Rösler A, Witztum E
Department of Endocrinology and Metabolism, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
N Engl J Med. 1998 Feb 12;338(7):416-22. doi: 10.1056/NEJM199802123380702.
Men with deviant sexual behavior, or paraphilia, are usually treated with psychotherapy, antidepressant drugs, progestins, and antiandrogens, but these treatments are often ineffective. Selective inhibition of pituitary-gonadal function with a long-acting agonist analogue of gonadotropin-releasing hormone may abolish the deviant sexual behavior by reducing testosterone secretion.
In an uncontrolled observational study, we treated 30 men (mean age, 32 years) with severe long-standing paraphilia (25 with pedophilia and 5 with other types of abnormal behavior) with monthly injections of 3.75 mg of triptorelin and supportive psychotherapy for 8 to 42 months. The efficacy of therapy was evaluated monthly by the Intensity of Sexual Desire and Symptoms Scale and yearly by the Three Main Complaints questionnaire.
All the men had a decrease in the number of deviant sexual fantasies and desires, from a mean (+/-SD) of 48+/-10 per week before therapy to zero during therapy (P<0.001), and a decrease in the number of incidents of abnormal sexual behavior (from 5+/-2 per month to zero, P<0.001) while receiving triptorelin. These effects were evident after 3 to 10 months of therapy (P<0.001) and persisted in all 24 men who continued therapy for at least 1 year. The men's mean serum testosterone concentration fell from 545+/-196 ng per deciliter (18.9+/-6.8 nmol per liter) before therapy to 23+/-14 ng per deciliter (0.8+/-0.5 nmol per liter, P<0.001) after 42 months of triptorelin. The main side effects were erectile failure, hot flashes, and decrease in bone mineral density in some men.
Continuous administration of triptorelin, a long-acting agonist analogue of gonadotropin-releasing hormone, together with supportive psychotherapy, may be an effective treatment for men with severe paraphilia.
有异常性行为或性偏好障碍的男性通常接受心理治疗、抗抑郁药物、孕激素和抗雄激素治疗，但这些治疗往往无效。使用促性腺激素释放激素的长效激动剂类似物选择性抑制垂体 - 性腺功能，可能通过减少睾酮分泌来消除异常性行为。
在一项非对照观察性研究中，我们对30名患有严重长期性偏好障碍的男性（平均年龄32岁，其中25名患有恋童癖，5名患有其他类型的异常行为）每月注射3.75毫克曲普瑞林并给予支持性心理治疗，为期8至42个月。通过性欲和症状强度量表每月评估治疗效果，通过三大主诉问卷每年评估一次。
所有男性的异常性幻想和欲望数量均减少，从治疗前平均每周48±10次降至治疗期间的零次（P<0.001），异常性行为事件数量也减少（从每月5±2次降至零次，P<0.001），在接受曲普瑞林治疗期间。这些效果在治疗3至10个月后明显（P<0.001），并在所有24名持续治疗至少1年的男性中持续存在。男性的平均血清睾酮浓度从治疗前的每分升545±196纳克（18.9±6.8纳摩尔/升）降至曲普瑞林治疗42个月后的每分升23±14纳克（0.8±0.5纳摩尔/升，P<0.001）。主要副作用是勃起功能障碍、潮热，以及部分男性骨矿物质密度降低。
持续给予促性腺激素释放激素的长效激动剂类似物曲普瑞林，并辅以支持性心理治疗，可能是治疗严重性偏好障碍男性的有效方法。
