How Hormone Therapy Can Help Singers

A few months ago I started on hormone therapy to see if it could help manage some of the effects of perimenopause I’ve been experiencing and ever since I’ve been thinking about how wrong I was about hormones and their impact on the female singing voice.  We’re often taught that hormones are bad for the voice or a detriment to our singing career, but I think we need to look more globally to understand the value of hormone therapy for a singer’s wellbeing.

What do hormones actually do to your voice?

It’s important to note that there aren't many studies about the effects of hormones on the female voice, most of the studies are quite small, and most do not look specifically at singers so we don’t have a lot to go on, but we do know how hormones affect tissues in the body.

Estrogen: The Vocal Protector Estrogen keeps vocal tissues hydrated, flexible, and supple. It also supports muscle and ligament density as we age, making it one of the most beneficial hormones for maintaining vocal health.

Progesterone: The Complicated Player Progesterone is often blamed for vocal difficulties as it can thicken vascular tissues, reduce suppleness, and dry out the voice. However, Progesterone also supports sleep quality and energy levels, both of which are essential for good performance.

Testosterone: The Deepening Influence Testosterone tends to lengthen and thicken the vocal folds, but how much it impacts the voice really depends on the dosage and how it is balanced out against Estrogen levels as estrogen reduces the impact of testosterone overall. Testosterone and androgens are less prescribed for women, but the effect on the voice is clear: it can lower the voice.  

Hormones affect you voice less than you think

How much do hormones actually affect your voice?

It’s complicated.  Most studies are on the natural menstrual cycles and limited to speaking range so it may be inconclusive to extrapolate that to singing range, but I think it gives us an understanding of the overall magnitude of physiological shifts.  

When looking at natural hormonal cycles, the average voice lowering in menopause is around 14hz and average lowering during postpartum is around 22 hz [for context that’s about ¼ -½ step].  So we’re not talking HUGE vocal shifts.

Older studies focusing on singers showed variations in vocal changes throughout the menstrual cycles, but some modern research suggests that while there may be physical changes in the voice, it’s not detrimental to vocal function and imperceptible even to knowledgeable listeners.

When we look at hormones in clinical settings, more recent studies are showing that using hormone therapy can actually stave off or reduce vocal changes for both perimenopause and premenstrual disorders.

How do hormones affect your body?

It’s important to remember that hormones don’t just affect the tissues of our throat, they impact all of the tissues in our bodies: muscles, fascia, and especially our brains.  Our brains are the powerhouse of our lived experience, when we’re hit with hormonal shifts it can throw our whole proprio and interoceptive experience for a loop.

In other words, how we feel in and about ourselves can change as much, if not more so than the body itself.  Even if nothing else in our bodies changed, our sense of what was happening would change would be imacted by these brain changes.

When I look at all the data on how hormones actually affect the tissues of the voice, it’s not that different from voice changes you manage in day-to-day life. Swelling, thickening, and stiffening of the vocal tissues happen for multiple reasons outside of hormonal changes including seasonal changes, illness, injury and overuse.  If you manage those changes in mild illness, then I’d hazard to say you can also manage changes due to hormone fluctuations.

How Hormone Therapy Can Help Singers

If you feel better, you sing better.

When you feel better you sing better, plain and simple. 

Knowing that our experience of our bodies can shift as much as our voices is an important context of understanding the value of hormone therapy.  We’re often using hormones to help treat specific issues - pain, lack of sleep, bleeding, mood, GI issues - all things that impact our quality of life and can impact our singing on their own accord.

When we’re using hormone therapy to manage conditions like premenstrual disorders, PCOS, Endometriosis and perimenopause, hormones can actually help balance out not just the physical symptoms of disease, but also the emotional and psychological impact of disease.  If you feel better physically, you’ll feel better emotionally.

And it’s precisely this piece of wellbeing that singers should be putting front and center.

I find it’s so easy to get lost in the ethos of “prima la voce" as a singer, but it’s important to remember that you and your quality of life is the main component of your instrument. When you’re struggling to exist in your body… if, like me, you find yourself struggling with sleep, hot flashes and achy joints, hormone therapy can help singers feel better inside their bodies.

Hormones aren’t for everyone

Some women struggle with sensitivity to certain hormones and the task of finding the right balance in an every-changing ecosystem can be too much to manage for many.  The benefit of more recent research in perimenopause means that we have access to different types of drugs than in previous decades.  Transdermal applications can often circumvent many of the issues women experience when trying hormone therapy… but even these aren’t bullet proof.  

Hormones Therapy isn’t for everyone and that’s ok too.  Finding a balance that works for your wellbeing is the key.

Why Technique Matters

When all else fails, I think it’s helpful to know technique can still help when hormones fall short.  Some studies show that technique changes can improve and even reverse many vocal changes due to hormonal changes. 

I think many singers notice vocal changes during hormonal fluctuations precisely because they haven't updated their technique to support those changes. It's easy to go along you're singing as you always do and suddenly things feel a little off. What happens?

Singers tend to start pushing when tissues in the throat get less pliable trying to get the same results or sensations as before the hormonal changes.  If you feel like you have to work a little harder to make the same sound as you did before any hormone fluctuation, you’re likely adding in a bit of extra tension even if you don't realize you're doing it. This extra layer of effort can cause many of the vocal issues that singers blame on hormones: hoarseness, loss of range and less resonance.

When I work with clients, I focus on finding flexibility and suppleness throughout the voice - which is even more important during times when hormones are shifting (or when progesterone is higher).  Knowing how to properly release the tissues of the throat with the least amount of pressure possible in phonation is key for maintaining healthy vocal function regardless of what your hormones are doing.

Having a technique that’s adaptable to where you are in life is key. Our brains want to believe that things remain consistent, but you are an ever-changing ecosystem.  How you feel and what you sense changes in your brain can change as much as the physical tissues in your body.  

Being open to the changes that are always happening helps us stay adaptable emotionally as much as vocally.

Beyond Hormone Therapy

It’s been a few months since I started Hormone therapy and if there have been any vocal changes, it’s only been for the better.  I’m sleeping better, I’m less on edge, and there’s more capacity in my nervous system which in turn means there’s more available to me in my singing.

Going into this I knew I would happily trade a high note or two for consistent sleep, but if anything the opposite has proven true.  I’m having more success in my upper range than I have in the past year.  Perhaps a direct benefit of hormone therapy, but also the benefit of my overall wellbeing.  With more resiliency in my nervous system I’m able to approach my singing with more ease and less overall frustration.

There’s a lot of misconceptions we carry about hormones and their affect on female voices, but at the end of the day hormones are a part of us.  Making them into something to be feared for female singers has only served as a disservice to our industry at large and plays into the inherent sexism women face in so many ways. If taking hormones helps you feel good, that can truly help your singing and performing in the long run.

The more we can make peace with our bodies and celebrate them in all their idiosyncrasies, the more comfortable we can be in our daily lives and the more magic we can make onstage.

If you're looking to take hormones or need help navigating hormonal effects on your singing voice, feel free to reach out and discuss with me directly. I have more resources and can help you feel confident finding what it is YOUR body and voice need to feel their best.