Puberty is a time of significant physical and emotional changes for adolescents. For trans and nonbinary individuals, these changes may be distressing due to the development of secondary sexual characteristics that are incongruent with their gender identities. Puberty blockers have become a key component of gender affirming healthcare for many trans and nonbinary adolescents.

One of the changes associated with puberty is deepening of the voice. This is caused by growth of the voice box (larynx) and lengthening of the vocal chords in response to hormones such as testosterone and puberty. Voice deepening tends to be much more prominent in people born with testes, because testosterone has a more substantial effect on the growth of the voice box. In people born with ovaries, voice deepening does occur, but it tends to occur to a much lesser degree.

Puberty blockers, also called gonadotropin-releasing hormone analogues (GnRHa's), are medications that temporarily halt the body's production of sex hormones such as testosterone and oestrogen. By doing so, they temporarily halt the development of secondary sexual characteristics associated with puberty. This includes temporarily halting the voice changes that would usually occur during puberty. Hence, if you are taking puberty blockers and have not yet undergone the voice changes associated with puberty, you are unlikely to undergo voice deepening while you are on puberty blockers. However, if you have already undergone the voice changes associated with puberty, taking puberty blockers will not reverse these changes.

Importantly, the effects of puberty blockers are reversible. Hence, if you stop taking puberty blockers, the effects of physiological puberty would recommence, including the associated voice changes. Also, if you commence hormone replacement therapy with testosterone or oestrogen while you are taking puberty blockers, then you would expect to undergo the voice changes associated with those hormones.

For some people, hormone replacement therapy on its own may not be enough to produce the desired voice changes. This may be because puberty has already commenced and some of the effects on the voice box of puberty have already occurred. Hence, for many people, voice training and speech therapy have important roles in helping them achieve the desired voice changes congruent with their gender identities. Trans and nonbinary people often work with speech and language therapists to learn techniques for adjusting pitch, resonance, and other aspects of vocal production.

In conclusion, puberty blockers are a valuable tool in gender affirming healthcare for transgender and non-binary youth. While puberty blockers may temporarily halt the voice changes associated with puberty, these voice changes can be expected to occur when hormone replacement therapy is commenced.

References

Cler, G. J., McKenna, V. S., Dahl, K. L., and Stepp, C. E. (2020). Longitudinal Case Study of Transgender Voice Changes Under Testosterone Hormone Therapy. Journal of Voice, 34(5), 748–762.

Ramos, E. (2023). Vocal therapy changes vocal cords of transgender patients without need for surgery. Science, 18th December 2023.

Ziegler, A., Henke, T., Wledrick, J., and Helou, L. B. (2018). "Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review". International Journal of Transgenderism, 19: 25-45.