A 40-year-old male with pedophilic disorder seeks treatment. He has not offended. The pharmacological treatment that reduces sexual drive by lowering testosterone via suppression of gonadotropins is:
- A Haloperidol
- B Fluoxetine
- C Leuprolide acetate (GnRH agonist — anti-androgen hormonal therapy) ✓
- D Naltrexone
Correct answer: C. Leuprolide acetate (GnRH agonist — anti-androgen hormonal therapy)
Explanation
Leuprolide acetate (a GnRH agonist used in a long-acting depot form) causes downregulation of pituitary GnRH receptors, suppressing LH/FSH and consequently testosterone to castrate levels, thereby reducing sexual drive and paraphilic urges. This 'chemical castration' is used in paraphilic disorders with high offense risk. SSRIs (fluoxetine) reduce obsessive sexual thoughts and may reduce drive. Naltrexone reduces compulsive sexual behaviors. Antipsychotics are not first-line.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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