This study compared cognitive-behavioral psychotherapy with leuprolide acetate (LA) to
cognitive-behavioral psychotherapy with saline injections for 12 months. Five white male
pedophiles (M age, 50 years; range, 36-58) volunteered for a two-year study. LA was
administered by Depo injection (7 mg initially, then 22.5 mg every 3 mos) for 12 months,
followed by saline placebo. Effects of LA on testosterone levels, sexual interest preference
by visual reaction time (Abel Assessment), penile tumescence (Monarch PPG), as well strong
urges and masturbatory frequency to children (polygraph), were measured every three months.
Subjects were treated with weekly cognitive-behavioral psychotherapy. On LA, testosterone
decreased to castrate levels. Because of the suppression of testosterone, physiologic arousal
response as measured by penile plethysmography (penile tumescence) was significantly
suppressed compared with baseline. However, sufficient response remained to detect pedophilic
interest. This pedophilic interest was also detected by visual reaction times. All subjects
self-reported a decrease in strong pedophilic urges and masturbation. When asked about having
pedophilic urges and masturbating to thoughts of children, polygraph responses indicated
subjects were not deceptive when they reported decreases. On placebo, testosterone and
physiologic arousal eventually rose to baseline levels. At baseline and on placebo, subjects
were consistently deceptive regarding increased pedophilic urges and masturbatory frequency
as noted by polygraph. Interest preference, as measured by Abel Assessment and Monarch PPG,
was generally unchanged throughout the study. Cognitive-behavioral psychotherapy augmented
with LA significantly reduced pedophilic fantasies, urges, and masturbation, but did not
change pedophilic interest during one year of therapy. Deceptive responses by polygraph
suggested that self-report was unreliable. Follow-up utilizing objective measures is
essential for monitoring efficacy of treatment in pedophilia. Our study supports the
supposition that modification of pedophilic behavior is possible. LA may augment
cognitive-behavioral psychotherapy and help break the sequence leading to a reoffense.