A Pilot Study of the Effects of Gonadotropin-Releasing Hormone Agonist Therapy on Brain Activation Pattern in a Man With Pedophilia

Abstract

Gonadotropin-releasing hormone (GnRH) agonists, such as leuprorelin, are recommended in the patients with pedophilia at highest risk of offending. However, the cerebral mechanisms of the effects of these testosterone-decreasing drugs are poorly known. This study aimed to identify changes caused by leuprorelin in a pedophilic patient's brain responses to pictures representing children. Clinical, endocrine, and fMRI investigations were done of a man with pedophilia before leuprorelin therapy and 5 months into leuprorelin therapy. Patient was compared with an age-matched healthy control also assessed 5 months apart. Before therapy, pictures of boys elicited activation in the left calcarine fissure, left insula, anterior cingulate cortex, and left cerebellar vermis. Five months into therapy, all the above-mentioned activations had disappeared. No such activations and, consequently, no such decreases occurred in the healthy control. The results of this pilot study suggest that leuprorelin decreased activity in regions known to mediate the perceptual, motivational, and affective responses to visual sexual stimuli.

Changed processing of visual sexual stimuli under GnRH-therapy – a single case study in pedophilia using eye tracking and fMRI

“…Similar to Moulier et al and Schiffer et al we found a decrease of hemodynamic responses in brain regions linked with perceptual processes and in the hippocampal region [53,54]. Another interesting point concerns the amygdala.…”

“…The patient showed lower or no activation in brain regions associated with the emotional or autonomic component of sexual arousal. In the second study a homosexual pedophilic patient was compared before and five months after the onset of the GnRH agonist treatment with an age-matched heterosexual healthy man [54]. Only the pedophile showed a decrease of hemodynamic responses under GnRH therapy in the left calcarine fissure, left insula, ACC and left cerebellar vermis.…”

“…Only the pedophile showed a decrease of hemodynamic responses under GnRH therapy in the left calcarine fissure, left insula, ACC and left cerebellar vermis. The authors suggest that GnRH treatment decreased the activation in regions known to mediate the perceptual, motivational and affective responses to visual sexual stimuli [54]. Finally, Habermeyer et al examined a homosexual pedophilic patient before and 10 months after the onset of a GnRH treatment [55].…”

Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review

“…To examine the effect of TLT by means of fMRI, three case studies with similar experimental designs were conducted, in which sexually relevant stimuli were presented at a supraliminal level to measure sexual interest. Based on the results of these three case studies, it can be assumed that TLT leads to a decreased activation in brain regions linked with sexual functions, especially with regard to the autonomic, the emotional, and the motivational component of sexual arousal (101)(102)(103). Results of an additional fMRI case study, in which visual sexual stimuli were presented subliminally further indicate that even at an unconscious level, TLT can lead to changes in the processing of sexually relevant stimuli, supposedly reflecting changes in cognitive and perceptive automatic processes (104).…”

Cerebral Lateralization of Pro- and Anti-Social Tendencies

“…In addition, a study on the effects of hormonal therapy for pedophilia found that, before treatment, viewing pictures of young boys activated various LH regions in the pedophiles' brains. Five month into the hormonal treatment, however, these brain activations disappeared [159]. Taken together, these studies imply that pedophilic urges are mediated by the LH, and are further facilitated by an under-activated RH that fails to temper and control those unsocial behaviors.…”