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Medical treatment options

Here we share some information about potential drugs that may lower sexual impulses. It is very important to understand that this cannot replace the personal consultation and pre-medication diagnosis done by a trained professional, i.e. a psychiatrist. Taking any medication requires regular contact with a clinician.

In general, there are two types of eligible medication classes. Antiandrogens (GnRH-analogues and androgen receptor antagonists) are a more specific medication for the reduction of sexual impulses; they hamper the effect of Testosterone, the male sexual hormone in the body. Selective serotonin reuptake inhibitors (SSRI) are a less specific medication, but may have the effect of diminishing sexual urges.

Antiandrogens

Antiandrogens are typically prescribed for the treatment of prostate cancer, which is often Testosterone-dependent. Another specific effect is the reduction of sexual impulses, especially to deter problematic sexual behavior. The drugs influence the effect of testosterone in the body either by interrupting its production or blocking the receptors. We will provide some detailed information about the regulation and effect of testosterone below.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs (also known as antidepressants) are a more or less unspecific drug for the reduction of sexual impulses. They are used in the treatment of depression but a decrease of sexual urges is a known side effect. In this case what is typically regarded as a side effect becomes the therapeutic effect, although you may benefit from a better mood as well!

The same medication can have different effects and side effects depending on the individual. Physical exercise, especially endurance sports and outdoor exercise, can influence the (side) effects of medication on an individual.

There are a lot of advantages (pros) and disadvantages (cons) of taking medication. The same effect can be considered as a pro for one person and as a con for another.

Possible advantages (pros):

  • Stress reduction
  • Diminished pornography consumption
  • Reduced masturbation
  • Increased sexual calmness in contact situations with children
  • Feeling released or liberated
  • Sexuality experienced with less urgency
  • More confidence and security to abstain from offending
  • Fewer sexual fantasies

Possible disadvantages (cons):

  • Reduced masturbation
  • Decreased erectile function
  • Fewer orgasms
  • Reduced interest in sex (g. with partner)
  • Life is boring/unexciting without sexuality
  • Unpleasant side effects of medication (e.g. breast enlargement (gynecomastia), tiredness, weight gain)

How is the testosterone balance regulated in men?

The hypothalamus is a small part of the brain that constantly monitors the level of testosterone concentration in the blood. If the level is too low, the hypothalamus sends a message to the pituitary gland by use of a messenger (luteinizing hormone-releasing hormone, or LHRH), to tell the body that testosterone should be produced. The pituitary instructs the testicles to produce testosterone by use of another messenger (luteinizing hormone, or LH). Furthermore, the adrenal glands are induced to produce androgens by use of a third messenger (adrenocorticotropic hormone, or ACTH). Androgens and testosterone are then converted into dihydrotestosterone (DHT) in the body. The adrenal glands contribute only slightly to the overall production of dihydrotestosterone.

If the testosterone level exceeds a certain point, the messengers that induce production of testosterone in the testicles and the adrenal glands decline – what is called negative feedback.

Testosterone plays a key role in the development of male reproductive tissues such as the testicles and prostate, as well as promoting secondary sexual characteristics, such as increased muscle tissue, bone mass and the growth of body hair.

Testosterone is responsible for the maintenance of sexual desires and urges.

Various body cells possess testosterone receptors, such as the brain, hair roots, fat cells, neural cells and cells in the testicles and prostate. Antiandrogens affect the precise area of the brain responsible for the reduction of sexual impulses by decreasing the level of testosterone in the blood or by blocking the receptors, thereby reducing the effectiveness of testosterone. There is a large body of research and experience with antiandrogens, and it is the medical treatment option with the greatest compatibility.

Experiences of men who chose to receive medication:

“I didn’t know that I could think of anything else, other than children in my fantasies… I am surprised by all the interesting activities I have discovered since I’m on medication.“

„I was feeling like I was up to my neck in it and always had to stand on my tiptoes to keep my nose above the water. Since I’m on medication I am absolutely relaxed and able to see what else is going on because I’m not constantly busy trying not to drown. Life has even started to appear relaxing.”

„Before beginning pharmacological treatment, I was constantly engaged in nothing else, other than children. It was all about boys. I couldn’t concentrate on anything else. On TV I was only looking for series with little boys and spent whole nights searching for pictures of boys, stored them and archived them. I had to masturbate up to 5 or 6 times a day. It took longer to come to an orgasm every time I masturbated. I spent hours on masturbating up to the point of exhaustion. I didn’t go to work nor did I do anything meaningful but nevertheless I was totally engrossed and exhausted. Since beginning medication, for the first time in my life I’m having a clear mind. I suddenly discovered new interests apart from boys… I’m feeling like being relieved from a huge burden. I only masturbate once or twice a day and in doing so I can also really relax.… On the other hand it doesn’t work that good with the medication  : you hardly get an erection, which is also not so stiff and it takes longer to reach orgasm and with time there’s less and less sperm. But you’re not so often in the mood to do it and that’s worth it to me.”

