To explore clinical characteristics and prognosis of puberty-related abnormal voice.This study included 63 children who visited the clinic due to an abnormal voice. The clinical data were analyzed, including basic characteristics, voice quality, laryngoscopic manifestations, treatment, and prognosis. Simultaneously, 63 healthy subjects were paired to compare differences in voice.Fifty-four boys and 9 girls with puberty-related dysphonia were included in the study, with an average age of 14.2 ± 1.7 years. Abnormal voice in all the patients was characterized as abnormal pitch. Thirty-three boys (61.1%) showed an undescended pitch, and 21 (38.9%) had an unstable pitch, with an onset at 12.4 ± 1.3 (8-15) years old. Fifty boys (92.6%) and their guardians were not aware that the voice changes were related to puberty; 3 favored previous voices, and 1 admired a female voice. Seven girls had abnormal descended pitch, with four having abnormal levels of androgen or pituitary hormones. The fundamental frequency (F0), jitter, and shimmer in boys were higher than those in healthy controls (P < 0.01), and the maximum phonation time (MPT) decreased (P < 0.01). The F0 and MPT in girls were lower (F0 P < 0.01, MPT P = 0.01). Immediately after preliminary voice therapy, 53.7% of boys showed significant improvement. And 90.7% of the boys who followed up ultimately improved their voices, which only occurred in 2 girls.Puberty-related abnormal voice in children is mainly characterized by abnormal pitch. Boys have a higher morbidity of undescended or unstable pitch, with children and their guardians often lacking correct understanding. However, their voices may return to normal after therapy. Girls often present with abnormal descended pitch, which may be related to abnormal hormone levels, making it difficult to achieve a good prognosis.Original reports (level 6).Copyright © 2025 The Voice Foundation. Published by Elsevier Inc. All rights reserved.