顺性别女性中与睾酮相关的嗓音变化：对处方医生和嗓音临床医生的调查

文献信息

中文摘要

目的： 描述处方提供者对睾酮相关嗓音变化的处方实践、咨询方法和认知，并考察嗓音临床医生管理推测与睾酮相关嗓音变化的经验。
方法： 横断面研究，使用基于REDCap的匿名调查，通过专业学会平台、在线论坛和直接联系向开具睾酮处方的医疗提供者和嗓音临床医生（喉科医生和言语语言病理学家[SLP]）分发。
结果： 在72名医疗提供者中，55名（76%）为顺性别女性开具了睾酮治疗处方。受访者主要在妇产科执业（64%），其次是初级保健（11%）和内分泌科（10%）。睾酮主要在绝经期开具（91%），通常用于性欲减退障碍（93%）。大多数提供者报告了详细（53%）或简要（37%）的嗓音风险咨询。对嗓音变化的管理包括停用睾酮（53%）、减少剂量（41%）和转诊专科医生（12%）。定性回答中报告的障碍包括评估雄激素使用与嗓音风险之间关联的文献证据有限、患者从社交媒体获取的错误信息以及缺乏女性特异性睾酮制剂。在87名嗓音临床医生受访者中，71%的喉科医生和83%的SLP报告治疗过推测有睾酮相关嗓音变化的女性。喉科医生在确立诊断时通常依赖临床判断（58%）或异常喉功能检查（例如，视频喉动态镜、声学和/或空气动力学嗓音分析）（38%）。声带增厚（67%）和水肿（38%）是最常见的喉部检查发现，而音调变低和音域丧失是最常见的就诊主诉。83%的喉科医生和86%的SLP认为睾酮相关嗓音变化被低估。
结论： 我们的研究表明，处方提供者和嗓音临床医生都认识到嗓音变化是睾酮治疗越来越常见的雄激素效应，尽管咨询和管理各不相同。喉科医生通常依赖临床判断，包括睾酮暴露与随后嗓音变化之间的时间关系，这反映了缺乏标准化诊断标准。这些发现强调了在顺性别女性中进行嗓音相关睾酮研究的必要性，以及处方提供者和嗓音临床医生之间合作以进行知情咨询和在嗓音变化发生时及时转诊的必要性。

英文摘要

AIMS: To characterize prescribing practices, counseling approaches, and perceptions of testosterone-associated voice change among prescribing providers and examine voice clinician experiences managing presumed testosterone-associated voice changes.
METHODS: Cross-sectional study using anonymous REDCap-based surveys distributed through professional society platforms, online forums, and direct outreach to testosterone-prescribing medical providers and voice clinicians (laryngologists and speech-language pathologists [SLPs]).
RESULTS: Among 72 medical providers, 55 (76%) prescribed testosterone therapy to cisgender women. Respondents primarily practiced in obstetrics-gynecology (64%), followed by primary care (11%) and endocrinology (10%). Testosterone was largely prescribed during menopause (91%), typically for hypoactive sexual desire disorder (93%). Most providers reported detailed (53%) or brief (37%) voice risk counseling. Management for voice changes included testosterone discontinuation (53%), dose reduction (41%), and specialist referral (12%). Reported barriers from qualitative responses included limited evidence in literature evaluating associations between androgen use and voice risk, patient misinformation from social media, and lack of female-specific testosterone formulations. Among 87 voice clinician respondents, 71% of laryngologists and 83% of SLPs reported treating women with presumed testosterone-associated voice changes. Laryngologists typically relied on clinical judgment (58%) or abnormal laryngeal function studies (eg, videostroboscopy, acoustic and/or aerodynamic voice analysis) (38%) when establishing a diagnosis. Vocal fold thickening (67%) and edema (38%) were the most common laryngeal exam findings, while pitch deepening and loss of vocal range were the most frequent presenting complaints. 83% of laryngologists and 86% of SLPs believed testosterone-associated voice changes are underrecognized.
CONCLUSIONS: Our study suggests that prescribing providers and voice clinicians alike recognize voice change as an increasingly common androgenic effect of testosterone therapy, though counseling and management varied. Laryngologists often relied on clinical judgment, including a temporal relationship between testosterone exposure and subsequent voice change, reflecting the absence of standardized diagnostic criteria. These findings underscore the need for voice‑related testosterone research in cisgender women and collaboration between prescribing providers and voice clinicians for informed counseling and timely referral when voice changes occur.