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Dear Doctor Spector,

I sincerely hope you can help me out and advise me. My problem is my voice. I am a 44 year old (straight) male who, it seems sounds more like a woman to people than a man.

As you can imagine, this has made life tough going for me . I feel that it may be genetic as my son seems destined to the same misery I have to live with unless I can get something done for him. I've been told that ENT Doctors are the specialists for voice disorders, but there's a 6 month waiting list to see one where I live and I'm afraid they may not be sympathetic. Have you come across this before and can anything be done about it?

Many Thanks,
J.
Ireland

Dear J.,

Problems with vocal pitch are encountered in various situations in an ENT practice, and can be from many different sources. In your particular situation, however, the most common diagnosis rendered is one that has several different names, but has been variably called mutational dysphonia, mutational falsetto, or puberphonia (or variations such as puberophonia or pubophonia).

These conditions have in common a post-pubescent male that demonstrates a voice consistently higher in pitch than the average for males (around 115 Hz), and is thus commonly mistaken for a female (with vocal frequency usually falling in the 200 Hz range). Other associated complaints are a breathy quality to the voice, 'pitch breaks,' and an inability to produce a sufficiently loud voice in all situations. The problem usually comes to the attention of an ENT due to the unwanted social issues involved with a voice that does not match the patient's appearance, as you have noted, and being consistently mistaken for the opposite gender on the telephone.

Surprisingly, the high pitch of your voice is very likely secondary to the way you are using your voice, and not because of an anatomic variation or lesion on your voice box. The other piece of good news is that for the vast majority of patients, the only necessary intervention is speech therapy performed by a qualified speech therapist with experience in treating this particular problem.

In some cases, speech therapy alone does not entirely fix the problem, and studies have been published detailing the use of Botox injections into the voicebox (a very common treatment for various voice problems), or even surgical procedures aimed at lowering the vocal pitch when all else fails, or the problem is due to an alternate etiology.

In your particular situation, the initial challenge will be to find the proper therapist, and I would recommend starting first with a visit to the ENT. He or she should confirm that there is in fact no anatomic explanation for your issue, and then refer you (and your son) to the proper speech therapist.

Thank you for your question!

Jared E. Spector, MD

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