Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

Gonzales Rengifo, Gustavo Francisco; Baltodano-Calle, Maria J.; Onton-Diaz, Melisa

dc.contributor.author	Baltodano-Calle, Maria J.
dc.contributor.author	Onton-Diaz, Melisa
dc.contributor.author	Gonzales Rengifo, Gustavo Francisco
dc.date.accessioned	2022-11-15T23:04:42Z
dc.date.available	2022-11-15T23:04:42Z
dc.date.issued	2022
dc.identifier.uri	https://hdl.handle.net/20.500.12866/12617
dc.description.abstract	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.	en_US
dc.language.iso	eng
dc.publisher	Wiley
dc.relation.ispartofseries	Andrologia
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	androgen deprivation therapy	en_US
dc.subject	androgens	en_US
dc.subject	paraphilic disorders	en_US
dc.subject	sexual behaviour	en_US
dc.subject	testosterone	en_US
dc.title	Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review	en_US
dc.type	info:eu-repo/semantics/review
dc.identifier.doi	https://doi.org/10.1111/and.14561
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.01
dc.relation.issn	1439-0272