Sexual Prefarence Disorders: Therapy

Therapy is required only when there is distress.

Cognitive behavioral therapy (CBT) is used for therapy. The goal of therapy is to enable the patient to develop skills to independently identify dysfunctional (faulty, one-sided) assumptions and thoughts. He then interrupts and corrects these and thus behaves more appropriately to the situation. A correction of the gender identity is thus not possible with monosexual identities, i.e. a homosexual remains a homosexual.

Consequently, in 2019, so-called conversion therapies for the “reversion” of homosexuals were banned. It is also forbidden to advertise such conversion therapies (2020).

In case of hypersexuality (“sex addiction”), if necessary, anti-hormonal therapy with cyproterone acetate and GnRH agonists.

Chemical castration with the GnRH antagonist degarelix (240 mg degarelix, subcutaneous) can effectively attenuate sexual desire in pedophiles. Total testosterone had decreased from an average of 467 ng/dl to 20 ng/dl after 2 weeks and was consistently low for 10 weeks thereafter.

The legal aspects of pedophilia will not be discussed here.

Couples therapy and sex therapy may have a positive effect on bisexual persons in stabilizing the love relationship in a marriage.

For trans people, gender-affirming hormone therapy (GAHT) and surgical gender reassignment can approximate the physical sex to the perceived gender identity.

  • GAHT quickly leads to significant, sometimes irreversible changes. Therefore, a clear indication is required!Likewise, the risks of hormone therapy must be considered before initiating GAHT. Chronic pre-existing conditions (eg, arterial hypertension, diabetes mellitus, dyslipidemia) must be recorded and adequately treated.To the woman: a feminizing treatment is carried out with 17-beta-estradiol valerate in combination with an antiandrogen.To the man: for a virilizing treatment transdermal or intramuscular testosterone preparations are used.
  • According to one study, the likelihood of needing psychological help – due to depression and/or anxiety disorders, for example – decreased by 8% per year after surgical gender reassignment.

In the case of patients with trans identity and intersexuality, the patient must know and accept that the medical measures to align their desired gender are irreversible. A possible bill should question the change before the age of fourteen.