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Kristin Kobes Du Mez, Calvin University

(The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.)

Kristin Kobes Du Mez, Calvin University

(THE CONVERSATION) The Research Brief is a short take on interesting academic work.

The big idea

White evangelical support for Donald Trump has long puzzled observers. To many, it seems hypocritical that Christians who have long touted family values could rally around a thrice-married man who was accused by several women of sexual assault. Scholars have commented on his crassness, defined by historian Walter G. Moss as a lack refinement, tact, sensitivity, taste or delicacy. Others have observed how he has broken rules of civil political engagement.

But in my research on evangelical masculinity, I have found that Trumps leadership style aligns closely with a rugged ideal of Christian manhood championed by evangelicals for more than half a century.

As I show in my book Jesus and John Wayne: How White Evangelicals Corrupted a Faith and Fractured a Nation, conservative evangelicals embraced the ideal of a masculine protector in the 1960s and 1970s in order to confront the perceived threats of communism and feminism.

Believing that the feminist rejection of macho masculinity left the nation in peril, conservative white evangelicals promoted a testosterone-fueled vision of Christian manhood. In their view, America needed strong men to defend Christian America on the battlefields of Vietnam and to reassert order on the home front.

Culture has played a critical role in shaping and sustaining this rugged vision of Christian manhood. In fashioning their masculine ideal, evangelicals have drawn liberally on Hollywood heroes on mythologized warriors like Mel Gibsons William Wallace in the movie Braveheart and on the heroic cowboys and soldiers played by John Wayne.

Reflecting the onscreen heroism portrayed by men like Gibson and Wayne, this masculine ideal condoned violence in the pursuit of righteousness and justified a vigorous, even ruthless assertion of power.

Why it matters

In 2016, exit polls revealed that 81% of white evangelicals voted for Donald Trump, a number higher than any other religious demographic.

I argue that the language evangelicals used to defend their support for Trump suggests that they were not betraying their values, rather that Trump embodied well the rugged and even ruthless ideal of evangelical masculinity.

I want the meanest, toughest son of a you-know-what I can find, explained Robert Jeffress, pastor of First Baptist Dallas. In their book The Faith of Donald J. Trump, Trumps evangelical biographers David Brody and Scott Lamb concurred: Trump would protect Christianity; he would be their ultimate fighting champion.

With his poll numbers flagging, maintaining white evangelical support is critical to the presidents reelection efforts.

That support is likely to hinge not on his presumed morality or Christian virtue, but rather on his ability to project rugged strength and masculine power.

[Get the best of The Conversation, every weekend. Sign up for our weekly newsletter.]

How I do my work

As a historian, I approach evangelicalism not as a set of abstract theological beliefs, but rather as a historical and cultural movement.

In order to understand American evangelicalism, I surveyed popular evangelical teachings on masculinity, sexuality and family values as revealed not only through sermons but also through Christian radio, film and the Christian publishing industry.

Collectively, books on Christianmanhood have millions of copies, sending the message of an aggressive, testosterone-driven ideal of Christian manhood and affirming the new evangelical identity.

What still isnt known

The relationship between evangelical consumerism and formal religious authorities is a fruitful area for further research. More work, too, can be done to explore how conflicting ideas of Christian manhood coexist within white evangelical communities and how conceptions of Christian masculinity vary across racial divides.

Whats next

I am beginning work on a project that is in many ways a counterpoint to Jesus and John Wayne, tracing the cultural and political ramifications of evolving ideals of white Christian womanhood.

This article is republished from The Conversation under a Creative Commons license. Read the original article here: https://theconversation.com/what-makes-donald-trump-and-john-wayne-heroes-of-the-christian-right-141961.

Read more from the original source:
What makes Donald Trump and John Wayne heroes of the Christian Right? - Midland Daily News

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Testosterone Replacement Therapy Sales Market Still Has Room to Grow With Emerging Players 2027 - The Daily Chronicle

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Testosterone Replacement Therapy Market Size, Analysis, and Forecast Report 2019-2025 - StartupNG

