Sexual delinquency is a global problem where those with
paraphilic disorders, such as paedophiles, are more likely to commit and reoffend.
Androgen deprivation
therapy (ADT) has been suggested as a
solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for
paraphilias. The importance of
testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti-
androgens,
GnRH agonists and
GnRH antagonists) and the effect of
testosterone replacement
therapy will be reviewed. The relationship between
androgens, brain, sexual behaviour and pathophysiology of
paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to
androgens and a higher methylation state of the
androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with
paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion,
androgens represent a significant part of the pathophysiology of
paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long-term ADT in paraphilic patients.