The Use of Medroxyprogesterone Acetate To Assist in the Treatment of Sexual Offenders

Abstract

Within a population of 5132 sexual offenders referred to an outpatient sexual abuse clinic, the first 100 cases receiving Medroxyprogesterone Acetate (MPA) as a long-acting intramuscular injection were retrospectively reviewed and compared to a matching cohort which did not receive the drug. MPA appeared to be a safe and effective short-term supplement to an ongoing treatment program emphasizing behavioral, cognitive, group, and family therapy approaches. Data indicate no interference with concurrent treatment approaches and no irreversible side-effects, although caution is advised regarding prolonged use of this medicine, as long term effects of MPA were not examined.These findings also help in defining the characteristics of sexual offenders who are most likely to need, and to benefit from, MPA. Those with histories of hypersexuality, poor sexual impulse control, developmental disabilities, aggressive sexuality, homosexual pedophilia, multiple paraphilias, and predatory patterns of inappropriate sexual behavior merit consideration for MPA. However, the drug should be employed as an aid, particularly early in therapy, rather than as a treatment by itself.Findings are offered with the caution that data collection and statistical analyses were relatively unsophisticated. Recommendations for further investigation are offered. Maletzky, B.M. (1991). The use of m esterone acetate to assist in the treatment of sexual offenders. Annals of Sex Research, 4,[117][118][119][120][121][122][123][124][125][126][127][128][129]

The Role of Testosterone in Sexuality and Paraphilia—A Neurobiological Approach. Part II: Testosterone and Paraphilia

“…None of the above-mentioned 13 studies reviewed by Briken et al 2003 met the eligibility criteria of Lösel and Schmucker, and they were therefore not included [6]. Six studies involving antiandrogen medication (MPA) were included [101][102][103][104][105][106]. These studies attained a higher effect (mean odds ratio for therapeutic success: 3.08) than did 35 studies involving cognitive behavioral therapy (mean odds ratio 1.45) or seven studies using classical behavioral therapy (mean odds ratio 2.19) but a lower odds ratio then the eight surgical castration studies (mean odds ratio 15.34).…”

“…Most studies were found to be at level 2 or 3, e.g., the control group was nonequivalent or equivalence was only assumed. Only one [102] of the six studies in which antiandrogen medication was used reached the highest level of 5; the other five studies were rated as being at level 2 ([101,103–106] and M. Schmucker, reference [5] and personal communication 02/2011). Eher et al.…”

Coercion, Incarceration, and Chemical Castration: An Argument From Autonomy

“…Chemical castration via administration of CPA and MPA has been found effective in reducing recidivism in sexual offenders with paraphilias in some small-scale, controlled studies (e.g., Fedoroff et al 1992 ; Maletzky, Tolan, and McFarland 2006 ; Meyer et al 1992 ). However, other studies found no significant effect (e.g., Hucker, Langevin, and Bain 1988 ; Maletzky 1991 ). 2 Several studies have shown high efficacy rates for GnRH agonists in dramatically reducing testosterone levels and self-reported deviant sexual desires and behaviours, including in individuals who did not respond to CPA or MPA.…”

Sex Offending and Sexual Appetite: The Clinical and Theoretical Relevance of Hypersexual Desire

“…These agents work by differing physiological mechanisms, but their net effect is the reduction of deviant sexual appetitive behaviors. The published data support this contention especially for hormonally based treatments (Berlin & Meinecke, 1981;Bradford & Pawlak, 1993a, 1993bCooper, 1981;Cooper, Sandhu, Losztyn, & Cernovsky, 1992;Federoff, Wisner-Carlson, Dean, & Berlin, 1992;Gagné, 1981;Kravitz, Haywood, Kelly, Liles, & Cavanaugh, 1996;Krueger & Kaplan, 2001;Langevin et al, 1979;Maletzky, 1991;Meyer, Collier, & Emory, 1992;Rosler & Witztum, 1998), although these data are limited by small samples and the lack of a placebo-controlled trial of GnRH agonists. Antiandrogen pharmacotherapy has been reported to diminish sex-offender recidivism in a meta-analytic study of sex-offender treatments as well, an effect size comparable to cognitive-behavioral treatment (Hall, 1995).…”