Steroid Sex Hormones Appear Present in and Have Effect on Human and Animal Vocal Folds

CLINICAL QUESTION

Are steroid sex hormones (SSH) present in the vocal folds of animals and humans, and what are the effects of SSH treatment or exposure on vocal fold tissue?

BOTTOM LINE

Findings suggest that estrogen, progesterone, and androgen receptors are present in the vocal folds of animals and humans and appear to affect fibrosis in vocal fold tissue.

BACKGROUND: Voice changes throughout sexual maturation have been attributed to the effects of sex hormones on the larynx, which suggests that age-related changes in SSH levels directly impact the structure and morphology of the larynx and vocal folds. There is no consensus regarding SSH receptor location or their effects on vocal fold tissue.

STUDY DESIGN: Database study

SETTING: Department of Otolaryngology–Head and Neck Surgery, Mount Sinai, New York

SYNOPSIS: Multiple databases were searched to identify studies that explored the presence of SSH receptors in the vocal folds and/or described the cellular and molecular effects of SSH on the vocal fold. A total of 32 studies met the inclusion criteria, three of which were review articles. Of the remaining 29 studies, 14 were performed in humans and 15 in animals. In articles directly examining receptors (n=17), estrogen receptors (ER) were found in 10 of 15 studies, progesterone receptors (PR) in 6/10, and androgen receptors (AR) in 6/9. The authors note, however, that significant differences in methodology among the studies preclude drawing a definitive conclusion. In studies examining the effects of SSH on vocal folds (n=16), estrogen had effects in 10/13, progesterone in 3/3, and androgens in 4/5. Regarding location, ER and PR were mostly identified in epithelium and fibroblasts of the lamina propria. Authors state that ER and PR presence in mucosal tissue serves to decrease fibrosis and help maintain the epithelial barrier, whereas AR, found in muscle, lamina propria, and epithelium, appears to be pro-fibrotic in epithelium and hypertrophic in muscle. Study limitations include a lack of standardization of methodologies among included studies.

CITATION: Pu S, et al. Cellular and molecular effects of steroid sex hormones on the vocal folds: a scoping review. Laryngoscope. 2025;135:540-554. doi:10.1002/lary.31771.