Is cyproterone acetate used to limit sexual urges in individuals with pedophilia?

Use of Cyproterone Acetate for Limiting Sexual Urges in Pedophilia

Yes, cyproterone acetate is used to limit sexual urges in individuals with pedophilia, acting as a powerful antiandrogen that reduces sexual fantasies and behaviors through competitive inhibition of androgen receptors. 1

Mechanism of Action

Cyproterone acetate works through two primary mechanisms:

• Creates feedback inhibition of pituitary LHRH release to suppress testosterone production
• Has direct effects on androgen receptors, blocking the effects of testosterone and dihydrotestosterone 2, 1

Evidence of Effectiveness

Research specifically examining cyproterone acetate in pedophilia has demonstrated:

• Significant reduction in sexual fantasies and behaviors in paraphilic men 1
• Decreased frequency of early morning erections, masturbation, and sexual frustration 3
• Reduced penile responses to sexual stimuli, though to a lesser and more variable degree 3

A double-blind placebo-controlled study of 19 paraphilic men who had committed sexual crimes showed that cyproterone acetate treatment was associated with significant reduction in sexual behavior, particularly sexual fantasies 1.

Clinical Considerations

Side Effects and Monitoring

• Hormonal regulators like cyproterone acetate may impair fertility and sexual function 4
• Can cause liver toxicity with long-term use, requiring regular liver function tests 2
• May cause fatigue, hot flashes, breast tenderness, mood changes, and erectile dysfunction 4
• Higher withdrawal rates due to side effects have been observed 4

Availability

• Cyproterone acetate is available in Canada and Europe but not in the United States 2

Treatment Approach

When considering cyproterone acetate for individuals with pedophilia:

1. Thorough evaluation of the individual's specific paraphilic behaviors, risk factors, and medical history
2. Informed consent discussing potential side effects, particularly impacts on fertility and sexual function
3. Regular monitoring including:
   • Liver function tests due to potential hepatotoxicity
   • Hormone levels (testosterone, FSH, LH)
   • Self-reported sexual urges and behaviors
   • Psychological assessment

Important Caveats

• Only a minority of pedophiles are likely to accept libido-reducing drugs 3
• Effects are reversible once therapy ceases 2
• Should be considered as part of a comprehensive treatment approach that may include psychological interventions

While cyproterone acetate has demonstrated effectiveness in reducing sexual urges in individuals with pedophilia, the decision to use this medication requires careful consideration of the potential side effects, particularly regarding fertility and sexual function.