What is the recommended dose of medroxyprogesterone (Medroxyprogesterone) for treating hypersexuality in an elderly person?

Medroxyprogesterone Dosing for Hypersexuality in the Elderly

For elderly patients with hypersexuality, medroxyprogesterone acetate (MPA) should be administered at a dose of 200-400 mg intramuscularly every 1-4 weeks, or 10-100 mg orally daily, with effects typically observed within 2-3 weeks of initiation.

Evidence for Medroxyprogesterone in Elderly Hypersexuality

Romanian and Serbian guidelines recommend medroxyprogesterone to treat sexual disinhibition in men with dementia 1. This recommendation is supported by several case studies and small trials demonstrating efficacy in managing inappropriate sexual behaviors in elderly patients with cognitive impairment.

The evidence for MPA use in this population includes:

• Case series showing successful control of inappropriate sexual behaviors in men with dementia 2
• Studies demonstrating rapid response (within 2-3 weeks) with significant reduction in sexual acting out behaviors 3
• Research showing 90% decline in serum testosterone and 60% decline in luteinizing hormone (LH) levels with MPA treatment 3

Dosing Recommendations

Intramuscular Administration (Preferred for Rapid Effect)

• Initial dose: 300-400 mg IM every 1-2 weeks
• Maintenance dose: 200-400 mg IM every 4 weeks
• Response typically occurs within 2 weeks 3

Oral Administration

• Initial dose: 50-100 mg daily
• Maintenance dose: 10-50 mg daily
• May require higher doses initially with gradual reduction based on response

Monitoring Parameters

1. Efficacy assessment:

   • Frequency of inappropriate sexual behaviors
   • Impact on caregivers and other residents (if in facility)
   • Need for physical or chemical restraints

2. Laboratory monitoring:

   • Baseline testosterone, LH, and prolactin levels
   • Follow-up hormone levels at 1 month and then quarterly
   • Liver function tests every 3-6 months

3. Side effect monitoring:

   • Weight gain
   • Fluid retention
   • Thromboembolic events (particularly in those with risk factors)
   • Mood changes

Treatment Algorithm

1. First-line approach (for non-dangerous sexual behaviors):

   • Serotonergic medications (SSRIs) 4

2. Second-line approach (if SSRIs fail or behaviors are more severe):

   • Medroxyprogesterone acetate at doses described above 4

3. Third-line approach (for treatment-resistant cases):

   • LHRH agonists (e.g., leuprolide) or estrogens 4

4. Combination therapy:

   • Consider adding an SSRI to MPA if partial response 4

Duration of Treatment

Treatment duration should be at least 6-12 months, with reassessment of the need for continued therapy. In one study, patients were treated for 1 year and followed for an additional year 3. When MPA was discontinued, testosterone and LH returned to baseline levels, with only one patient showing return of sexual behaviors (at reduced intensity).

Important Considerations

• Effects on sexual behavior typically occur within 2-3 weeks of initiating therapy 3
• Treatment should be continued for at least 6-12 months before attempting discontinuation
• Gradual tapering rather than abrupt discontinuation is recommended
• MPA has been used without significant adverse effects in elderly populations with dementia 3
• Consider medical clearance before initiating hormonal therapy in elderly patients

Pitfalls and Caveats

1. Ensure that hypersexuality is not due to other causes (medication side effects, delirium, pain, or discomfort)

2. Obtain informed consent from the patient when possible, or from surrogate decision-makers when necessary

3. Document clearly the behaviors, failed non-pharmacological interventions, and rationale for MPA use

4. Balance the ethical considerations of using hormonal treatments against the potential harm from inappropriate sexual behaviors

5. Consider the risk-benefit ratio carefully in patients with cardiovascular disease, as hormone therapies may increase risk of thromboembolic events