By John Vandermosten

NASDAQ:LPCN

READ THE FULL LPCN RESEARCH REPORT

Up and Coming Milestones

Tlando PDUFA date August 28, 2020

Primary endpoint results for LiFT (LPCN 1144) 4Q:20

Patent Infringement trial February 2021

Complete Phase II LiFT (LPCN 1144) 2Q:21

Second Quarter 2020 Operational and Financial Results

On August 6, 2020 Lipocine (NASDAQ:LPCN) filed its second quarter 2020 10-Q and posted its earnings release for the three month period ending June 30, 2020. The company reported zero revenues and a net loss per share of ($0.13) compared to prior year revenues of zero and loss of ($0.14) per share. Activity during the second quarter revolved around several items including presentation at the American Urological Association (AUA) conference, demonstration of treatment potential for LPCN 1144, investigational new drug clearance for LPCN 1148, affirmation of the USPTO decision and the dismissal of a shareholder lawsuit. The companys shares also exceeded $1.00 in June, and have remained above this level, allowing Lipocine to regain compliance with NASDAQ minimum bid requirements. The most important item on the calendar is the FDAs response to Tlandos NDA submission, which is expected on or before August 28th.

We anticipate that upon approval, Lipocine will find a partner to commercialize Tlando and use associated upfront and milestone payments to further develop the existing portfolio, especially LPCN 1144 and LPCN 1148. Potential licensees are waiting until approval is granted before performing their due diligence. This suggests that a deal would be announced in the fourth quarter of 2020 rather than in the weeks following an assumed approval.

Operational expenses for 2Q:20 were $4.2 million, up 26% and net loss totaled ($6.4) million or ($0.13) per share. Research and development expenses totaled $2.5 million. The 16% rise over prior year amounts reflects increased costs related to the LiFT study and higher personnel expenditures offset by a decrease in amounts related to the ABPM study, lower spend on the Tlando XR program and a fall in manufacturing costs for LPCN 1107. General and administrative costs rose 41% over last years second quarter to $2.0 million on an expansion in legal expenditures related to the Clarus dispute and an increase in personnel costs offset by lower marketing expenses, administrative travel and other expenses. A rise in the share price increased the warrant liability and required the recognition of a $2.1 million non-cash loss in other income.

Cash and marketable securities balance was $18.2 million as of June 30, 2020. There is another $5 million of restricted1 cash which will remain on hold until Tlando is approved. Current and non-current debt is carried on the balance sheet at $6.3 million. Cash burn for 2Q:20 was approximately ($4.1) million and net cash provided by financing was $11.7 million representing a stock offering and warrant proceeds partially offset by a small amount of debt repayment.

Tlando

On November 11 of last year, Lipocine announced that it had received a complete response letter (CRL) for Tlando. The CRL identified one deficiency stating that the trial did not meet one of the three secondary endpoints for maximal testosterone concentrations (Cmax). No deficiencies related to chemistry, manufacturing and controls were noted. FDA guidelines call for 85% of subjects to achieve a Cmax below 1500 ng/dL and no more than 5% of subjects presenting a Cmax between 1800 ng/dL and 2500 ng/dL and 0% above 2500 ng/dL. In the most recent dosing validation (DV) study, 85% of subjects were below 1500 ng/dL and 7% were between 1800 ng/dL and 2500 ng/dL. Although there were small variations from the FDA guidelines in the original SOAR study for subjects above 2500 ng/dL, the FDA did not identify these as a deficiency during the original New Drug Application (NDA) submission.

Following the Post Action meeting with the FDA, Lipocine was advised to address the outstanding deficiencies with a reanalysis of existing data. This recommendation relieved Lipocine of the time and cost of an additional trial and also allowed the resubmission of the Tlando NDA in February. A target action date of August 28th was provided. While the resubmission is a positive, Tlando has faced significant hurdles gaining the favor of the FDA. We published a note on February 25th that discussed details regarding the resubmission.

LPCN 1144

Lipocine announced in August 2018 the pursuit of a new indication in nonalcoholic steatohepatitis (NASH). We discuss the indication and Lipocines efforts in an earlier piece that can be accessed here. Full enrollment of 36 subjects was achieved in November 2018.

In January 2019, Lipocine announced meaningful liver fat reduction in patients participating in its Liver Fat Study and informed investors that the company had filed an investigational new drug (IND) application to begin a Phase II study for NASH. Since LPCN 1144 is the same molecule as TLANDO, for which there were numerous safety studies completed, LPCN was allowed to perform a proof of concept (POC) clinical study under the original IND to assess liver fat changes. This 36-person study was conducted in hypogonadal men at risk of developing non-alcoholic steatohepatitis (NASH) and results were measured using the magnetic resonance imaging proton density fat fraction (MRI-PDFF) technique. Topline results were announced in 1Q:19 demonstrating a 4.0% to 8.2% percentage point reduction in liver fat depending on baseline liver fat category. We discussed the results in further detail in our NASH Topline article.

