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There is increasing evidence that LHRH agonists are more effective than steroidal antiandrogens in lowering paraphilic sexual thoughts and behaviors. Current research also is based on methods that might be less susceptible to faking (eg, eye-tracking, brain imaging, and viewing-time measures). Side effects occurring most frequently are fatigue, hot flashes, depressive mood, weight gain, high blood pressure, diabetes, gynecomastia, loss of erectile function, and loss of bone mineral density.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Although LHRH agonists seem to be the most effective drugs in the treatment of paraphilic fantasies and behaviors, they should be reserved for patients with a paraphilic disorder and the highest risk of sexual offending because of their extensive side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>This systematic review considers all types of research on LHRH agonist treatment in patients with paraphilic disorders, thereby providing a complete overview of the current state of research. However, most studies are case reports or observational studies and randomized controlled clinical trials have not been conducted or published.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LHRH agonists are a useful treatment when combined with psychotherapy in patients with a paraphilic disorder and the highest risk of sexual offending. However, throughout treatment, close monitoring of side effects is needed and ethical concerns must always be kept in mind.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jsxm.2017.11.013","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T03:24:31Z","timestamp":1514345071000},"page":"77-93","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":71,"title":["Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review"],"prefix":"10.1093","volume":"15","author":[{"given":"Daniel","family":"Turner","sequence":"first","affiliation":[{"name":"Institute for Sex Research and Forensic Psychiatry , Hamburg \u00a0 Germany"},{"name":"University Medical Center Hamburg-Eppendorf , Hamburg \u00a0 Germany"},{"name":"Department of Psychiatry and Psychotherapy , Mainz \u00a0 Germany"},{"name":"University Medical Center Mainz , Mainz \u00a0 Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peer","family":"Briken","sequence":"additional","affiliation":[{"name":"Institute for Sex Research and Forensic Psychiatry , Hamburg \u00a0 Germany"},{"name":"University Medical Center Hamburg-Eppendorf , Hamburg \u00a0 Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,1,1]]},"reference":[{"key":"2023012309340437700_bib1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","article-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013"},{"key":"2023012309340437700_bib2","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/YCO.0000000000000099","article-title":"Assessment methods and management of hypersexuality and paraphilic disorders","volume":"27","author":"Turner","year":"2014","journal-title":"Curr Opin Psychiatry"},{"key":"2023012309340437700_bib3","first-page":"23","article-title":"Psychiatrische Diagnosen von Sexualstraft\u00e4tern: Eine empirische Untersuchung von 807 inhaftierten Kindesmissbrauchst\u00e4tern und Vergewaltigern","volume":"23","author":"Eher","year":"2010","journal-title":"Psychiatric diagnoses of sexual offenders: an empirical investigation of 807 incarcerated child sexual abusers and rapists Z\u00a0Sex Forsch"},{"key":"2023012309340437700_bib4","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4088\/JCP.v65n0302","article-title":"Psychiatric and legal features of 113 men convicted of sexual offenses","volume":"65","author":"Dunsieth","year":"2004","journal-title":"J\u00a0Clin Psychiatry"},{"key":"2023012309340437700_bib5","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4088\/JCP.v60n0613","article-title":"Psychiatric features of 36 men convicted of sexual offenses","volume":"60","author":"McElroy","year":"1999","journal-title":"J\u00a0Clin Psychiatry"},{"key":"2023012309340437700_bib6","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1037\/0022-006X.73.6.1154","article-title":"The characteristics of persistent sexual offenders: a meta-analysis of recidivism studies","volume":"73","author":"Hanson","year":"2005","journal-title":"J\u00a0Consult Clin Psychol"},{"key":"2023012309340437700_bib7","first-page":"2993","article-title":"The role of testosterone in sexuality and paraphilia\u2014a neurobiological approach. 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