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A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise in the treatment of the paraphilias, with substantially less side effects than medroxyprogesterone acetate or cyproterone acetate. This paper reports the results of treatment using a depot suspension of leuprolide acetate on 12 patients with paraphilic disorders or with sexual disorders not otherwise specified to suppress or help these individuals control their deviant sexual behavior or impulses. The method involved uncontrolled observations of individuals treated with depot-leuprolide acetate for various lengths of time, from 6 months to 5 years, with the follow-up intervals ranging from 6 months to 6 years. Leuprolide acetate resulted in a significant suppression of deviant sexual interests and behavior as measured by self-report and was well tolerated. However, the three patients who were on long-term therapy developed bone demineralization, suggesting that this is a significant side effect of prolonged therapy. Leuprolide acetate shows promise as a treatment for the paraphilias.
KEY WORDS: sex offenders; paraphilia; leuprolide acetate; antiandrogens; LHRH agonists.
INTRODUCTION
The paraphilias are a significant source of social costs (Bradford, 1998) and victimization (Rosler and Witztum, 1998), as well as personal distress for individuals with these disorders. Surgical castration and antiandrogen agents have been used to treat these disorders (Bradford, 1985, 1988), but have substantial adverse side effects (Gijs and Gooren, 1996). Recently, a number of reports have detailed the use of gonadotropin-releasing hormone agonists to treat the paraphilias. Although several of these agents have been synthesized and are available, their actions are similar (Ascoli and Segaloff, 1996). Three groups have reported on the use of triptorelin (Rosler and Witztum, 1998; Thibaut et al., 1993, 1996). Rousseau et al. (1990) reported on the use of LHRH ethylamide. Single case-reports of use of leuprolide acetate for the treatment of a patient with exhibitionism and Huntington's Disease (Rich and Ovsiew, 1994), and of patients with pedophilia (Cooper and Cernovsky, 1994, Dickey, 1992) have been described. We present herein the use of leuprolide acetate to treat 12 individuals with paraphilic disorders or with sexual disorders not otherwise specified.
METHODS
Patients were obtained through consultation with a state hospital system or from a private practice with a specialty of treatment of individuals with paraphilias. The decision to administer depot-leuprolide acetate was...