To the Editor The study by Landgren et al1 aimed at generating evidence to use degarelix for the treatment of pedophilic disorder in men. Notwithstanding the importance of the topic covered and ingenious method of assigning temporary identification numbers to the participants, there were some methodologic issues that deserve attention. The study population was men who were required to self-report their urges and behaviors, some of which were reportable by law if revealed in their entirety. The study equated the presence of sexual desire and pedophilic attraction (part of the primary outcome) with sexually abusive behavior, which threatens the validity of the study. Also, the reduction of testosterone level is unusually prolonged, and the described effect does not match the previously discovered pharmacodynamic properties of degarelix.2 Testosterone reduction beyond 1 month of single-dose treatment is unusual for degarelix, which hints at the possibility of additional factors playing a role, eg, other medications not reported by the participants. Moreover, while the authors inquired about previous manic episode, current hypomania, and psychotic symptoms, it was not clear if they assessed any change in regimen or dose of psychiatric medications during the follow-up period. Such changes, if present, could have an additive role in improving pedophilic urges.3-5
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ElSayed M, Gupta R. Does Degarelix Hold Potential for the Treatment of Pedophilic Disorder? JAMA Psychiatry. 2020;77(10):1084–1085. doi:10.1001/jamapsychiatry.2020.2594
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