Hormonal and psychopharmacological interventions in the treatment of paraphilias: An update

Interest in the pharmacotherapeutic treatment of paraphilias is growing. Two classes of drugs have been tested: drugs that interfere with the normal production and action of androgens and psychotropic medications, in particular, anti‐depressants. We present a review of the supposed modes of action, the usual dosages, and the effectiveness of these drugs. Although the empirical validation of pharmacological interventions shows many methodological shortcomings, we conclude that pharmacological strategies as part of a “complete” psychotherapeutic programme can make a limited, yet relevant contribution to the treatment of paraphilias. More specifically, and provided that there is informed consent, antiandrogens should seriously be considered in the case of paraphilias, which are characterized by intense and frequent sexual desire and sexual arousal predisposing someone strongly to paraphilic behavior. Psychopharmacological interventions, also on the condition of informed consent, can be considered in the case of paraphilias, which are associated with obsessive‐compulsive or depressive disorders. Nonetheless, methodologically well‐designed studies remain a prerequisite for a definitive assessment of pharmacotherapy for paraphilias.