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Previous Volume 338:416-422 February 12, 1998 Number 7 Next

	Full Text PDF Editorial by Bradford, J. M.W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Men with deviant sexual behavior, or paraphilia, are usually treated with psychotherapy, antidepressant drugs, progestins, and antiandrogens, but these treatments are often ineffective. Selective inhibition of pituitary–gonadal function with a long-acting agonist analogue of gonadotropin-releasing hormone may abolish the deviant sexual behavior by reducing testosterone secretion.

Methods In an uncontrolled observational study, we treated 30 men (mean age, 32 years) with severe long-standing paraphilia (25 with pedophilia and 5 with other types of abnormal behavior) with monthly injections of 3.75 mg of triptorelin and supportive psychotherapy for 8 to 42 months. The efficacy of therapy was evaluated monthly by the Intensity of Sexual Desire and Symptoms Scale and yearly by the Three Main Complaints questionnaire.

Results All the men had a decrease in the number of deviant sexual fantasies and desires, from a mean (±SD) of 48±10 per week before therapy to zero during therapy (P<0.001), and a decrease in the number of incidents of abnormal sexual behavior (from 5±2 per month to zero, P<0.001) while receiving triptorelin. These effects were evident after 3 to 10 months of therapy (P<0.001) and persisted in all 24 men who continued therapy for at least 1 year. The men's mean serum testosterone concentration fell from 545±196 ng per deciliter (18.9±6.8 nmol per liter) before therapy to 23±14 ng per deciliter (0.8±0.5 nmol per liter, P<0.001) after 42 months of triptorelin. The main side effects were erectile failure, hot flashes, and decrease in bone mineral density in some men.

Conclusions Continuous administration of triptorelin, a long-acting agonist analogue of gonadotropin-releasing hormone, together with supportive psychotherapy, may be an effective treatment for men with severe paraphilia.

Source Information

From the Department of Endocrinology and Metabolism, Hadassah–Hebrew University Medical Center, Jerusalem (A.R.), and Mental Health Center Beer-Sheva, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva (E.W.) — both in Israel.

Address reprint requests to Dr. Rösler at the Department of Endocrinology and Metabolism, Hadassah University Hospital, P.O. Box 12000, IL-91120 Jerusalem, Israel.

Full Text of this Article

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Treatment of Paraphilia with an Analogue of Gonadotropin-Releasing Hormone
Reichlin S., Windhaber J., Eher R., Rösler A., Witztum E.
Extract | Full Text  
N Engl J Med 1998; 338:1923-1924, Jun 25, 1998. Correspondence

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