Leuprolide Acetate Suppresses Pedophilic Urges and Arousability

Hormone therapy is aimed at modification of the basic sex drive, whereas cognitive-behavioral psychotherapy targets cognitive processes that precede all events leading to pedophilic behavior. Obsession/compulsion and sex drive might affect the decision process. Because of a suggested relationship between obsessive compulsive disorder and paraphilias, SSRIs have been utilized. Most reports have been documented from individual case studies or uncontrolled, retrospective studies (Kafka, 2000).

Reports of the efficacy of drug therapy for suppression of sexual drive and modification of behavior continue to emerge. The anti-androgens, MPA and CPA, are the most widely used drugs. They provide variable testosterone suppression, dependent on dose. LHRH inhibitors and GNRH agonists also provide profound testosterone suppression. More recently, triptorelin, an agent similar to LA, (Rosler & Wilztum, 1998) and selective serotonin reuptake inhibitors (SSRIs) have also been investigated (Raymond, Grant, Kim,.& Colemen, 2002; Stein, Hollander, Anthony, Schneier, Fallon, Liebowitz, Klein, 1992).

Despite recent advances in the use of testosterone-suppressing drugs for the treatment of pedophilia, limited information is available in the form of well designed, controlled objective studies. The lack of standardized, objective outcome measures has hampered objective assessment of efficacy of interventions for pedophilia (Briken, Hill, & Berner, 2003; Hanson et al., 2002; Marshall & Barbaree, 1990). A multi-disciplinary team of experts is needed to assess concurrent, objective physiologic measures of response. Though some results of treatment are promising, a reliable, well-tolerated approach that can be objectively monitored for efficacy is lacking.

The specific aspects of behavior that are affected by therapy, as well as the efficacy, limitations, and side effects of treatment need to be determined (Briken, Hill, & Berner, 2003; Raymond, Robinson, Kraft, Rittberg, & Coleman, 2001). The present study assessed the impact of cognitive-behavioral psychotherapy alone versus cognitive-behavioral psychotherapy augmented with a potent testosterone-lowering drug, LA, for suppression of pedophilic urges and arousability. The psychotherapy program comprised cognitive and behavioral therapy. Objective assessments of sexual interest preference and physical arousal, as well as sexual urges and masturbation, were monitored before, during, and after therapy. The research objectives were to explore the relationship between testosterone level and sexual interest preferences, physiologic responses to sexual stimuli (auditory and visual), and self-reported sexual behaviors.

METHOD Subjects Five men (M age, 50 years; range, 36-58), with a diagnosis of pedophilia (American Psychiatric Association, 1994) and who were "out of denial" were recruited for study. Subjects were identified by a focus group of judges, attorneys, Probation and Parole officials, representatives from the District Attorney's office and psychologists who were invited to a seminar regarding the Lupron Project. After potential subjects were identified, the Principal Investigator screened case histories to determine eligibility for study inclusion (Table 1). These potential subjects were contacted by the Principal Investigator. They were interviewed, informed of the study, and invited to participate. Three additional subjects were screened, but excluded. These included one psychotic adult, one adolescent, and one elderly, nonerectile adult. The study was conducted during a two-year period in a medical research center in north western Pennsylvania. The study was reviewed and approved by the local Institutional Review Board. All subjects provided informed consent. Participation was voluntary and not a condition of probation or parole. The subjects were informed that they would receive either a drug or placebo without an indication of duration of dose, the sequence, nor if a sequence would occur. The subjects did not know one another. They lived in diverse geographical locations and their only contact was during group cognitive-behavioral psychotherapy.