A hoarse voice signifies a change in the quality, pitch, or volume of one’s voice. This can manifest as a rough, raspy, strained, or breathy sound, and the voice may be softer or higher/lower than usual. Steroid use is a common concern for its potential to induce vocal alterations. This article explores how different types of steroids affect vocal function, how to identify these changes, and strategies for managing or preventing them.
How Steroids Affect the Voice
Steroids can influence vocal cords through distinct mechanisms. Inhaled corticosteroids primarily exert localized effects on the larynx. When inhaled, these medications can leave residual particles on the vocal cords, potentially leading to irritation, dryness, or swelling of the delicate laryngeal tissues.
This local deposition can also create an environment conducive to fungal overgrowth, such as oral candidiasis (thrush), which directly contributes to hoarseness and discomfort. Additionally, some inhaled corticosteroids may cause a localized muscle weakness, known as myopathy. This can impair the vocal cords’ ability to close and vibrate effectively, resulting in voice changes.
Anabolic-androgenic steroids (AAS) affect the voice through a different, more systemic mechanism. These steroids are derivatives of testosterone and exert androgenic effects throughout the body, including on the vocal cords. These steroids cause thickening of the vocal cords due to increased muscle tissue and changes in laryngeal structure. This physically alters the vocal cords.
Recognizing Steroid-Induced Voice Changes
The characteristics of voice changes can vary depending on the type of steroid. Hoarseness from inhaled corticosteroids is often described as breathy, weak, or rough. Individuals might also experience vocal fatigue. Accompanying symptoms can include a persistent cough or general throat irritation. In some instances, white patches indicative of candidiasis may be visible in the mouth or throat.
Voice alterations caused by anabolic steroids include a permanent deepening of the voice. This masculinization of the voice, known as virilization, can also include a loss of higher vocal range and increased vocal instability or creakiness. Unlike the effects of inhaled corticosteroids, these changes are structural and do not present with localized irritation or fungal infections. The voice change can be particularly pronounced in females due to the androgenic effects on their vocal cords.
Managing and Preventing Vocal Issues
For individuals using inhaled corticosteroids, proper technique and hygiene are key to prevention. Rinsing the mouth and gargling with water immediately after each dose can help remove residual medication from the mouth and throat, reducing the risk of local irritation and fungal infections. Using a spacer device with metered-dose inhalers can also help deliver the medication more effectively to the lungs, minimizing deposition in the throat.
If hoarseness develops from inhaled corticosteroids, vocal rest and increased hydration alleviate symptoms. Avoiding vocal irritants such as smoking, excessive shouting, or prolonged speaking is beneficial. If a fungal infection is present, antifungal treatments prescribed by a healthcare provider can resolve the issue. Changes due to anabolic steroids are irreversible, but vocal therapy can help optimize their changed voice.
It is important to consult a healthcare professional if hoarseness persists, worsens, or is accompanied by other concerning symptoms like pain, difficulty swallowing, or breathing difficulties. A doctor can diagnose the cause of the voice change and recommend interventions. This may include a referral to an ear, nose, and throat (ENT) specialist or a speech-language pathologist for evaluation and management.