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..
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.
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
(Click on these links to view helpful tables for voice evaluation:)
Perceptual Tasks vs. Instrumental Evaluations
Normal Data: Fundamental Frequency During Reading for Adults
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.
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.
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".
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
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.
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)
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)
What are androgenic/anabolic steroids?
Effects of androgenic steroids on the voice, general effects
Common uses for androgenic steroids