“My son's voice is very high-pitched and he finds it socially embarrassing. Is there anything we can do?”
My son is 16, and he has a very soft and high-pitched voice and he finds it very embarrassing socially. Is there a way that this can be treated?
4 Answers
Voice is created in an area of the throat called the Larynx or voice box. It is situated at the entrance of the wind pipe called trachea. The larynx is located in the throat at the top of the trachea, or windpipe. The larynx contains two structures called vocal cords or vocal folds besides the supporting structures. They are two small muscles folds in the middle of the larynx. The relaxation and tightening of these muscle folds create voice by changing the air that flows through the larynx. And with the help of the mouth and the tongue different sound with different pitch and volumes can be created. High pitch or low pitch voices are therefore the result of alteration on the vocal cord as they tighten or relax. Any change in your larynx can affect the vocal cords and therefore affects your voice. High pitch is as a result of shortening or tightening of the vocal folds while low pitch is the result of lengthening or relaxation of the vocal folds. It is similar to a piano or guitar. When the strings of the piano or guitar are small and tight, they produce high pitch sound and when they are long and loose they produce low pitch sounds. The adjacent and supporting structures in the larynx also play a role in resonance of the voice.
During childhood, there is a significant growth changes in the larynx, the vocal folds and the supporting structures. At birth, the length of the vocal folds is around 2 mm. They are the same size for males and females. For the next 18- 22 years of life, the vocal cords grow about 0.7 mm per year in males. However for female the vocal cord only grows about 0.4 mm per year. The maximum adult male length of the vocal cord is about 18 mm, while it is about 12 mm for females. The male vocal folds are over 60% more than the female vocal cord.
As we grow during childhood into adolescence our voices get deeper. Infants produce the highest pitch because they have the smallest vocal cord. As the time progress even before puberty male and female pitches start to be different as the vocal cords become bigger and ticker in male than female even though both of them are getting bigger and the pitches are getting deeper for both males and female (more deeper for males than females).
Puberty greatly affects the voice change. The vocal cords get longer and thicker as puberty progress from childhood to adolescence. Testosterone affects the muscles and the vocal cords (folds) more than estrogen or progesterone, though both of the later hormones can affect the larynx to some extent. However testosterone has a powerful effect on the growth of the vocal cords and the surrounding structure of the larynx that help with voice and resonance.
Boys make much more testosterone than females 10-20 times, therefore the male vocal cord are bigger and thicker and huskier than females. Adolescent girls have husky voices to a lesser extent but they are not much noticeable. In boys and girls the age when puberty starts are variable because some are early bloomers , some are late bloomers, and others are average bloomers.
Puberty is divided in 5 stages called tanner stages. Tanner stage 1 is no puberty (prepubertal). Tanner stage 2 is starting early puberty. Boys will have testicular enlargement followed by penile enlargement and pubic hair. At this stage they can produce viable perm cell.
Tanner 3 is further enlargement of testicles, the penis and pubic hair, and (cracking of voice may start).
Tanner 4 is were growth of more testicular tissue;t up to 20 ml testicles, enlarged penis, growth spurt and deepening of voice.
Tanner stage 5 is achieving adult type sexual development.
The usual age when puberty will start in boys is about the age of 10 for girls and 12-13 years for boys. But most girls will have by 13 years and most boys by 15 years old. The tempo of Puberty can last from 2-5 years but most adolescent complete it in 2 and half years. The voice change or cracking may start at around 12-13 years for boys. Once boys start cracking the voice, the deepening of the voice takes place within few weeks as cracking tapers. Most voice changes take place during tanner 4 during growth spurt. However most voice changes are complete around 15-18 years. Some may complete the voice change in their late twenties and few may never achieve this, though they may be perfectly normal.
Once they complete the voice change the pitch is much lower (deeper). As men maintain a higher concentration of testosterone and since testosterone spikes at times substantial longer and thicker vocal folds are formed leading to deeper voices than women.
Babies cry for 5-7 hours a day at a sustained pitch of 400–600 Hz. As we grow old the pitch intensity drops as the vocal folds that vibrate become longer and thicker. The adult person has about 60 percent longer than a female, and that is why men speak at about 110 Hz, and women speak around 150 to 200 Hz. AS the spicks of testosterone fluctuates the pitches of voices will also fluctuate accordingly until a stable stage is reached. The voice of male finally deepens by an octave (about 8 notes or pitches) while girls are few notes or pitches deeper and not badly noticeable.
