Treatment of Men With Paraphilia With a Long-Acting Analogue of Gonadotropin-Releasing Hormone

Ariel Rösler, Eliezer Witztum

    Research output: Contribution to journalArticlepeer-review

    177 Scopus citations

    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.

    Original languageEnglish
    Pages (from-to)416-422
    Number of pages7
    JournalNew England Journal of Medicine
    Volume338
    Issue number7
    DOIs
    StatePublished - 12 Feb 1998

    ASJC Scopus subject areas

    • General Medicine

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