Voice frequency in healthy children and adolescents: A biomarker of androgen action in puberty

Holmboe Stine A; Lea Vilmann; Grøndahl Veronica R; Thomsen Charlotte E.; Fritzbøger Andrés Ø.; Pernille Edström; Busch Alexander S.; Lise Aksglaede; Hagen Casper P.; Anders Juul

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ESPE Abstracts (2024) 98 FC13.6

ESPE2024 Free Communications Pituitary, Neuroendocrinology and Puberty 2 (6 abstracts)

Voice frequency in healthy children and adolescents: A biomarker of androgen action in puberty

Stine A Holmboe ^1,2 , Lea Vilmann ^1,2 , Veronica R Grøndahl ^1,2 , Charlotte E. Thomsen ^1,2 , Andrés Ø. Fritzbøger ^1,2 , Pernille Edström ^1,2 , Alexander S. Busch ^1,2 , Lise Aksglaede ^1,2 , Casper P. Hagen ^1,2 & Anders Juul ^1,2,3

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¹Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. ²International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. ³Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

Introduction: The pubertal transition is accompanied by voice break in boys. Studies asking men to retrospectively recall their age at voice break report an average age of voice break corresponding to 13.4-14.0 years. However, it may be difficult to remember precisely when your voice broke, and recall bias is quite large. Little is known about voice frequency in boys and girls in relation to pubertal timing.

Aim: To assess voice frequency objectively using a voice analysis app (Voice Analysts, Speechtools Ltd) in healthy children and adolescents.

Methods: 697 children and adolescents (58% girls) aged 5-21 years from 6 public schools in the greater Copenhagen area participated as part of the Copenhagen Puberty Study III (COPUS), ClinTrials.gov #NCT04884620. Pubertal stage was evaluated according to Tanner. Height, weight, and body composition were recorded. Blood sampling was performed, and sex steroids were quantified by LC-MS/MS. Voice frequency was recorded by a voice analysis app (Speechtools Ltd). All children were instructed to provide a sustained vowel ‘aaah’ for 4 seconds at a comfortable volume and pitch and secondly were asked to read a short standardized text to capture intonation while continuously speaking. The app was validated against an advanced computerized analysis system (Multi-Dimensional Voice Program (MDVP)) and the two methods showed great correlation (Spearmans R = 0.99, P <0.001).

Results: Voice frequency did not differ between prepubertal boys and girls. Boys exhibited a pronounced decline in voice frequency during puberty (median voice frequency in G1 vs. G5: 254 Hz vs. 114 Hz, P <0.01) with the most pronounced decline seen from G3 to G4. The decline in girls was less pronounced (median voice frequency in B1 vs. B5: 256 Hz vs. 215 Hz, P <0.01). From G4 and B4 levels of voice frequency were completely separated in boys vs. girls.

Conclusion: Voice frequency is an easy non-invasive biomarker of androgen action in healthy children and decreases profoundly during male puberty. Interestingly, girls also present with a moderate pubertal voice break.