AAPL's guidelines are probably the best to follow. In the AAPL review course mention of SSRIs and antipsychotics are used. SSRIs could reduce sex drive, antipsychotics could reduce sex drive too. More D2 blockage, the more prolactin means less testosterone.
More extreme is chemical castration.
CBT has been found to help.
My recommendation is don't try to tackle this type of case unless you have forensic training unless the paraphilia is low danger such as a streaker or flasher.
Hebephilia unless there's newer data out there that I'm not aware of is not considered a pathology. The DSM editor Micheal Furst wrote an editorial about this in AAPL. He didn't say it was morally right, but the bottom line is too many adults find adolescents sexually attractive and in some parts of the US it's still culturally acceptable for an adult of say 30 to be dating a 16 year old. (Hmm have we've forgotten that Jerry Seinfeld was in his late 30s while dating a teenager? Add to that that his current wife, he met her on her honeymoon with another guy and he seduced her away from her husband). For this reason he couldn't consider it pathology and for legal cases it shouldn't be branded as so.
Even as a forensic psychiatrist I couldn't stand to be in the position to treat a paraphilic. It was mostly due to these reasons. 1-There is very little if anything that could be used to determine their safety in the community 2-most of the time the meds I felt safe giving didn't work well, or 3--and here's where I need to write a paragraph...
Patient on chemical castration usually were started on it in a correctional or forensic facility where the doctor was less than helpful when it came to educating the patient about the risks of such. Chemical castration is very outside the norm of treatment and could be arguably outside the standard of care or reasonable care. After all you'd likely giving birth control at 10x more the dosage it was FDA approved for in women. It does carry significant risk of fatal outcomes such as a pulmonary embolism and you're not supposed to smoke while on Depo Provera but despite that several paraphilics do it anyway only significantly increasing the risk they'll die under your care.
So guess what? Judge orders the guy can only be released if he's on Depo-Provera, so fine, he starts getting it in the jail or forensic hospital, then a few weeks later he's discharged. Now I'm the doc and they specifically want me cause I got a board-certification in forensic psychiatry.
So then I asked the patient if he was told about the risks because this is very unconventional and he tells me no, so I tell him and give him material on it and now he doesn't want to be on it anymore. So I call the parole officer and tell him what am I supposed to do cause this guy is now released and doesn't want to be on it and the parole officer is like "WTF why did you tell him there were risks?"
Turns out no one, I mean no one from the judge to the doctor that started the Depo-Provera, to the patient, to the parole officer didn't consider for one moment the side effects and problems considering this is very extreme and out of the norm treatment.
See what I'm talking about? And now you're the guy who's supposed to prescribe it.
