For over a year while living in Austin, Texas, I had a strained, hoarse, deeper-pitched voice. The doctor said it was allergies and prescribed Claritin and Nasonex. I have since moved back to Palm Desert, California, but the problem persists. I have never experienced allergy problems here in the past. I think it's intensified by my high-paced job in sales. Also, I body-build, and although I would never use steroids, my trainer had me take 19-Norandrostendione a year ago. I've seen reports that it is safe for women and doesn't cause androgynous effects. Could it be the culprit?

K.K.

You say, "... although I would never use steroids ..." What did you think you were taking? You were given an anabolic steroid -- a close relative of the male sex hormone testosterone. As far as I am aware, anabolic steroids have only one legitimate use: They are used in men who are deficient in testosterone. Anabolic steroids also build muscle mass, hence their use (and abuse) by athletes and body-builders.
Unfortunately, anabolic steroids are so closely related to testosterone that they have very masculinizing effects. Some of these effects are temporary. A masculine pattern of hair growth, for example, would revert to a feminine pattern once a woman stopped using steroids.

Anabolic steroids have a direct effect on the vocal cords. This is normal during male puberty; early on, a boy's voice varies jerkily between a relatively higher-pitched child's voice and the voice of a young man. Eventually, the deeper pitch becomes permanent. Women who take steroids undergo some of the changes associated with male puberty. The physical changes that occur in the larynx are currently thought to be permanent.

That is the case for injected steroids, at least. Many over-the-counter steroid supplements, however, are drinks advertised to be growth supplements. Anabolic steroids taken orally are not properly absorbed, and the amount that's absorbed is broken down by the liver. The result is that, unlike injected steroids, oral steroid supplements have little or no effect.

By the way, anabolic steroids must be distinguished from catabolic steroids such as Prednisone or hydrocortisone. Catabolic steroids are very potent anti-inflammatory drugs. They have a whole host of potential side effects, but masculinization is not one of them.

As you must surely realize, I am only speculating based on the limited set of facts that you have provided. It is very important to bear in mind that there are other possible explanations for pitch changes. Steroid use is only one. What causes a deepening of the voice? Think of guitar strings -- the fatter the string, the deeper the note. Anything that increases the bulk of the vocal cords will tend to deepen the voice. Allergy can do this, but a more common explanation is inflammation due to chronic exposure to stomach acid and digestive enzymes as in gastroesophageal reflux disease and/or cigarette smoke. If you have reflux or are a smoker, you might be able to improve your voice by correcting these problems.

Your next step must be to find an ENT (ear, nose and throat doctor) who knows something about voice. He or she will need to take a detailed history and examine you carefully to determine the cause of your voice changes. Not all ENTs are created equal: Some are superb at treating voice problems, while others are deficient. If all else fails, try to find a laryngologist (an ENT who specializes in voice problems) at a local medical school.