trelstar and Exhibitionism

In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) are commonly used but can have serious side effects. Selective serotonin reuptake inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that luteinizing hormone-releasing hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients.. MEDLINE was searched for clinical trials, case-control studies, case reports, and other clinically and theoretically important literature published between 1980 and November 2002 on the treatment of paraphilia with LHRH agonists. Keywords included LHRH agonists, GnRH- agonists, antiandrogens, paraphilia, pedophilia, and sex offenders.. We found 4 case reports, 1 case- control study, 7 open uncontrolled studies, and 1 study comparing patients receiving CPA with those receiving LHRH agonist treatment in forensic hospitals. In total, the studies reported on a sample of 118 treated patients with different forms of paraphilias (sadism, pedophilia, exhibitionism, voyeurism). Nearly all of the studies used self-reports to measure the effects of medication. Duration of follow-up was between 6 months and 7 years and revealed that there were no relapses if patients remained under treatment. Patients previously treated with other agents like CPA, MPA, or SSRIs reported better effects when taking LHRH agonists.. Although there is a need for further research, LHRH agonists offer a treatment option for patients with severe paraphilia. We propose a differentiated pharmacologic treatment regarding side effects, symptomatology, and severity.

Topics: Algorithms; Androgen Antagonists; Clinical Protocols; Clinical Trials as Topic; Cyproterone Acetate; Delayed-Action Preparations; Exhibitionism; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Male; Outcome Assessment, Health Care; Paraphilic Disorders; Pedophilia; Rape; Sex Offenses; Treatment Outcome; Triptorelin Pamoate

A severe exhibitionist has been treated with the combination of an LHRH agonist and the antiandrogen flutamide in order to maximize androgen blocking and to control his severe deviant behaviour. The results obtained show that the androgen blockade ended his exhibitionistic behaviour and markedly decreased his sexual fantasies and activities, especially masturbation, without significant side effects.

Topics: Administration, Oral; Adult; Anilides; Dihydrotestosterone; Drug Therapy, Combination; Exhibitionism; Flutamide; Follow-Up Studies; Gender Identity; Gonadotropin-Releasing Hormone; Humans; Injections, Subcutaneous; Male; Masturbation; MMPI; Paraphilic Disorders; Sexual Behavior; Sperm Count; Sperm Motility; Testosterone; Triptorelin Pamoate