Lipocine launched its Phase II clinical study for LPCN 1144 and dosed its first patient last September. Prior to the start of the trial, Lipocine announced that the FDA would allow the Phase II LiFT trial to enroll eugonadal patients in addition to the NASH patients that were initially targeted. This expansion was based on research that we discussed in a July 29th note. The study is anticipated to last for 18 months and cost approximately $8 million.

LiFT, an acronym of Liver Fat intervention with oral Testosterone, is a paired biopsy Phase II study in NASH subjects. The study design will employ a three-arm, double-blind, placebo-controlled structure and enroll approximately 75 biopsy confirmed male NASH subjects with a NAS2 score of greater or equal to four. The primary endpoint for the study is 12-week MRI-PDFF liver fat reduction and the first patient was enrolled in 3Q:19. As for the anticipated timeline, Lipocine expects top line liver fat reduction data in 4Q:20 as measured by MRI-PDFF at 12 weeks. Biopsy data at 36 weeks is expected to be available in the second quarter of 2021.

Exhibit I LiFT Study Timeline3

NASH Environment

A lot has happened in the NASH space in 2020. Genfit (GNFT) announced that it will halt development of elafibranor after it failed to distinguish itself compared to placebo earlier this year. CymaBay (CBAY) announced that the FDA had lifted the hold on seladelpars Phase II study last month. No evidence was found for liver injury for the drug and the trial is expected to resume. Intercepts (ICPT) OCA received a complete response letter from the FDA in late June noting that the agency remains uncertain that the benefits of the drug outweigh the risks. Viking (VKTX) is conducting the Phase IIb VOYAGE trial for VK2809 which is still ongoing. A bright spot in the space has been results from Akeros (AKRO) Phase IIb trial for efruxifermin in NASH which were announced June 30. The study found that 48% of patients had fibrosis improvement of at least one stage with a 62% response rate. Fibrosis improved by at least two stages for 28% of the group with a 38% response rate and 48% experienced NASH resolution without worsening of fibrosis across all dose groups.

LPCN 1148

Lipocine is preparing to develop its testosterone molecule to treat NASH cirrhosis patients. While the target market is smaller than that of pre-cirrhotic NASH, there are no other FDA approved products available. The inverse relationship between testosterone and sarcopenia and the increased risks of advancing NASH cirrhosis validates this pursuit. Pending funding, Lipocine plans to initiate a proof of concept trial to evaluate the potential of this candidate. The companys Investigational New Drug (IND) application was cleared by the FDA in May 2020. We anticipate Lipocine will launch the Phase II trial after the start of commercialization of Tlando and upon availability of sufficient capital to fund it. Management has guided to a 4Q:20 or 1Q:21 start.

Exhibit II Lipocine Pipeline4

Markman Hearing

On March 26th, Lipocine announced the outcome of the Markman Hearing, also known as a claim construction hearing. This meeting is an important precursor to a patent infringement lawsuit and provides the definitions of terms critical for a jurys determination on whether or not a patent has value. A patent should not be too specific, as it provides insufficient protection to an invention, or too broad, in which case a court may rule it indefinite. In the hearing order5, Judge Bryson did not agree with most of Clarus claims and sided with Lipocine on the majority of definitions and clarifications. While the terms and definitions are subject to an evolving construction, the order is favorable to Lipocines dispute against Clarus. While this order could be appealed again, it is unlikely in the opinion of Lipocines counsel. Lipocine and Clarus are currently engaged in the fact discovery phase of the lawsuit and the jury trial is anticipated to take place in February 2021. Lipocine need only prevail on one claim to merit damages, which places them in a strong position to succeed in the trial or provide incentive for Clarus to settle.

USPTO Decision Affirmed

The US Court of Appeals affirmed the decision of the USPTO in April 2020 to grant Lipocines Priority Motion in the interference case that cancelled Clarus claims to the 428 patent in January 2019. The USPTO, through its Patent Trial and Appeal Board (PTAB), had granted Lipocines priority motion in the related interference case and entered adverse judgment against Clarus. As we have previously shared, this outcome was expected as it is rare for a federal court to overturn a USPTO ruling. As a reminder, in 2Q:19 Lipocinefiled suitagainst Clarus alleging that Jatenzo infringed on six of Lipocines patents. The injunction filing may slow down commercialization of Jatenzo and force Clarus to come to the table to negotiate a settlement. While the cost of pursuing such legal action could be high, we anticipate by the time the case works its way through the courts, cash flow from Tlando could be sufficient to support the legal efforts.

