Ciproterone effect on compulsive masturbation in a frontotemporal dementia patient.

Case Report A 75-year-old man, without previous known diseases or family history of dementia, was seen for slowly progressive behavioral changes. Over the previous 4 years, he insidiously started being sexually uninhibited, making proposals to all women, including his own daughter, and irresistible masturbating several times a day. He also developed many other behavioral features like excessive food intake, complete hygiene neglect, garbage collecting, and compulsive cigarette smoking, averaging three packs a day. At the time of our first evaluation the main symptom was clearly the compulsive masturbation, which he did at least eight times a day. This was also the most disruptive symptom to his wife, with whom he did not have sexual intercourse over the preceding years. Neuropsychological study showed severe dysfunction in all frontal lobe-directed tests, and brain MRI revealed frontotemporal atrophy; the PET scan showed hypometabolism on the same location. Sertraline, 100 mg/day, led to some symptomatic relief in all nonsexual symptoms. Quetiapine was then added and increased until a 400 mg daily dose was reached. The effect on the masturbatory acts was only slight, with the patient still doing them five to six times daily. Ciproterone (50 mg/day) was then prescribed, with complete resolution of this particular behavior, an effect sustained over the 6-month available follow-up without any reported side effects. Curiously, cigarette smoking was not at all affected.