OBJECTIVE: To report a case of permanent voice virilization caused by androgenic anabolic steroids (AAS). CASE REPORT: A 27-year-old healthy woman complained of a deepened voice for the past 5 years. She noted that the onset of symptoms occurred after a flu episode in which corticosteroids had been administered, which did not improve the flu symptoms. She had no history of smoking, alcohol abuse, or professional voice use. Her menstrual cycle was regular and was denied hormonal treatment for gynecologic or endocrine disorders. Physical examination and hormonal levels did not reveal any abnormalities. Voice auditory perceptual analysis demonstrated lower vocal pitch. However, laryngoscopic and stroboscopic examination revealed an anatomically and functionally normal larynx. When asked again about the possibility of any hormonal treatment, she reported the use of AAS for 1 month before the onset of the symptoms. CONCLUSION: Vocal issues related to sex hormones are common in women and may be physiological i.e., even the menstrual cycle can cause slight voice changes. Recently, there is growing consumption of AAS among women. AAS consumption is associated with increased androgen levels and muscle hypertrophy and is believed to improve athletic performance. The virilizing effects of these agents on the female voice are known to be irreversible, and the pathogenesis and structural changes in the vocal folds are poorly understood, but have been noted to occur more due to consumption rather than the dose or type of steroids. The indiscriminate use of AAS causes deleterious side-effects in the short and long term, and it is our duty to warn patients about the same. The use of AAS should always be considered in patients with changes in the vocal frequency.