Many women that have abnormal male hormones, testosterone or the weaker androgens (there are many of them), due to adrenal anomalies such congenital adrenal hyperplasia including late onset, adrenal tumors or polycystic ovarian syndrome, or, insulin resistance may suffer from deep or husky voice similar to male or in some case even worse than the average male's voice.
Most boys progress in sexual development in a reasonably predictable way. However some may not progress as predicted. Few may be perfectly ok and others may have a physiological or pathological conditions. Late bloomer (delayed growth and sexual development) and children with hypogonadism (low testosterone in males) may not show sexual development or voice changes as they get older. These two entities should be differentiated carefully. The late bloomers are fine except that they have a slower tempo of puberty. They only need watchful waiting if they do not have emotional difficulties. If they develop emotional and psychological problems, with their delayed sexual development, a 6 month course of low testosterone will help them get into puberty. As they enter in to puberty they with show voice changes as puberty progress.
Boys who have hypogonadism for various reasons, such as pituitary anomalies ( Kallmenn syndrome or disorders with the pituitary ) or primary or testicular disorders ( Klinefelter's syndrome or testicular anomalies) need proper evolution including imaging studies and karyotype (genetic testing). Once the diagnosis is established treatment with testosterone can be liberally (200 mg every week or every 10 days) considered.
If a person have normal sexual development for his age, but, he is not showing voice changes and have a normal male karyotype; he may be perfectly fine. If the person have emotional and psychological issues testosterone treatment can be tried to see if he can crack the voice.
Going back to your son: Your son is 16 years old. At this age he should be in puberty. If he is not in puberty he should have a proper evaluation and if every thing is fine, and that he is only a late bloomer, and he has emotional difficulties with his current situation, a course of testosterone therapy can be considered to help him enter into puberty sooner (50-100 mg of testosterone cypionate for 4-6 months) after discussing this with his doctor. Once he goes through puberty his voice change will come in time. But if your son is a not a late bloomer, he needs to be worked up for the various causes of delayed puberty or hypogonadism. And treatment should be sought based on the real cause. On the other hand if your son is in full blown puberty but he has emotional issues with his voice (high pitch voice) either watchful waiting or a trial of testosterone could be considered if indicated after consulting with his doctor.
remember some times these things take time to progress. Things are not always simple in life. But if he is experiencing emotional and psychological issues counseling and testosterone trail may help.
Please consult with your doctor about these issue in detail he will decide what steps to take to help your son.
Good Luck
During childhood, there is a significant growth changes in the larynx, the vocal folds and the supporting structures. At birth, the length of the vocal folds is around 2 mm. They are the same size for males and females. For the next 18- 22 years of life, the vocal cords grow about 0.7 mm per year in males. However for female the vocal cord only grows about 0.4 mm per year. The maximum adult male length of the vocal cord is about 18 mm, while it is about 12 mm for females. The male vocal folds are over 60% more than the female vocal cord.
As we grow during childhood into adolescence our voices get deeper. Infants produce the highest pitch because they have the smallest vocal cord. As the time progress even before puberty male and female pitches start to be different as the vocal cords become bigger and ticker in male than female even though both of them are getting bigger and the pitches are getting deeper for both males and female (more deeper for males than females).
Puberty greatly affects the voice change. The vocal cords get longer and thicker as puberty progress from childhood to adolescence. Testosterone affects the muscles and the vocal cords (folds) more than estrogen or progesterone, though both of the later hormones can affect the larynx to some extent. However testosterone has a powerful effect on the growth of the vocal cords and the surrounding structure of the larynx that help with voice and resonance.
Boys make much more testosterone than females 10-20 times, therefore the male vocal cord are bigger and thicker and huskier than females. Adolescent girls have husky voices to a lesser extent but they are not much noticeable. In boys and girls the age when puberty starts are variable because some are early bloomers , some are late bloomers, and others are average bloomers.
Puberty is divided in 5 stages called tanner stages. Tanner stage 1 is no puberty (prepubertal). Tanner stage 2 is starting early puberty. Boys will have testicular enlargement followed by penile enlargement and pubic hair. At this stage they can produce viable perm cell.
