Medroxyprogesterone and paraphiles: do testosterone levels matter?
H. M. Kravitz, T. W. Haywood, J. Kelly, S. Liles and J. L. Cavanaugh, Jr.,
Bull. Amer. Acad. Psychiatry & the Law
24(1): 73-83, 1996.
We examine the associations between pretreatment testosterone (TTS) levels and sociodemographic,
clinical, and sexual behavioral characteristics. Two groups, low and normal pretreatment TTS, were
treated with medroxyprogesterone acetate (MPA) and compared on clinical response (deviant and
nondeviant sexual behaviors; recidivism) and length of time to return to pretreatment TTS after
discontinuing MPA. Thirteen paraphilic men who were treated with MPA and had TTS levels
monitored at approximately three-month intervals during and after MPA were followed
naturalistically. The principal outcome measures pertained to TTS levels and data from a self-report
psychosexual inventory, which quantified deviant and nondeviant sexual activities. Time to return
to baseline TTS levels were analyzed with Kaplan-Meier survival analysis. Nonparametric methods
were used to compare the two groups on other variables. Multiple regression was used to examine
the contribution of combinations of variables to TTS outcome. Subjects with low pretreatment TTS
received MPA for longer periods of time, and older subjects took longer to return to pretreatment
TTS levels despite being treated for shorter periods of time. Although subjects with lower
pretreatment TTS levels may be more sensitive to MPA's TTS-suppressive effects, the multiple
regression analysis showed that age may be an important determinant of the time it take for TTS
levels to return to pretreatment baseline. Sociodemographic, clinical, and self-reported measures of
sexual behavior did not distinguish between low and normal TTS level groups. Only one relapse was
detected. Further studies with larger samples are required to better understand the role of TTS
monitoring of sex offenders treated with MPA, in order to justify its continued use as a measurement
of treatment adequacy and to study its potential role as a predictor of treatment outcome.