Ciproterone acetate has proved quite effective because of its antiandrogenic, antigonadotrophic, and progestational effects. (54> This agent blocks intracellular testosterone uptake as well as the intracellular metabolism of antiandrogens. As a consequence, it drastically reduces circulating testosterone and therefore reduces the paraphiliac's sexual drive. The oral dosage is usually 50 to 200 mg/ day but it is also available in an intramuscular form, requiring a dosage of 200 to 400 mg once every 1 or 2 weeks. Side-effects include liver damage, gynaecomastia (usually temporary and reversible), and reduction of sexual drive, fantasies, erections, frequency of masturbation, and sexual intercourse. This drug was first used in 1971, and a number of studies have shown it to be highly effective at reducing recidivism.(55) Ciproterone acetate is available throughout Europe and Canada, but is not available in the United States.

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