Validation of the Change or Stop Testosterone-Lowering Medication (COSTLow) Scale Using the Delphi Method Among...

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Psychology

Background:

• Guidelines for treating paraphilic disorders exist, but managing testosterone-lowering medications (TLM) requires updated approaches due to patient aging and treatment duration.
• Switching or discontinuing TLM is a critical clinical consideration in long-term patient management.

Purpose of the Study:

• To assess and refine a structured professional judgment procedure for guiding changes or withdrawal of TLM in patients with paraphilic disorders.
• To develop a reliable instrument for clinical decision-making regarding TLM management.

Main Methods:

• The Delphi method was employed, involving two stages with 30 and 18 experts, respectively.
• Experts evaluated 10 factors related to TLM management, leading to the development of a new instrument.

Main Results:

• A 15-factor instrument, the COSTLow-R Scale, was developed to structure the process of changing or discontinuing TLM.
• The factors are categorized into: age/duration of treatment, therapeutic alliance, psychopathology/risk factors, motivation, and compliance/control.

Conclusions:

• The COSTLow-R Scale offers a structured approach for clinicians managing TLM in patients with severe paraphilic disorders.
• This instrument aids in the complex decision-making process of modifying or discontinuing TLM, considering various patient-specific factors.