progression  of the voice,  The patient's task is to be sure to start the first work high enough so that the remaining words can be produced with musical quality (i.e., now below basal pitch or the terminal note of the musical range)." (p. 239)
 
 

The clinician should encourage the client to use a conversational range which allows for the voice to vary naturally in pitch and flexibility.  This can generally be done by attempting to habituate one optimal pitch level for the individual client.  An overall pitch range for conversation (this will vary with each client) can be established by the SLP.  This can be reinforced by use of visual feedback, if available.  Use of instrumentation in this case will assist the patient in understanding the concepts and monitoring of the practice.  Use sentences which facilitate "upward inflections in the voice, such as exclamations, positive feelings, onomatopoeic words, and meanings associated with height, lightness, or energy." (Andrews, 1999).

(For a table of such activities, click here)

 


 
 
 
 

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What are androgenic/anabolic steroids?

Effects of androgenic steroids on the voice, general effects

Common uses for androgenic steroids

References