The effect of oxandrolone on voice frequency in growth hormone-treated girls with Turner syndrome

J Voice. 2011 Sep;25(5):602-10. doi: 10.1016/j.jvoice.2010.06.002. Epub 2010 Oct 25.


Objectives/hypothesis: Oxandrolone (Ox) increases height gain but may also cause voice deepening in growth hormone (GH)-treated girls with Turner syndrome (TS). We assessed the effect of Ox on objective and subjective speaking voice frequency in GH-treated girls with TS.

Study design: A multicenter, randomized, placebo (Pl)-controlled, double-blind study was conducted.

Methods: One hundred thirty-three patients were included and treated with GH (1.33 mg/m2/d) from baseline, combined with Pl or Ox in a low (0.03 mg/kg/d) or conventional (0.06 mg/kg/d) dose from the age of 8 years and estrogens from the age of 12 years. Yearly from starting Ox/Pl until 6 months after discontinuing GH+Ox/Pl, voices were recorded and questionnaires were completed.

Results: At start, mean (±standard deviation [SD]) voice frequency SD score (SDS) was high for age (1.0±1.2, P<0.001) but normal for height. Compared with GH+Pl, voices tended to lower on GH+Ox 0.03 (P=0.09) and significantly lowered on GH+Ox 0.06 (P=0.007). At the last measurement, voice frequency SDS was still relatively high in GH+Pl group (0.6±0.7, P=0.002) but similar to healthy girls in both GH+Ox groups. Voice frequency became lower than -2 SDS in one patient (3%) on GH+Ox 0.03 and three patients (11%) on GH+Ox 0.06. The percentage of patients reporting subjective voice deepening was similar between the dosage groups.

Conclusions: Untreated girls with TS have relatively high-pitched voices. The addition of Ox to GH decreases voice frequency in a dose-dependent way. Although most voice frequencies remain within the normal range, they may occasionally become lower than -2 SDS, especially on GH+Ox 0.06 mg/kg/d.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anabolic Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Estrogens / administration & dosage
  • Female
  • Follow-Up Studies
  • Growth Disorders / drug therapy
  • Hormone Replacement Therapy / methods
  • Human Growth Hormone / administration & dosage*
  • Humans
  • Infant
  • Oxandrolone / administration & dosage*
  • Turner Syndrome / drug therapy*
  • Voice Quality / drug effects*


  • Anabolic Agents
  • Estrogens
  • Human Growth Hormone
  • Oxandrolone

Associated data

  • ISRCTN/ISRCTN54336338