MEDROXYPROGESTERONE TREATMENT FOR PARAPHILIACS

This study addresses the following questions: (1) what are the essenti al components of a medroxyprogesterone acetate (MPA) pretreatment eval uation?; (2) do paraphilic men treated with MPA (Depo-Provera) report a lowering of both deviant and nondeviant sexual drive and activities? ; (3) is behavioral improvement associated with testosterone level red uctions?; and (4) what significant side effects are associated with MP A treatment? A total of 29 paraphilic men who underwent a comprehensiv e psychiatric, medical, and legal evaluation and were eligible for tre atment with MPA were followed naturalistically white receiving concurr ent MPA and group therapy. The principal outcome measures were data ob tained from a weekly self-reported psychosexual inventory that quantif ied five dimensions of deviant and nondeviant sexual activities and te stosterone levels that were drawn pretreatment and after three and six months of MPA. Self-reported data were analyzed by nonparametric meth ods. Because MPA's effectiveness is evident early in treatment, we rep ort on data from the first six months. Subjects reported a differentia l rate of suppression of sexual activities, a median of up to two week s for deviant and 2 to 10 weeks for nondeviant behaviors (p less than or equal to .01 for each of the five dimensions). Testosterone levels suppressed to less than 0.5 ng per milliliter for all but two subjects at three months and for all at six months. Recidivism was reported fo r one subject. Except for one subject who developed pulmonary emboli, no major medical problems were encountered. MPA safely and effectively reduced sex drive, controlled deviant sexual impulses and behavior, a nd lowered the testosterone levels of these paraphilic men during the first six months of treatment. However, the relative rapidity and comp leteness of the response raises questions regarding possible distortio ns in self-reported sexual activities. This should alert the practicin g clinician to consider the use of collateral sources of information i n interpreting treatment outcome for patients with paraphilic behavior s. Also, longer follow-up periods are required for monitoring treatmen t efficacy.