All of the subjects had been diagnosed with at least one paraphilia (pedophilia, sexual sadism, frotteurism, and paraphilia not otherwise specified). All had been in a residential program for adolescent sex offenders prior to being treated with leuprolide. They were selected for a trial with leuprolide after their evaluations and longitudinal indications suggested pharmacological treatment was appropriate. Leuprolide, a luteinizing hormone-releasing-hormone agonist (LHRH-A), is a testosterone-lowering agent that has been studied in patients with central precocious puberty, prostate cancer, and endometriosis. Since the early 1990's leuprolide has been used in treating patients with paraphilia and has gained growing acceptance partly because its side-effect profile is less severe than MPA. Moreover, leuprolide has apparently been effective with some patients who failed to respond to MPA or other similar agents. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide, which consisted of 7.5 mg/month and flutamide (250 mg p.o. TID for the first 14 days of treatment with leuprolide). Clinical response was rated subjectively by the treating physicians. Clinicians rated four subjects as much improved and two as moderately improved. Treatment was well tolerated by all subjects. These preliminary cases support the conclusion that leuprolide deserves further investigation as a possibly safe and effective component of treatment for young adults with paraphilia. 1 table and 26 references