Indications for Depo-Provera (Medroxyprogesterone Acetate) in Males
The primary indication for administering Depo-Provera (medroxyprogesterone acetate) injections to males is for chemical castration in the treatment of sex offenders to reduce sexual interest and activity by lowering testosterone levels. 1
Mechanism of Action in Males
- Medroxyprogesterone acetate (MPA) works in males by reducing testosterone blood levels
- This reduction in testosterone corresponds with decreased sexual interest and sexual activity
- The medication is typically administered as an intramuscular injection
Clinical Applications
Primary Indication
- Treatment of sexual offenders through court-mandated therapy
- Chemical castration as an alternative to surgical castration
- Reduction of pathological sexual behaviors when other treatments have failed
Administration Protocol
- Typically administered as intramuscular injections
- Similar to the female contraceptive dosing of 150mg every 12 weeks
- May require monitoring of testosterone levels to ensure therapeutic effect
Evidence Base
The evidence supporting this use comes from studies evaluating MPA's effectiveness with court-committed sexual offenders. In one study, eight subjects served as their own controls by alternating between Depo-Provera injections for 16 weeks and saline injections for 16 weeks 1. The results demonstrated MPA's ability to reduce sexual interest and activity through testosterone suppression.
Important Considerations
- This is an off-label use of Depo-Provera, as the FDA label indicates it is approved for contraception in females of reproductive potential 2
- The FDA specifically notes limitations of use, stating it's not recommended as a long-term birth control method (longer than 2 years) unless other options are inadequate 2
- There is no evidence in medical literature indicating contraindications or significant interactions between Depo-Provera and other medications commonly prescribed to this population 3
Side Effects and Monitoring
When used in males, clinicians should monitor for:
- Weight gain
- Fatigue
- Decreased sexual desire (intended effect)
- Potential bone mineral density loss with long-term use
- Mood changes
Clinical Caution
It's important to note that this treatment should be implemented within a comprehensive treatment program for sexual offenders, not as a standalone intervention. The medication addresses the physiological aspects of sexual behavior but does not address psychological factors that may contribute to offending behaviors.
Unlike its use in females for contraception, where self-administration is now an option 4, administration in males for behavioral modification should be provider-administered to ensure compliance with treatment protocols.