The hormonal treatment of sexual offenders.

The hormonal treatment of sexual offenders is part of a pharmacological approach to the reduction of the sexual drive. Sexual drive reduction can also be brought about by stereotaxic neurosurgery and castration. These other methods of sexual drive reduction are closely related to the pharmacological approach, and all are dependent on the complex interactions between higher central nervous system functions, located in the cortex and limbic systems, and neuroendocrine mechanisms mediated via the hypothalamic pituitary axis, the gonads, and their various feed-back mechanisms. The higher functions of the central nervous system are channeled through the hypothalamic-pituitary axis where complex neurological correlates of behavior are transformed into neuroendocrine responses. Gonatrophin releasing factor (GRF) is released from the hypothalamus irregularly in bursts. The ante rio-pituitary in response releases luteinizing hormone (LH) and follicular stimulating hormone (FSH), also in episodic bursts of secretion. In the normal male, FSH acts on the germinal epithelium of the seminiferous tubules to produce spermatazoa. LH stimulates the Leydig cells to secrete testosterone that is then released into the serum where it forms approximately 95 percent of the plasma testosterone. The other 5 percent in secreted from the adrenal cortex through d4androstenedione. J During puberty, both sexes show an increase in the volume of gonadotrophin secretion, and in the male this is associated with increased testosterone secretion during sleep. There is an associated circadian rhythm resulting in sleep related increases in gonadotrophic hormone production. J Testosterone in the male regulates spermatogenesis and is responsible for the development of secondary sex characteristics. Estrogens are also produced by the testes. The exact role of oestrogens in the male reproductive system is not fully understood. J Testosterone (T) is the principal androgen produced by the Leydig cells of the testes, and it is a 17 hydroxylated c-19 steroid. It is transported in the plasma by testosterone-binding globulin (TBG), which binds about 97 to 99 percent of circulating testosterone. The free testosterone is assumed to be the metabolically active portion. J Testosterone is carried to various target glands, such as the prostate where it is converted into dihydrotestosterone (DHT). DHT and T are the important androgens involved in sexual activity. J Testosterone (T) is secreted episodically. and mUltiple peaks can be observed if continuous blood sampling is performed. It is also subject to a diurnal variation with peak levels between 8 a.m. and 10 a.m. J