On TikTok the other day, Lee asked, “why the heck did I lose so much strength in my voice now that I’m on T? Can I build some back? I miss singing!

Let’s talk about how testosterone affects the voice because it is so interesting and I have so much to say about it. An important note: If your body can't produce adequate testosterone levels to affect your voice, store-bought is fine. The changes that occur are exactly the same, so when I talk about "testosterone" or "T" I'm referring to both body sources and non-body sources of T.

In a nutshell, T causes a thickening of the vocal folds and growth of the pliable cartilage of the larynx, which causes lengthening of the vocal folds as the anchor points of the vocal ligaments move away from each other.

If you are older when you undergo your testosterone puberty (like late twenties or older), your larynx may be less pliable, and may not grow. This means that you'll get the thickening of the vocal folds but not the lengthening. Thicker vocal folds create the buzziness that we associate with a masculine voice, but longer vocal folds and a large larynx are responsible for lowering the pitch.

Now, back to Lee's question: why might a person lose vocal strength when taking T?

There are a few reasons why this might happen but here are the top two most common reasons:

1. Hoarseness caused by strain

As your voice changes, your brain has to relearn how to efficiently and easily create sound. Eight sets of muscles are involved in phonation, so it can be complicated for your brain to relearn efficient phonation from scratch. In the meantime, your brain will continue to go down old pathways, causing you to use your new instrument incorrectly, leading to strain, fatigue, and hoarseness.

The best way to treat this is to do repetitive, exploratory exercises that retrain your brain, which I will show you in another blog post!

2. Water retention causes inflexibility of vocal tissue

A possible side effect of testosterone is water retention. This can occur in all muscle tissue, including vocal tissue. This can lead to stiff, inflexible vocal folds. This can make it challenging to phonate and possibly lead to incomplete closure of the vocal folds, leading to an airy, light sound.

The way to figure out if this is the case for you is to make a sound in your head voice (the upper part of your register), and if there is a gap between the attempt to phonate and the sound, this is likely the issue. The longer the gap, the worse the swelling.

If this is your situation, you actually want to avoid vocal exercises because attempting to sing through this can cause damage. However, water retention from T is a temporary side effect, and if you're patient, it will pass.

In fact, it's important to remember that any new challenges that develop during the first year or so of your testosterone puberty are likely temporary and being patient and gentle with yourself is super important.