title: The role of testosterone in sexuality and paraphilia--a neurobiological approach. Part II: testosterone and paraphilia.
abstract: BACKGROUND
  Antiandrogen therapy has been used for 30 years to treat paraphilic patients and sexual offenders. Yet the therapeutic success of antiandrogens is uncertain. Furthermore, there is still a lack of comprehensive knowledge about the effects of androgen-lowering therapy in paraphilic patients.
  
  
  OBJECTIVE
  We discuss endocrinological, neurobiological, and therapeutic aspects of paraphilia with the aim of integrating these on the basis of the current neurobiological and clinical knowledge on testosterone that was set out in Part I of this review.
  
  
  METHODS
  Our review of the human literature comprises the current knowledge about the neurobiology of paraphilia and the known endocrinological, pathophysiological, and genetic aspects of this disorder. The role of testosterone is discussed. A survey of antiandrogen therapy and its outcome in paraphilic patients and sex offenders is provided.
  
  
  RESULTS
  Although not all data are consistent, current imaging research suggests that structural and functional changes in pedophilia appear for the most part in brain regions also involved in sexual functions. Not exclusively testosterone but also some other endocrinological and neurochemical parameters could be disturbed in pedophilic patients and child molesters; these include changes in hypothalamic-pituitary function, prolactin levels, and dopaminergic or serotonergic functions. There appears to be a sex-steroid-related genetic influence on antisocial traits, externalizing behavior, and sexual behavior. Most of the studies in which antiandrogen therapy in paraphilic patients and sex offenders have been examined were case reports, or observational or open-label studies, and many did not include adequate control groups. Only a few placebo-controlled double-blind studies have been published with inconsistent results concerning treatment effects. Outcome measures differ between the studies and do not seem ideally suited to their purpose.
  
  
  CONCLUSIONS
  On the basis of the current knowledge about testosterone and its effects on brain and behavior as described in Part I, and of available results on the relationship between testosterone and paraphilia as well as antiandrogen therapy, we present from a neurobiological perspective an extended scientific proposal for design features to investigate the effects of antiandrogen treatment in large clinical trials.
authors.affiliation: Georg August University of Göttingen--Department of Forensic Psychiatry and Psychotherapy, Göttingen, Germany. kirsten.jordan@medizin.uni-goettingen.de
authors.forename: Kirsten
authors.initials: K
authors.lastname: Jordan
authors.forename: Peter
authors.initials: P
authors.lastname: Fromberger
authors.forename: Georg
authors.initials: G
authors.lastname: Stolpmann
authors.forename: Jürgen Leo
authors.initials: JL
authors.lastname: Müller
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D001921:Brain / Q000502:physiology*; D005260:Female; D006801:Humans; D007989:Libido / Q000187:drug effects / Q000502:physiology; D008297:Male; D008954:Models, Biological; D018377:Neurotransmitter Agents / Q000502:physiology; D010262:Paraphilic Disorders / Q000188:drug therapy / Q000503:physiopathology*; D011944:Receptors, Androgen / Q000235:genetics / Q000502:physiology; D012742:Sex Offenses; D012725:Sexual Behavior / Q000187:drug effects / Q000502:physiology; D019529:Sexuality / Q000187:drug effects / Q000502:physiology; D013739:Testosterone / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018377:Neurotransmitter Agents; D011944:Receptors, Androgen; D013739:Testosterone