The Steroid Sopranos - Wadler’s Whining Gets High-Pitched
No, HBO will not be returning this fall with a juiced-out cast of muscled-up mobsters. Although if you ask me, it might not be so bad, as a little extra lean mass would only make Tony’s threats that much more intimidating. What we are talking about here is a new side effect of steroid use; one brought to the attention of the general public by the World Anti-Doping Agency’s own Dr. Gary Wadler. Dr. Wadler is currently the most vocal and widely quoted critic of steroid use and its dangers. During a recent ESPN television special, he shocked many viewers by disclosing yet another new danger of steroid use. Apparently, steroids can affect the male vocal chords. More to the point, Wadler claimed that speaking in a high-pitched feminine voice was a side effect of steroid use! Since this was news to me, I decided to devote this month’s column to getting to the bottom of this potential new steroid evil.
To give Wadler the proper credit for his words, here was his exact quote from the program. When discussing the various side effects of steroid use, Wadler warned, “The side effects of steroid use are enormous. Most of us believe it enhances the likelihood of coronary disease, as well as stroke. If you take oral varieties there is no question there is liver problems associated with it. They [men] get feminized. They get breasts. Their testicles atrophy. They could wind up with a high-pitched voice.” Wadler starts to run down the usual list of sensationalized risks, however his description of “feminization” is anything but. In all my years of experience and study, I have never heard of a side effect of “high-pitched voice.” So does Wadler know something I do not? Or is he as clueless as Jessica Simpson at a MENSA meeting?
Masculinization and Feminization
Anabolic steroids are derivatives of male hormones (androgens). However, some of these compounds are capable of converting to estrogen in the body, just as our own natural testosterone is. This means certain anabolic steroids can increase levels of both male and female hormones. Wadler is, therefore, correct insofar as saying both masculinizing and feminizing side effects can be seen in men and women who misuse these drugs. Men can get gynecomastia, for example, which refers to the development of female breast tissues. This would be a legitimate feminizing side effect (though an easily avoided one). Women, on the other hand, can notice such masculinizing effects as thickening and coarsening of the skin and deepening of the voice. Again, misuse is key. But that really isn’t the issue of this article. What is at issue is the statement Wadler made (twice in the show, actually) about steroids “feminizing” the vocal chords of men. So how far does this “feminization” thing really go?
Androgens and Vocal Pitch
Androgens are known to be integral to vocal development in men. This link is a well-substantiated one. We know this because when males grow up with abnormally low levels of testosterone (as in hypogonadotrophic hypogonadism), normal masculinization of the larynx is not achieved. These men tend to speak with a vocal pitch that falls somewhere between the average range of men and women. We also find that testosterone injections, when properly applied at the right age, can do a good job of correcting the vocal differences in such patients.[1] Here, steroids administration is replacing the hormones the body is not capable of making on its own. Women are also well documented to notice masculinization of the voice with steroid abuse, as mentioned already. Everywhere you look, you keep finding links, but they are links between a deepening of the voice and steroid use, not an increase in its pitch. The generally understood logic of how these drugs affect the voice is entirely opposite of what Wadler is describing.
Testing His Logic
Wadler seems to be thinking one of two things. One is that high estrogen conversion and levels (produced by such drugs as testosterone or Dianabol) can directly “feminize” the voice. This is the simplest causative explanation. The other is that steroid use causes lasting hypogonadism, and that the vocal problems noticed with hypogonadism in developing children will be duplicated in adult men (but here masculinization of the larynx will be reversed). Although we know prolonged hypogonadism secondary to steroid use is highly unlikely, let’s humor the logic of this theory for a second. Males are known to be most responsive to changes in vocal pitch during a very specific window of time, namely the later stages of puberty identified as Tanner Stages G3 and G4.[2] The issues of hormones and voice have always been issues of childhood development, not adult maintenance. Even if we could create a state in adulthood that mimics that noticed with childhood hypogonadism, what would that actually do? With either scenario, is it even possible to increase the pitch of the adult male voice with hormones?
Transsexual Truth
To put the nail in the coffin for Wadler’s theory, let us examine what happens with extreme examples of hormonal manipulation. Let’s find examples so good that they represent both of the above scenarios at the same time. We want to see what happens to the voice of men who are castrated, so they would no longer produce normal levels of androgens. This induces hypogonadism, just as would be noticed in the children with low testosterone levels. But we want to go one step further and give these castrated men high doses of estrogen. This is about as radical as you can find, and clearly exceeds any example of steroid use in regard to the imbalance between androgen and estrogen levels produced. But where would we get such examples to study? Actually, such examples are common in transsexualism. The goal there is to create a physical female appearance in every regard possible. To achieve this, the androgen source (testes) is removed during sexual reassignment surgery and high doses of estrogen are given thereafter to support feminine characteristics.
With the transsexual patient, you have taken an adult male and intentionally produced a hormonal state of peak femininity. The estrogenicity here is far greater than you could ever achieve with anabolic steroids, which, of course, always present high androgen levels to the user. Surely the typical transsexual patient must be singing soprano in no time, right? Not quite. Even long courses of estrogen therapy have minimal effects on vocal pitch, and retention of the male voice is a major physiological issue for post-operative transsexual patients.[3] What has evolved are a number of procedures to surgically adjust the vocal chords, which can alter pitch to a neutral range in most cases, and sometimes even to a distinctly female range.[4] The minute you look at these transsexual cases, you see that Wadler’s theory doesn’t hold a drop of water. As these patients find, it’s not easy to alter the voice of an adult male. Even with drastic changes in hormone levels caused by simultaneous castration and estrogen use, the only way to achieve a high “feminine” vocal pitch is through surgery!
Ending in Disappointment
When I think about the fact that Dr. Gary Wadler is the most widely quoted critic of anabolic steroid use these days, and that he is greatly fueling the current “steroid hysteria,” I become deeply disappointed and discouraged. Clearly, he is no expert on anabolic steroids. The obviously erroneous statement he made about the effects of steroids on male voice underline a great lack of understanding about these drugs. If he is charged with representing an important issue to the government and public alike, shouldn’t he be more educated on the subject? I would go so far as to say that his mistake should undermine his entire credibility on this issue, as clearly he has not taken the time to truly study the drugs he is preaching against. I just wish the average TV viewer was educated enough on the subject to see this. If they were, the Gary Wadlers of the world would probably get little airtime, except as an occasional comedic side note. Unfortunately, I suspect we’ll be seeing a lot more of Dr. Wadler and his anti-steroid… what do you call it? Oh yeah, “propaganda.” SAME BIO.
References:
[1] Voice changes after androgen therapy for hypogonadotrophic hypogonadism. Akcam T, Bolu E, et al. Laryngoscope. 2004 Sep;114(9):1587-91.
[2] Changes in the male voice at puberty. Harries M, Walker J et al. Arch Dis Child 1997;77:445-447.
[3] The importance of the voice in male-to-female transsexualism. Neumann K, Welzel C. J Voice 2004 Mar;18(1):153-67.
[4] Expert phoniatric assessment of voice adaptation in male to female transsexualism. Rosanowski F, Eysholdt U. HNO 1999 Jun;47(6):556-62.
No, HBO will not be returning this fall with a juiced-out cast of muscled-up mobsters. Although if you ask me, it might not be so bad, as a little extra lean mass would only make Tony’s threats that much more intimidating. What we are talking about here is a new side effect of steroid use; one brought to the attention of the general public by the World Anti-Doping Agency’s own Dr. Gary Wadler. Dr. Wadler is currently the most vocal and widely quoted critic of steroid use and its dangers. During a recent ESPN television special, he shocked many viewers by disclosing yet another new danger of steroid use. Apparently, steroids can affect the male vocal chords. More to the point, Wadler claimed that speaking in a high-pitched feminine voice was a side effect of steroid use! Since this was news to me, I decided to devote this month’s column to getting to the bottom of this potential new steroid evil.
To give Wadler the proper credit for his words, here was his exact quote from the program. When discussing the various side effects of steroid use, Wadler warned, “The side effects of steroid use are enormous. Most of us believe it enhances the likelihood of coronary disease, as well as stroke. If you take oral varieties there is no question there is liver problems associated with it. They [men] get feminized. They get breasts. Their testicles atrophy. They could wind up with a high-pitched voice.” Wadler starts to run down the usual list of sensationalized risks, however his description of “feminization” is anything but. In all my years of experience and study, I have never heard of a side effect of “high-pitched voice.” So does Wadler know something I do not? Or is he as clueless as Jessica Simpson at a MENSA meeting?
Masculinization and Feminization
Anabolic steroids are derivatives of male hormones (androgens). However, some of these compounds are capable of converting to estrogen in the body, just as our own natural testosterone is. This means certain anabolic steroids can increase levels of both male and female hormones. Wadler is, therefore, correct insofar as saying both masculinizing and feminizing side effects can be seen in men and women who misuse these drugs. Men can get gynecomastia, for example, which refers to the development of female breast tissues. This would be a legitimate feminizing side effect (though an easily avoided one). Women, on the other hand, can notice such masculinizing effects as thickening and coarsening of the skin and deepening of the voice. Again, misuse is key. But that really isn’t the issue of this article. What is at issue is the statement Wadler made (twice in the show, actually) about steroids “feminizing” the vocal chords of men. So how far does this “feminization” thing really go?
