Low-dose oral medroxyprogesterone acetate in the management of the paraphilias.
BACKGROUND
There are no reports on the use of low-dose oral medroxyprogesterone acetate (MPA) in the treatment of the paraphilias. High-dose depot MPA treatment (500-800 mg i.m. weekly) has proven to control the behavioral manifestations of the paraphilias when testosterone levels decrease from pretreatment to prepubescent levels, but at the price of significant morbidity.


METHODS
Oral MPA (60 mg/day for an average of 15.33 months) was given in an open nonblind trial to seven patients who met criteria for DSM-III-R paraphilias. Four of the subjects had shown inadequate improvement after 1 year of psychotherapy.


RESULTS
Six subjects responded at 60 mg/day. Testosterone levels decreased by 50% to 75% (range, 100-400 ng/dL). No patient displayed significant side effects. All patients described significantly fewer paraphilic fantasies, and no patient reported engaging in paraphilic behaviors during oral MPA treatment.


CONCLUSIONS
Double-blind placebo and phallometrically controlled tumescence studies need to be carried out to test the results of this study.
Gottesman
H G
HG
Department of Psychiatry, MetroHealth Medical Center, Cleveland, OH 44109-1998.
Schubert
D S
DS
D000284:Administration, Oral; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008875:Middle Aged; D010262:Paraphilic Disorders / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D013739:Testosterone; D017258:Medroxyprogesterone Acetate