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Introduction: Different clinical guidelines suggest using testosterone-lowering medications (TLM) in sex offender treatment in addition to psychotherapy. Within Germany, there are two officially approved agents. So far, no current data exist about the routine use of TLM in a clinical context., Aim: The present observational study evaluates the frequency of the prescription of TLM and other medications in sex offender treatment in German forensic-psychiatric institutions. Experts are asked about the observed effects and side effects of TLM., Method: The heads of all 69 German forensic-psychiatric hospitals and outpatient clinics were asked to fill out a questionnaire assessing offender characteristics and treatment methods in use., Main Outcome Measures: Main outcome measures were the number of patients being treated with TLM and other pharmacological agents for reducing sexual drive. Further effects and side effects of the agents were evaluated., Results: Thirty-two participating institutions reported on 3,963 patients, 611 of them being sex offenders (15.4%). Most sex offenders had been convicted for child sexual abuse (39.8%) or a sexual assault/rape (37.6%). Almost all sex offenders were treated psychotherapeutically and 37% were receiving an additional pharmacological treatment. Of all the sex offenders, 15.7% were treated with TLM; 10.6% were treated with a gonadotropin-releasing hormone agonist; and 5.1% were treated with cyproterone acetate. Of these, 26.0-75.4% showed improvements in such outcomes as reduction of frequency and/or intensity of sexual thoughts. The remaining 21.3% of sex offenders who received a pharmacological agent were treated with selective serotonin reuptake inhibitors (11.5%) or antipsychotic medications (9.8%)., Conclusions: TLM are a frequently used addition to psychotherapy in sex offenders. In light of the lack of controlled clinical trials and the many side effects, benefits and risks should always be thoroughly assessed., (© 2012 International Society for Sexual Medicine.)

We examine the associations between pretreatment testosterone (TTS) levels and sociodemographic, clinical, and sexual behavioral characteristics. Two groups, low and normal pretreatment TTS, were treated with medroxyprogesterone acetate (MPA) and compared on clinical response (deviant and nondeviant sexual behaviors; recidivism) and length of time to return to pretreatment TTS after discontinuing MPA. Thirteen paraphilic men who were treated with MPA and had TTS levels monitored at approximately three-month intervals during and after MPA were followed naturalistically. The principal outcome measures pertained to TTS levels and data from a self-report psychosexual inventory, which quantified deviant and nondeviant sexual activities. Time to return to baseline TTS levels were analyzed with Kaplan-Meier survival analysis. Nonparametric methods were used to compare the two groups on other variables. Multiple regression was used to examine the contribution of combinations of variables to TTS outcome. Subjects with low pretreatment TTS received MPA for longer periods of time, and older subjects took longer to return to pretreatment TTS levels despite being treated for shorter periods of time. Although subjects with lower pretreatment TTS levels may be more sensitive to MPA's TTS-suppressive effects, the multiple regression analysis showed that age may be an important determinant of the time it take for TTS levels to return to pretreatment baseline. Sociodemographic, clinical, and self-reported measures of sexual behavior did not distinguish between low and normal TTS level groups. Only one relapse was detected. Further studies with larger samples are required to better understand the role of TTS monitoring of sex offenders treated with MPA, in order to justify its continued use as a measurement of treatment adequacy and to study its potential role as a predictor of treatment outcome.

Total testosterone concentrations in the serum of patients treated with antiandrogens were measured by means of an industrially produced radioimmunological testosterone assay kit (VEB Sächsisches Serumwerk Dresden). Antiandrogen therapy using cyproterone acetate (Androcur) leads to a reduction in serum testosterone concentration which is significant at the p less than 0.01 level. The data suggest that testosterone concentrations vary inversely with increasing Androcur dosage; they are around 7 nmol/l at the doses conventionally administered. The testosterone concentrations obtained under depot-Androcur treatment suggest that intervals between injections should be less than 10 days.

The endocrine effects of drugs on two groups of 12 male sexual offenders in a special hospital were studied. In the first study benperidol, chlorpromazine and placebo were compared and in the second ethynyl oestradiol and cyproterone acetate were compared with no treatment. In the first study there was no difference between the three drugs in their effects on plasma testosterone or luteinizing hormone (LH). In the second study cyproterone acetate produced a reduction in plasma testosterone, LH and follicle-stimulating hormone (FSH). Ethynyl oestradiol produced a rise in plasma testosterone and LH, and no change in FSH. Neither drug changed total plasma oestrogen levels. The unexpected effects of ethynyl oestradiol were attributed to an increase in sex hormone-binding globulin (SHBG) leading to a rise in bound, inactive testosterone. Direct measurement showed a two- to threefold increase in SHBG with ethynyl oestradiol treatment and no change in SHBG with cyproterone acetate treatment. In spite of these contrasting endocrine effects, ethynyl oestradiol, cyproterone acetate and benperidol produced similar behavioural changes.