Thursday, July 25, 2013

Anti-androgenic Pharmacological Treatments in Paraphilia Disorders and Sexual Offenders

Sara Holland, Student, School of Psychology; Joan Read, Faculty, School or Psychology

Androgen is the nonspecific word for any compound that promotes or regulates the development of male characteristics in vertebrates. Androgen deprivation therapy (ADT) is a treatment used to subdue the production or action of male hormones, predominantly testosterone. ADT is considered an effective strategy with paraphilia disorder and in sexual offender treatment.

Though the aetiology of paraphilia disorders is still not entirely appreciated, pharmacological treatments have been recommended for some of these disorders. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have been used in the treatment of various types of paraphilia disorders and with sexual offenders. Anti-libidinal hormonal treatments or anti-androgen drugs, such as medroxyprogesterone acetate (MPA), cyproterone acetate (CPA), and gonadotrophin-releasing hormone (GnRH) analogues (also known as luteinizing hormone releasing hormone agonists - LHRH agonists), have also been reviewed and deemed effective in paraphilic disorders and with some sexual offenders. All of these pharmacological treatments have been observed to decrease or diminish sexual interest or libido, sexual fantasies, sexual urges/behaviours, sexual arousal, and sexual performance. Additional research is essential to demonstrate treatment efficacy and to improve our knowledge of long-term tolerance. Available data on the use of SSRI’s, steroidal anti-androgens and GnRH analogues currently suggest the efficacy of these treatments for paraphilic disorders.

Much debate is taking place regarding the ethics and legality of ADT with sex offenders. Unfortunately, the empirical studies of sex offender treatment have mostly been methodologically weak. It could be comfortable to presume that if treatment is accessible on a voluntary and consensual basis that there are no ethical issues implicated; there remain concerns over the issue of the offender's consent. Additionally, ethical concerns have been introduced due to the use of “off label” medication with sexual offenders. It is obvious that further research is essential to assess the precise efficacy of pharmacological ADT.

The purposed poster will review the use of anti-androgenic drugs in paraphilia disorders and with sexual offenders, and will review the literature regarding efficacy, side effects, and ethics.

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