The Effect of Oxandrolone on Voice Frequency in Growth Hormone-Treated Girls With Turner Syndrome

• Published in: Journal of voice Vol. 25; no. 5; pp. 602 - 610
• Main Authors: Menke, Leonie A, Sas, Theo C.J, van Koningsbrugge, Sophie H.L, de Ridder, Maria A.J, Zandwijken, Gladys R.J, Boersma, Bart, Dejonckere, Philippe H, de Muinck Keizer-Schrama, Sabine M.P.F, Otten, Barto J, Wit, Jan M
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-09-2011
• Subjects: Adolescent; Anabolic Agents - administration & dosage; Child; Child, Preschool; Dose-Response Relationship, Drug; Estrogen replacement therapy; Estrogens - administration & dosage; Female; Follow-Up Studies; Growth Disorders - drug therapy; Growth hormone therapy; Hormone Replacement Therapy - methods; Human Growth Hormone - administration & dosage; Humans; Infant; Otolaryngology; Oxandrolone; Oxandrolone - administration & dosage; Turner syndrome; Turner Syndrome - drug therapy; Voice; Voice Quality - drug effects; Oxandrolone; Estrogen replacement therapy; Turner syndrome; Voice; Growth hormone therapy
• ISSN: 0892-1997; 1873-4588
• DOI: 10.1016/j.jvoice.2010.06.002

Summary Objectives/Hypothesis Oxandrolone (Ox) increases height gain but may also cause voice deepening in growth hormone (GH)-treated girls with Turner syndrome (TS). We assessed the effect of Ox on objective and subjective speaking voice frequency in GH-treated girls with TS. Study Design A multicenter, randomized, placebo (Pl)-controlled, double-blind study was conducted. Methods One hundred thirty-three patients were included and treated with GH (1.33 mg/m2 /d) from baseline, combined with Pl or Ox in a low (0.03 mg/kg/d) or conventional (0.06 mg/kg/d) dose from the age of 8 years and estrogens from the age of 12 years. Yearly from starting Ox/Pl until 6 months after discontinuing GH + Ox/Pl, voices were recorded and questionnaires were completed. Results At start, mean (±standard deviation [SD]) voice frequency SD score (SDS) was high for age (1.0 ± 1.2, P < 0.001) but normal for height. Compared with GH + Pl, voices tended to lower on GH + Ox 0.03 ( P = 0.09) and significantly lowered on GH + Ox 0.06 ( P = 0.007). At the last measurement, voice frequency SDS was still relatively high in GH + Pl group (0.6 ± 0.7, P = 0.002) but similar to healthy girls in both GH + Ox groups. Voice frequency became lower than −2 SDS in one patient (3%) on GH + Ox 0.03 and three patients (11%) on GH + Ox 0.06. The percentage of patients reporting subjective voice deepening was similar between the dosage groups. Conclusions Untreated girls with TS have relatively high-pitched voices. The addition of Ox to GH decreases voice frequency in a dose-dependent way. Although most voice frequencies remain within the normal range, they may occasionally become lower than −2 SDS, especially on GH + Ox 0.06 mg/kg/d.