Gonadotrophin hormone releasing hormone agonist in cases of severe paraphilia: a lifetime treatment?
Six patients with severe paraphilia were treated with a long-acting gonadotrophin hormone releasing hormone analogue (GnRH-a). In five cases, the antiandrogen treatment ended their deviant sexual behaviour and markedly decreased their sexual fantasies and activities without significant side-effects. The beneficial effects of this treatment were maintained for 7 years in the patient where there was the longest follow-up. Two patients abruptly withdrew front their antiandrogen treatment at the end of the first and third year, respectively. Both relapsed within 8-10 weeks. One of them asked for resumption of antiandrogen treatment. In another case, in order to phase out antiandrogen treatment, testosterone (T) was added to the GnRH-a. In spite of normal T levels, and of resumption of normal sexual activities and deviant fantasies, deviant sexual behaviour did not return. A smoother phasing out of GnRH-a treatment is thought to be better than an abrupt withdrawal. However, the duration of antiandrogen treatment necessary to ensure a complete disappearance of deviant sexual behaviour remains uncertain, but is at least 4 years.
Thibaut
F
F
Department of Pschiatry, University of Rouen, France.
Cordier
B
B
Kuhn
J M
JM
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D001883:Borderline Personality Disorder / Q000188:drug therapy / Q000523:psychology; D003692:Delayed-Action Preparations; D005084:Exhibitionism / Q000188:drug therapy / Q000523:psychology; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000819:agonists*; D006801:Humans; D008607:Intellectual Disability / Q000150:complications / Q000523:psychology; D008297:Male; D008418:Masturbation; D010262:Paraphilic Disorders / Q000188:drug therapy* / Q000523:psychology; D010378:Pedophilia / Q000523:psychology; D010554:Personality Disorders / Q000188:drug therapy / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D013739:Testosterone / Q000097:blood
D003692:Delayed-Action Preparations; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone