Is Depo Provera (medroxyprogesterone) effective for treating sexual aggression?

Depo Provera for Sexual Aggression

Depo Provera (medroxyprogesterone acetate) is not FDA-approved for treating sexual aggression, and current guidelines do not recommend its use for this purpose despite some historical research showing potential effectiveness.

Mechanism and Evidence

• Medroxyprogesterone acetate (MPA) has antiandrogen properties that can lower testosterone levels, which has been associated with reduced sexual interest and activity in males 1
• Early research from the 1970s through 1990s suggested some effectiveness in controlling certain sex-offending behaviors, with one study showing an 18% reoffense rate during therapy compared to 58% in controls who refused treatment 2
• Studies have shown differential rates of suppression for sexual behaviors when MPA is administered, with deviant sexual behaviors reportedly suppressed earlier than non-deviant behaviors 3
• Research in non-human primates (stumptail macaques) showed that DMPA treatment reduced female sexual attractiveness but was associated with increased female agonistic behavior 4

Clinical Considerations

• MPA is primarily approved and recommended as a female contraceptive with a typical use failure rate of 6% and perfect use failure rate of 0.2% 5
• The standard contraceptive dose is 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks 5
• There are no approved contraceptive methods using hormonal agents like Depo Provera for men 5
• The Centers for Disease Control and Prevention advise against prescribing Depo Provera for men due to lack of approval, evidence of efficacy, and safety data 5

Side Effects and Risks

• Significant medical side effects have been reported with MPA treatment for sexual offending, including:
  • Excessive weight gain
  • Malaise
  • Migraine headaches
  • Severe leg cramps
  • Elevated blood pressure
  • Gastrointestinal complaints
  • Gallbladder stones
  • Diabetes mellitus
  • Pulmonary emboli (rare but serious) 2, 3
• Long-term use of Depo Provera in women is associated with decreased bone mineral density 6
• The risk-benefit ratio must be carefully considered given these potential serious side effects

Current Recommendations

• Current guidelines from the Centers for Disease Control and Prevention do not recommend Depo Provera for treating sexual aggression 5
• For men seeking contraception, the CDC recommends only approved methods: condoms (18% typical failure rate) and vasectomy (0.15% typical failure rate) 5
• The American Academy of Pediatrics and other major medical organizations do not include Depo Provera in their guidelines for managing sexual aggression 7

Ethical and Legal Considerations

• The use of hormonal treatments for behavioral control raises significant ethical concerns about informed consent and autonomy
• Any consideration of off-label use should involve comprehensive psychiatric, medical, and legal evaluation 3
• Treatment decisions should prioritize morbidity, mortality, and quality of life outcomes rather than solely focusing on behavioral control

Alternative Approaches

• Current standard of care for sexual aggression typically involves psychological interventions, including:
  • Individual psychotherapy
  • Group therapy
  • Cognitive-behavioral interventions
  • Risk assessment and management strategies

While some historical research suggests potential effectiveness of Depo Provera in reducing sexual aggression, the lack of current guideline support, absence of FDA approval for this indication, and significant potential side effects make it difficult to recommend as a standard treatment approach for sexual aggression.