Publications and Abstracts

Results from Lipocines Liver Fat Study were published in Hepatology Communications in an article entitled LPCN 1144 Resolves Non-Alcoholic Fatty Liver Disease In Hypogonadal Males." The study served to identify the prevalence of non-alcoholic fatty liver disease (NAFLD) in hypogonadal males and quantify the beneficial impact of LPCN 1144 on hypogonadism. 36 hypogonadal males were evaluated using MRI-PDFF measurements for liver fat. 81% of those with baseline liver fat equal to or greater than 5% showed improvement in liver fat content and NAFLD resolved in one-third of the group at six weeks and 48% after 16 weeks. The paper concluded that treatment with LPCN 1144 resolved NAFLD in about half of affected patients without any safety signals.

Lipocine submitted several abstracts to the American Urological Association (AUA) Virtual Experience, which took place from May 15 to 17, 2020. Three titles were presented.

Impact of a new oral testosterone undecanoate on blood pressure and cardiovascular risk was presented by Dr. Mohit Khera which investigated the chronic use of testosterone replacement therapy (TRT) on cardiovascular risk. Jatenzo, Xyosted and Tlando were assessed in their impact on blood pressure and cardiovascular risk in hypogonadal men. Marginal increases in blood pressure were observed and no meaningful impact on cardiovascular risk was noted.

A novel oral testosterone therapy restores testosterone to eugonadal levels without dose titration was presented by Dr. Martin Miner and highlights the shortcomings of dose titration when prescribing TRT. The abstract concluded that fixed dose Tlando normalizes testosterone levels in hypogonadal patients while avoiding the potential problems associated with titrated TRT.

Effects of a new oral testosterone undecanoate (TLANDO) therapy on liver was presented by Dr. Irwin Goldstein and compares oral methyltestosterone (MT) with TRT in males deficient in endogenous testosterone. The study results suggested that unlike MT, Tlando has no adverse effects on liver and can be used for an extended period to potentially reduce liver fat.

Milestones

Tlando CRL November 9, 2019

Tlando FDA post action meeting January 2020

Resubmission of Tlando NDA February 2020

Investigational New Drug (IND) clearance for LPCN 1148 May 2020

Wajda v. Patel shareholder suit dismissed July 2020

Tlando PDUFA date August 28, 2020

Primary endpoint results for LiFT (LPCN 1144) 4Q:20

Patent Infringement trial February 2021

Complete Phase II LiFT (LPCN 1144) 2Q:21

Summary

Since our previous update, Lipocine has participated in scientific conferences, published an article in the journal Hepatology Communications and advanced several months towards the upcoming August 28 PDUFA date for Tlando. Assuming a favorable outcome for the application, Lipocine will seek a commercialization partner and should receive upfront and milestone proceeds in conjunction with a deal. The Phase II LiFT trial continues to be a bright spot for the company and is potentially able to address a large unmet need in NASH patients in contrast to other programs which have met with difficulty. Management has guided towards a year-end readout of LiFT trial results. Lipocine is also developing LPCN 1148 for cirrhosis patients which was recently given clearance to begin a Phase II study. While we do not see this program entering the clinic until sufficient capital is available, we do think it will advance if Phase II data for LPCN 1144 are positive.

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________________________

1. Tlando was not approved by the FDA by May 31, 2018, and therefore Lipocine is required to maintain $5.0 million of cash collateral at Silicon Valley Bank (the lender) until such time as it is approved by the FDA.

2. NAS: NAFLD (Non-alcoholic fatty liver disease) Activity Score. Discussion of the metric can be found here.

3. Source: Lipocine Corporate Presentation May 2020.

4. Source: Lipocine Corporate Presentation July 2020.

5. A link to the Markman Hearing Order can be found on this page: https://ir.lipocine.com/presentations

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LPCN: Tlando: Target Action Date This Friday - Zacks Small Cap Research

VIRGINIA BEACH, Va. - A Virginia Beach Police officer was arrested Tuesday on multiple drug charges.

Earlier in the year, the Virginia Beach Police Department received information about one of its officers. This information led the department to start a criminal investigation and put the officer, 24-year-old Hugo Diaz-Rivera, on administrative assignment.

That investigation resulted in Diaz-Rivera to be charged with seven counts of possessing a schedule III substance without having a valid prescription.

