The interest in pharmacological treatments of paraphilias and sex offenders has been increasing in the past decade. The optimal pharmacotherapy for paraphilias should reduce the sexual deviant behavior and not cause other adverse side effects. Selective Serotonin Reuptake Inhibitors (SSRIs) may cause general inhibition of sexual activity, and the reduction of impulsiveness, obsessive-compulsive characteristics, underlying depressive symptoms, and an indirect reduction of testosterone serum levels. Androgens (testosterone and dihydrotestosterone) play a crucial role in the hormonal regulation of male sexuality. Antihormonal substances, such as cyproterone acetate/CPA, medroxyprogesterone acetate/MPA, and luteinizing hormone-releasing hormone agonists (LHRH agonists), were tested on patients with deviant sexual behavior. Both the results of open, uncontrolled clinical studies with SSRIs and LHRH agonists in paraphilic outpatients confirm the positive effects of these substances. A survey was conducted in German hospitals on the use of CPA and LHRH agonists. The results show that half of the patients treated with any kind of (anti-) hormonal agents received a LHRH agonist. The side effects of these agents involved changes in blood pressure, weight gain, temporary renal dysfunction, and osteoporosis. A treatment program should start with supportive or intensive cognitive behavioral or psychodynamic psychotherapy and pharmacological treatment of comorbid disorders if needed. In mild cases with strong deviant fantasies or impulses and any risk for sexual offenses, psychotherapy in combination with SSRI treatment should be considered, especially if the paraphilia is less severe, and if the paraphilic patient shows additional symptoms, such as anxiety, depression, and obsessions. CPA or MPA should be given if there is an insufficient improvement and a moderate to high risk for hands-on offenses. LHRH agonists seem to be effective in some cases in which CPA and SSRIs failed. 2 figures, 63 references