Androgens and Vocal Pitch
Androgens are known to be integral to vocal development in men. This link is a well-substantiated one. We know this because when males grow up with abnormally low levels of testosterone (as in hypogonadotrophic hypogonadism), normal masculinization of the larynx is not achieved. These men tend to speak with a vocal pitch that falls somewhere between the average range of men and women. We also find that testosterone injections, when properly applied at the right age, can do a good job of correcting the vocal differences in such patients.[1] Here, steroids administration is replacing the hormones the body is not capable of making on its own. Women are also well documented to notice masculinization of the voice with steroid abuse, as mentioned already. Everywhere you look, you keep finding links, but they are links between a deepening of the voice and steroid use, not an increase in its pitch. The generally understood logic of how these drugs affect the voice is entirely opposite of what Wadler is describing.
Testing His Logic
Wadler seems to be thinking one of two things. One is that high estrogen conversion and levels (produced by such drugs as testosterone or Dianabol) can directly “feminize” the voice. This is the simplest causative explanation. The other is that steroid use causes lasting hypogonadism, and that the vocal problems noticed with hypogonadism in developing children will be duplicated in adult men (but here masculinization of the larynx will be reversed). Although we know prolonged hypogonadism secondary to steroid use is highly unlikely, let’s humor the logic of this theory for a second. Males are known to be most responsive to changes in vocal pitch during a very specific window of time, namely the later stages of puberty identified as Tanner Stages G3 and G4.[2] The issues of hormones and voice have always been issues of childhood development, not adult maintenance. Even if we could create a state in adulthood that mimics that noticed with childhood hypogonadism, what would that actually do? With either scenario, is it even possible to increase the pitch of the adult male voice with hormones?
Transsexual Truth
To put the nail in the coffin for Wadler’s theory, let us examine what happens with extreme examples of hormonal manipulation. Let’s find examples so good that they represent both of the above scenarios at the same time. We want to see what happens to the voice of men who are castrated, so they would no longer produce normal levels of androgens. This induces hypogonadism, just as would be noticed in the children with low testosterone levels. But we want to go one step further and give these castrated men high doses of estrogen. This is about as radical as you can find, and clearly exceeds any example of steroid use in regard to the imbalance between androgen and estrogen levels produced. But where would we get such examples to study? Actually, such examples are common in transsexualism. The goal there is to create a physical female appearance in every regard possible. To achieve this, the androgen source (testes) is removed during sexual reassignment surgery and high doses of estrogen are given thereafter to support feminine characteristics.
With the transsexual patient, you have taken an adult male and intentionally produced a hormonal state of peak femininity. The estrogenicity here is far greater than you could ever achieve with anabolic steroids, which, of course, always present high androgen levels to the user. Surely the typical transsexual patient must be singing soprano in no time, right? Not quite. Even long courses of estrogen therapy have minimal effects on vocal pitch, and retention of the male voice is a major physiological issue for post-operative transsexual patients.[3] What has evolved are a number of procedures to surgically adjust the vocal chords, which can alter pitch to a neutral range in most cases, and sometimes even to a distinctly female range.[4] The minute you look at these transsexual cases, you see that Wadler’s theory doesn’t hold a drop of water. As these patients find, it’s not easy to alter the voice of an adult male. Even with drastic changes in hormone levels caused by simultaneous castration and estrogen use, the only way to achieve a high “feminine” vocal pitch is through surgery!
Ending in Disappointment
When I think about the fact that Dr. Gary Wadler is the most widely quoted critic of anabolic steroid use these days, and that he is greatly fueling the current “steroid hysteria,” I become deeply disappointed and discouraged. Clearly, he is no expert on anabolic steroids. The obviously erroneous statement he made about the effects of steroids on male voice underline a great lack of understanding about these drugs. If he is charged with representing an important issue to the government and public alike, shouldn’t he be more educated on the subject? I would go so far as to say that his mistake should undermine his entire credibility on this issue, as clearly he has not taken the time to truly study the drugs he is preaching against. I just wish the average TV viewer was educated enough on the subject to see this. If they were, the Gary Wadlers of the world would probably get little airtime, except as an occasional comedic side note. Unfortunately, I suspect we’ll be seeing a lot more of Dr. Wadler and his anti-steroid… what do you call it? Oh yeah, “propaganda.” SAME BIO.
References:
[1] Voice changes after androgen therapy for hypogonadotrophic hypogonadism. Akcam T, Bolu E, et al. Laryngoscope. 2004 Sep;114(9):1587-91.
[2] Changes in the male voice at puberty. Harries M, Walker J et al. Arch Dis Child 1997;77:445-447.
[3] The importance of the voice in male-to-female transsexualism. Neumann K, Welzel C. J Voice 2004 Mar;18(1):153-67.
[4] Expert phoniatric assessment of voice adaptation in male to female transsexualism. Rosanowski F, Eysholdt U. HNO 1999 Jun;47(6):556-62.