Cyproterone Acetate in the Treatment of Sexual Disorders: Pharmacological Basis and Clinical Experience

Cyproterone acetate (CPA), discovered over 25 years ago, was the first clinically suitable antiandrogen. It inhibited both endogenous and exogenous androgens in various organs and had broader effects such as on skin thickness and sebaceous gland function. CPA was indicated for conditions like prostate cancer, androgen-induced skin disorders, precocious puberty, and sexual disorders in men. Clinical trials for sexual deviations began in 1966. CPA treatment (100-200 mg daily orally or 300 mg weekly i.m.) led to loss of libido and erectile function within 14 days, with effects reversing upon cessation. Approximately 75-80% of patients responded well, though side effects included tiredness, depressive moods, and slight gynecomastia in 20% of patients. Alternatives like pure antiandrogens, tranquilizers, high-dose estrogens, orchidectomy, and LHRH analogues were less suitable due to inefficacy or severe side effects.