Hormonal Changes, Vocal Changes

This is a post I have been procrastinating writing for some time, as I wanted to have some useful conclusions about outcomes to report before doing so. But stability seems some way away yet and I have been prompted to write it anyway in anticipation of seeing a lot of my singing friends at the end of this month. It would be tiresome to say this 1500 times when people ask how things are going, so I’ll say it once here in the interests of having more varied conversations in Harrogate.

We all know that that hormonal changes affect the voice. We went through it in adolescence, the boys more dramatically than the girls, but everyone affected to some extent. And it is becoming more widely recognised that hormonal changes at other life stages also affect the voice: when I read Singing Through Change back in 2020, it came conveniently at a moment when I could relate quite directly to its themes.

The hormonal changes of puberty and menopause come upon us somewhat gradually: whilst there are moments of marked change, the process happens over months and years and we have some time to adapt as it goes along. Perimenopause brought a degree of vocal instability to me, and a noticeable extension of my lower range, along with a reduction stamina in higher registers. I could still get up there, but couldn’t hang out there as long as I used to. I became more acutely aware of the difference between range and tessitura.

I’m not sure how much starting HRT moderated this change for me, as I started on it just as we were coming back into choral life after COVID, and I was deliberately working on my range in anticipation of resuming regular musical activity. Either way, I found myself in a place in which, whilst I wasn’t comfortable living for extended periods in my soprano range, I was okay to visit it in the course of working with other singers.

By contrast, the medically-induced hormonal changes one goes through when being treated for breast cancer, at least as I experienced them, are sudden and their effects on the voice commensurately dramatic.

(For those who didn’t know about the cancer diagnosis, you can stop worrying immediately. All cured, and the ongoing treatment is to ensure that any recurrence will also remain readily curable.)

The first change was coming off HRT just before Christmas last year. The type of cancer I had is fed by oestrogen and progesterone, and so as soon as it was identified I needed to stop feeding it. I noticed when choir rehearsals resumed in January that notes I had demonstrated during the autumn term (not necessarily well, but effectively enough for our purposes) were now inconsistently available to me, and not very nice when I did get them.

After recovering from surgery I was started on endocrine treatment, which will continue for 5 years. The point of this is to strip out the residual oestrogens so that should any cancer recur, (a) it won’t be fed and (b) it will be less likely to travel round the body. Apparently even after one’s ovaries cease supplying oestrogen, the liver produces oestrogen-like hormones that serve various similar functions, some useful (like protecting one’s bone density), some unhelpful (like feeding my type of cancer).

Less than two weeks after I started on this medication back in March, I tried to demonstrate a soprano line that I had taught by singing it earlier that month and discovered that those notes were no longer readily available. It was a sudden and dramatic shift, and measurable by specific pieces of music. And rather disconcerting to discover in real time during rehearsal.

My instinctual response was to think: well, I’ll have to work on range again then. It’s tissue, it will stretch. I didn’t get on with working on this immediately as the next stage was radiotherapy and that takes it out of you such that you have to ration your energy quite carefully and it’s not the time to start major projects.

But as the energy returned over the summer, I started to make a point of gently stretching my upper range, to keep what I still have in use, and maybe open a bit more back up. And I am visiting notes in warm-up that weren’t available to me back in the spring, even if the space above the stave is not currently reliable for demo purposes in rehearsal.

At the same time though, I think that the voice is still moving away from its old equilibrium and has not yet found a new one. I notice it in tone quality as well as range, and have noticed it when revisiting recordings I did for my choir this time last year in comparison to how I’m sounding now, as well as in my relationship with range in seasonal repertoire we are starting to revisit from a year ago.

And it’s not all about loss. The colour changes that have accompanied the range shift are interesting, and have their own beauty. There are layers of richness and warmth that weren’t there before, along with them different opportunities for expression from what I have previous been able to access.

Nonetheless, I shall be telling my oncologist on my annual review in January that the side-effects of these drugs are impacting my ability to do my job. My choir are dealing with it, because they’re nice, and what else can they do? But it’s becoming clear that I will need to develop more strategies for doing technical demonstration to help singers in ranges where I can no longer actually demonstrate effectively. I’ve not given up hope on the range-stretch project, but it’s clearly going to be a long-term effort and may ultimately only serve to maintain what remains rather than restore what’s been lost.

Anyway, sharing because it’s not something people tell you to expect, and chances are it may also affect people in your lives. There’s lots of us out there who have been successfully treated for breast cancer (yay for successful treatments!), and many of us sing, so if we can share these experiences we can help each other develop the coping strategies we need. And at least I now have an encouragingly long life-expectancy in which to work on them.