Tanner 3 is further enlargement of testicles, the penis and pubic hair, and (cracking of voice may start).
Tanner 4 is were growth of more testicular tissue;t up to 20 ml testicles, enlarged penis, growth spurt and deepening of voice.
Tanner stage 5 is achieving adult type sexual development.
The usual age when puberty will start in boys is about the age of 10 for girls and 12-13 years for boys. But most girls will have by 13 years and most boys by 15 years old. The tempo of Puberty can last from 2-5 years but most adolescent complete it in 2 and half years. The voice change or cracking may start at around 12-13 years for boys. Once boys start cracking the voice, the deepening of the voice takes place within few weeks as cracking tapers. Most voice changes take place during tanner 4 during growth spurt. However most voice changes are complete around 15-18 years. Some may complete the voice change in their late twenties and few may never achieve this, though they may be perfectly normal.
Once they complete the voice change the pitch is much lower (deeper). As men maintain a higher concentration of testosterone and since testosterone spikes at times substantial longer and thicker vocal folds are formed leading to deeper voices than women.
Babies cry for 5-7 hours a day at a sustained pitch of 400–600 Hz. As we grow old the pitch intensity drops as the vocal folds that vibrate become longer and thicker. The adult person has about 60 percent longer than a female, and that is why men speak at about 110 Hz, and women speak around 150 to 200 Hz. AS the spicks of testosterone fluctuates the pitches of voices will also fluctuate accordingly until a stable stage is reached. The voice of male finally deepens by an octave (about 8 notes or pitches) while girls are few notes or pitches deeper and not badly noticeable.
Many women that have abnormal male hormones, testosterone or the weaker androgens (there are many of them), due to adrenal anomalies such congenital adrenal hyperplasia including late onset, adrenal tumors or polycystic ovarian syndrome, or, insulin resistance may suffer from deep or husky voice similar to male or in some case even worse than the average male's voice.
Most boys progress in sexual development in a reasonably predictable way. However some may not progress as predicted. Few may be perfectly ok and others may have a physiological or pathological conditions. Late bloomer (delayed growth and sexual development) and children with hypogonadism (low testosterone in males) may not show sexual development or voice changes as they get older. These two entities should be differentiated carefully. The late bloomers are fine except that they have a slower tempo of puberty. They only need watchful waiting if they do not have emotional difficulties. If they develop emotional and psychological problems, with their delayed sexual development, a 6 month course of low testosterone will help them get into puberty. As they enter in to puberty they with show voice changes as puberty progress.
Boys who have hypogonadism for various reasons, such as pituitary anomalies ( Kallmenn syndrome or disorders with the pituitary ) or primary or testicular disorders ( Klinefelter's syndrome or testicular anomalies) need proper evolution including imaging studies and karyotype (genetic testing). Once the diagnosis is established treatment with testosterone can be liberally (200 mg every week or every 10 days) considered.
If a person have normal sexual development for his age, but, he is not showing voice changes and have a normal male karyotype; he may be perfectly fine. If the person have emotional and psychological issues testosterone treatment can be tried to see if he can crack the voice.
Going back to your son: Your son is 16 years old. At this age he should be in puberty. If he is not in puberty he should have a proper evaluation and if every thing is fine, and that he is only a late bloomer, and he has emotional difficulties with his current situation, a course of testosterone therapy can be considered to help him enter into puberty sooner (50-100 mg of testosterone cypionate for 4-6 months) after discussing this with his doctor. Once he goes through puberty his voice change will come in time. But if your son is a not a late bloomer, he needs to be worked up for the various causes of delayed puberty or hypogonadism. And treatment should be sought based on the real cause. On the other hand if your son is in full blown puberty but he has emotional issues with his voice (high pitch voice) either watchful waiting or a trial of testosterone could be considered if indicated after consulting with his doctor.
remember some times these things take time to progress. Things are not always simple in life. But if he is experiencing emotional and psychological issues counseling and testosterone trail may help.
Please consult with your doctor about these issue in detail he will decide what steps to take to help your son.
Good Luck
I would check sexual hormone levels first in your son
Best of luck
LG
Best of luck
LG
Take your son to a pediatric endocrinologist who will perform a physical exam to be sure that his puberty is according to his age
It sounds like this may be a temporary situation related to changes during puberty. You could ask his physician to check him out to make sure it is just a temporary puberty issue.
