Georg August University of Göttingen--Department of Forensic Psychiatry and Psychotherapy, Göttingen, Germany.
J Sex Med. 2011 Nov;8(11):3008-29. doi: 10.1111/j.1743-6109.2011.02393.x. Epub 2011 Jul 28.
Antiandrogen therapy has been used for 30 years to treat paraphilic patients and sexual offenders. Yet the therapeutic success of antiandrogens is uncertain. Furthermore, there is still a lack of comprehensive knowledge about the effects of androgen-lowering therapy in paraphilic patients.
We discuss endocrinological, neurobiological, and therapeutic aspects of paraphilia with the aim of integrating these on the basis of the current neurobiological and clinical knowledge on testosterone that was set out in Part I of this review.
Our review of the human literature comprises the current knowledge about the neurobiology of paraphilia and the known endocrinological, pathophysiological, and genetic aspects of this disorder. The role of testosterone is discussed. A survey of antiandrogen therapy and its outcome in paraphilic patients and sex offenders is provided.
Although not all data are consistent, current imaging research suggests that structural and functional changes in pedophilia appear for the most part in brain regions also involved in sexual functions. Not exclusively testosterone but also some other endocrinological and neurochemical parameters could be disturbed in pedophilic patients and child molesters; these include changes in hypothalamic-pituitary function, prolactin levels, and dopaminergic or serotonergic functions. There appears to be a sex-steroid-related genetic influence on antisocial traits, externalizing behavior, and sexual behavior. Most of the studies in which antiandrogen therapy in paraphilic patients and sex offenders have been examined were case reports, or observational or open-label studies, and many did not include adequate control groups. Only a few placebo-controlled double-blind studies have been published with inconsistent results concerning treatment effects. Outcome measures differ between the studies and do not seem ideally suited to their purpose.
On the basis of the current knowledge about testosterone and its effects on brain and behavior as described in Part I, and of available results on the relationship between testosterone and paraphilia as well as antiandrogen therapy, we present from a neurobiological perspective an extended scientific proposal for design features to investigate the effects of antiandrogen treatment in large clinical trials.
抗雄激素治疗已被用于治疗性癖患者和性犯罪者 30 年。然而，抗雄激素的治疗效果并不确定。此外，关于降低雄激素治疗在性癖患者中的效果，仍缺乏全面的认识。
我们讨论了性癖的内分泌、神经生物学和治疗方面，旨在根据本综述第一部分中关于睾酮的当前神经生物学和临床知识，将这些方面整合在一起。
我们对人类文献的综述包括性癖的神经生物学的现有知识，以及该疾病已知的内分泌、病理生理学和遗传方面。讨论了睾酮的作用。提供了抗雄激素治疗及其在性癖患者和性犯罪者中的结果的调查。
尽管并非所有数据都一致，但目前的成像研究表明，恋童癖的结构和功能变化在很大程度上出现在涉及性功能的大脑区域。不仅仅是睾酮，还有一些其他的内分泌和神经化学参数可能在恋童癖患者和恋童癖者中受到干扰；这些包括下丘脑-垂体功能、催乳素水平以及多巴胺能或 5-羟色胺能功能的变化。似乎存在与性别相关的遗传影响，涉及反社会特征、外向行为和性行为。在检查性癖患者和性犯罪者的抗雄激素治疗的大多数研究中，都是病例报告，或观察性或开放性研究，并且许多研究没有包括足够的对照组。只有少数发表的安慰剂对照双盲研究报告了治疗效果不一致的结果。研究之间的结果衡量标准不同，并且似乎并不完全适合其目的。
基于第一部分中描述的关于睾酮及其对大脑和行为的影响的现有知识，以及关于睾酮与性癖以及抗雄激素治疗之间关系的现有结果，我们从神经生物学的角度提出了一个扩展的科学建议，以设计特征来研究大型临床试验中抗雄激素治疗的效果。
