It is possible for females to have a noticeable laryngeal prominence, which is the anatomical feature commonly referred to as the Adam’s apple. This protrusion is formed by the thyroid cartilage, a shield-shaped structure that surrounds and protects the larynx, or voice box. While this feature is typically associated with male development, its visibility in females is usually a result of natural biological variation or an underlying medical influence. Understanding the structure of the prominence and the factors that influence its size can clarify why this anatomical difference occurs.
Defining the Laryngeal Prominence
The laryngeal prominence is not a separate organ but rather the point where the two plates of the thyroid cartilage meet at the front of the neck. This cartilage protects the vocal folds, which are responsible for producing sound. In all individuals, the larynx and its surrounding cartilage increase in size during puberty.
The difference in visibility between males and females stems from the angle at which the cartilage plates fuse. In adult males, hormones cause the cartilage to grow larger and fold into a more acute angle (typically around 90 degrees), creating a sharp, noticeable protrusion. For adult females, cartilage growth is less extensive, and the fusion angle is wider (often around 120 degrees), making the prominence appear smaller or almost flat.
The Role of Androgen Excess
Excessive exposure to androgens, or male sex hormones, is the most frequent medical reason for the development of a prominent laryngeal cartilage in females. Androgens stimulate the growth of laryngeal tissues, including the thyroid cartilage and the vocal folds themselves. This process, known as virilization, can lead to a noticeable protrusion and a permanent deepening of the voice.
One common condition associated with hyperandrogenism is Polycystic Ovary Syndrome (PCOS), an endocrine disorder affecting up to 10% of reproductive-age women. PCOS can result in elevated testosterone levels that may cause laryngeal enlargement over time. Another, less common cause is Congenital Adrenal Hyperplasia (CAH), a genetic condition where the adrenal glands produce an excess of androgens.
In rare cases, an androgen-producing tumor on the adrenal gland or ovary can cause a rapid increase in hormone levels, leading to virilization. The growth of the laryngeal cartilage in response to androgens is considered an irreversible process. Even if the underlying hormonal issue is treated, the structural enlargement of the cartilage and corresponding voice changes often remain.
Non-Hormonal and Developmental Causes
Not all instances of a noticeable laryngeal prominence in females are linked to a hormonal imbalance. Natural genetic variation plays a significant role in determining the final size and structure of the thyroid cartilage. Some individuals may simply inherit a naturally larger laryngeal structure or a more sharply angled cartilage, similar to inheriting other unique facial or skeletal features.
The overall body composition and neck anatomy also influence how visible the prominence appears. In individuals with a slender neck and less surrounding subcutaneous fat, the underlying thyroid cartilage may be more easily seen and felt, even if the cartilage size is within the typical female range. This visual effect is not due to cartilage enlargement but rather a lack of tissue to conceal the normal anatomy.
In some cases, the use of external substances can induce laryngeal growth. Long-term use of certain medications, such as anabolic steroids or prescribed testosterone therapy, can cause a permanent enlargement of the thyroid cartilage. This iatrogenic cause mimics the effect of high endogenous androgen levels, leading to structural growth that is irreversible.
Diagnosis and Treatment Options
A medical evaluation for a noticeable laryngeal prominence typically begins with a physical examination and a review of the patient’s medical history for any signs of virilization. If a hormonal cause is suspected, the clinician may order a hormone panel to measure the levels of circulating androgens, such as testosterone. Imaging, such as a computed tomography (CT) scan or a laryngoscopy, may be used to precisely assess the size and structure of the thyroid cartilage and the vocal folds.
Treatment for a prominent laryngeal cartilage is often divided into two paths: managing the underlying cause and cosmetic intervention. If an endocrine disorder like PCOS or CAH is identified, a physician will focus on treating the hormonal imbalance with medications to reduce androgen production or block their effects. This management prevents further cartilage growth and virilization but does not reverse existing structural changes.
For individuals seeking to reduce the visibility of the prominence, the surgical procedure is called chondrolaryngoplasty, often colloquially referred to as a tracheal shave. This procedure involves carefully shaving down the protruding portion of the thyroid cartilage through a small incision in the neck. Surgeons take care not to remove too much cartilage, which could compromise the structural integrity of the larynx or damage the vocal cords.