„I have the feeling that I am much more vulnerable, since beginning medication. Before I was living in a suit of armor, inside a tank, always trying to hide myself and my feelings. This need is gone now. Even if I don’t tell anybody how I think and feel, I have become much more open and not so anxious that somebody could discover me, that one could see who I really am. I’m also calmer and more relaxed in front of other adults, because I don’t have the feeling anymore that I have to hide something. It’s there, but it doesn’t disturb me that much anymore. I even look at chance encounters with boys from a more distant point of view.… At the same time you have to be careful that you don’t rely too much on the medication and that you don’t shift your own responsibility onto them… Well, that’s just about the limit, when you masturbate several times daily before and now, suddenly, just once a week and it is far from the same experience. But I would always take the medication again, because you just have some peace and quiet. I scrapped my entire collection of pictures, because collecting made me feel silly since I took the medication. I couldn’t understand why I had saved 4,000 pictures, which meant nothing to me anymore.”

Overview: detailed drug information

 

 

Gonadotropin-releasing
hormone analogue
(GnRH-analogue)
CyproteronacetatSelective serotonin reuptake
inhibitors (SSRIs)
Group
Trade Name
Antiandrogen
e.g. Decapeptyl®, Enantone®, Trenantone®
Antiandrogen
Androcur®
Antidepressants
e.g. Seroxat®, Tagonis®, Zoloft®, Cipramil®
ApplicationThese drugs are usually used to treat prostate cancer. Prostate cancer growth is inhibited if the testosterone level in the blood drops.Like GnRH-analogue, Androcur was originally developed for the treatment of prostate cancer. Additionally, it is used to reduce testosterone levels in women.Selective serotonin reuptake inhibitors were originally developed for the treatment of depression. They are the most commonly used drugs for this purpose and are also used for other psychiatric disorders, such as anxiety disorders.
Mode of actionThese drugs ensure that the pituitary gland gets the signal that there is sufficient testosterone. In accordance, the pituitary gland down-regulates the production of messengers to the testicles. The testicles then no longer produce any testosterone.In the body, Androcur blocks testosterone receptors. Testosterone remains in the blood, but is less effective. In this way a similar effect is achieved as if lowering the level of testosterone.The concentration of serotonin (a neurotransmitter in the brain) is increased in the synapses (junctions of neuronal cells) and occupies the receptors, causing the antidepressant effects. In people without depression it has no effect. It is still not entirely understood how SSRIs reduce sexual fantasies and sexual impulses, as they do not affect the testosterone stores. One assumption is that the effect could be explained by a slower flooding of emotional states.

Effects on

sexuality

Very often: reduction of fantasies and sexual impulses, reduction of erection and orgasm capacity.

Sexual fantasies and sexual impulses, but remain unchanged in their focus.

A similar effect on sexuality is described as in GnRH-analogue, only less intensive.

Often: reduction of sexual fantasies and sexual impulses, fewer erections and reduced orgasm capacity.

Sexual fantasies and sexual impulses, but remain unchanged in their focus.

Reduction of sexual impulses, sexual arousal and orgasm capacity (not in all patients). It is a much smaller effect than in antiandrogens.
Unwanted
Effects

Increased sweating, hot flashes, bone pain, decreased bone density, weight gain, tiredness, joint pain, backache, asthenia (lack of energy), decreased muscle mass, impaired sperm production, testicular shrinkage, depressed mood, body hair decrease.

Rarely: After stopping use, the level of testosterone no longer reaches the original level.

Elevated liver values, tiredness, poor concentration, breast enlargement (gynecomastia), weight gain, thrombosis, impaired sperm production, depressed mood.In general, SSRIs are safe and well tolerated medications. Initial side effects like restlessness, nausea, dizziness, and insomnia usually improve after 1-2 weeks.
FeatureAt the beginning of treatment a testosterone flare-up will occur. Therefore, an antiandrogen has to be taken additionally.  
Requirements for physicals (before and during)Regular control of blood values and bone density measurements every 1-2 years depending on age and pre-existing conditions.Regular control of
blood values, especially
liver values, and possibly
control of body weight
and blood sugar.
ECD, blood and liver values
IntakeIntramuscular injection every 3 months.Either as an injection every 2 weeks or as an oral medication daily. The injection burdens the body less than the tablet.A tablet taken once to several times a daily. It cannot be given as an injection.
EvaluationReliable reduction of sexual fantasies and sexual impulses. Better results than antiandrogens and good general compatibility.Reliable reduction of sexual fantasies and sexual impulses. Good results and good general compatibility.Unreliable and only a weak reduction of sexual fantasies and sexual impulses. Good general compatibility.
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