Authors: Menke LA, Sas TCJ, Van Koningsbrugge SHL, De Ridder MAJ, Zandwijken GRJ, Boersma B, Dejonckere PH, De Muinck Keizer-Schrama SMPF, Otten BJ, Wit JM
Title: The effect of oxandrolone on voice frequency in growth hormone-treated girls with turner syndrome
Source: Journal Of Voice 2011 25(5): 602-610
Year: 2011
Research Design: Randomised Controlled Trial
Rating Score: 06/10
This rating is confirmed
Eligibility specified - Y
Random allocation - Y
Concealed allocation - N
Baseline comparability - N
Blind subjects - Y
Blind therapists - Y
Blind assessors - Y
Adequate follow-up - N
Intention-to-treat analysis - N
Between-group comparisons - Y
Point estimates and variability - Y

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/m 2/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.

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