Journal of Voice · Dec 16, 2025

The Effects of Hormone Replacement Therapy on Vocal Fundamental Frequency in Postmenopausal Women

By Shah AH, Horton S, Baker NL et al.

OBJECTIVE: To explore differences in vocal fundamental frequency (F0) between premenopausal and postmenopausal women through associations with age and hormone use, including estrogen-progesterone therapy with testosterone replacement (EPT-HRT) and birth control (BC). METHODS: This cross-sectional, multi-institutional study recruited four groups: postmenopausal women taking EPT-HRT, postmenopausal women not taking HRT (HRT-naïve), premenopausal women taking BC, and premenopausal women not taking BC (hormone-naïve). The primary outcome was F0 in Hertz (Hz), compared between groups as a difference (Δ) with 95% confidence interval (CI) and correlated (r) with demographic variables. RESULTS: Ninety-six participants were recruited, with 24 per group: postmenopausal women on EPT-HRT (mean age:51; range:32-65), HRT-naïve postmenopausal women (60 [49-74]), premenopausal women on BC (26 [23-30]), and hormone-naïve premenopausal women (29 [22-45]). There was no significant difference in F0 between postmenopausal women with (174 ± 14 Hz) and without EPT-HRT (173 ± 20Hz) (P = 0.91) or premenopausal women with (198 ± 24 Hz) and without BC (191 ± 20 Hz) (P = 0.19). Mean F0 of postmenopausal women on EPT-HRT was lower than in both premenopausal women on BC (Δ24.3 [CI: 13.6-35.7]; P < 0.0001) and not on BC (Δ16.7[CI: 5.3-28.1]; P = 0.005). A moderate negative correlation was observed between age and F0 (r = -0.39; P < 0.001). CONCLUSIONS: This study found that F0 decreases with age in women, with no significant effect from testosterone-containing HRT.

doi.org/10.1016/j.jvoice.2025.11.040Open accessPubMed 41407643Populations