According to the Drug Enforcement Administration (DEA), Schedule III drugs, substances or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples include products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids and testosterone.

Diaz-Rivera was immediately suspended without pay and is being held at the Virginia Beach Correctional Facility without bond.

He has been with VBPD since November 2018; he was assigned to the uniform patrol division. The Office of Internal Affairs will continue with the responsibility of conducting the appropriate internal administrative review.

This criminal investigation is being led by the DEA and is fully supported by the Virginia Beach Police Department. The criminal investigation is ongoing.

Stay with News 3 for updates.

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Virginia Beach Police officer arrested, charged with drug possession without having valid prescription - wtkr.com

On the nights when the mental sexual images of children were most overwhelming, Joseph Parker took cold showers and baths, hoping the shock of freezing water would push his intrusive thoughts away. Other times, he would fixate on a picture of the Sri Lankan Buddhist monk Henepola Gunaratana, so that the monk's "wrinkly face" might replace the disturbing imagery in his head.

Parker, who is using a pseudonym to protect his identity, had known he was attracted to children since he was 17, but he didn't start having overpowering sexual urges until he was 24. (He's now 26.) These urges were the worst when he was falling asleep. "As soon as I tried to release myself from wakefulness, my mind would sink into the pool of sexual energy, and I would feel this horrible sense of joy and happiness towards children, he said.

He read online about medications that could lower testosterone levels and, as a result, sex drivea process sometimes referred to as "chemical castration." When he asked a psychiatrist for these drugs, he was given Risperidone, an antipsychotic, instead. He took that for about a year, then added on Sertraline, an antidepressant, but only found these drugs mildly helpful. He turned to the internet to get what he had wanted in the first place.

From a Turkish division of the pharmaceutical company Bayers, he ordered cyproterone acetate, which lowers testosterone, along with the female hormone estradiol, and now takes the two medications together. The website that processes the sales is frequently shut down because of its illicit nature: "To my knowledge this is their third or fourth website change, at least, since I came upon them 14 months ago," he said.

Parker wishes it wasn't this hard for pedophiles to get sex-drive reducing medications. But for many pedophilesand especially pedophiles who have not committed crimesaccess to even talk therapy, let alone medication, can be difficult to come by, and the process is riddled with fears about being reported to legal authorities.

In the past several decades, researchers have arrived at new understandings about pedophilia, the sexual attraction to children. Pedophilia appears to be an in-born sexual preference, something a person does not choose and cannot change. A pedophile's attraction to children is consistentnot a phaseand they develop their attraction to children around the same time that other people develop sexual attractions.

While researchers' knowledge has been evolving, access to widespread, up-to-date healthcare hasn't kept up pace. Outside of the handful of researchers who provide therapy and medication to pedophiles, the barriers to finding an informed therapist or psychiatrist remain high. This has led to a hodgepodge of therapeutic approaches in the community, or people self-medicating, like Parker did. Many pedophiles are only directed towards treatment in the context of the criminal justice system, where in some states, chemical castration is used on sex offenders.

Yet importantly, researchers have established there's a distinction between pedophilia and child molestation, a difference between the attraction itself and the crime. Most people hear these words and think that they're synonyms. They're not, said James Cantor, a Canadian clinical psychologist and neuroscientist who studies pedophilia.

Only about half of child sex offenders are genuine pedophiles. The other half prefer adults sexually, and are abusing children because theyre available or easily manipulated. (Child porn offenders, on the other hand, are nearly always pedophiles because of the ready availability of adult porn alternatives.)

The goal of any modern, preventative treatment for pedophila should be to help people manage their sexual interests rather than try to change them, Cantor said. This can involve the voluntary use of hormone-reducing medication to control urges or therapy. Since pedophilia and sexual abuse are not synonymous, treatment for pedophilia is also not solely about preventing child sexual abuseits about helping people with their overall mental health and well-being too. Thats a concept that may be hard to accept. It involves recognizing that people who are sexually attracted to children deserve to live healthy and meaningful lives.

Online support groups for non-offending pedophiles have only recently entered the public eye. The most well-known group, the Virtuous Pedophiles, was formed in 2012 as a safe place for pedophiles to discuss their struggles and commitment to not offend. Parker belongs to the Virtuous Pedophiles and is known to the community as Double22. Another organization, the Association for Sexual Abuse Prevention (ASAP) was formed by some members of the Virtuous Pedophiles, and they are currently ramping up their goal to create a platform to connect pedophiles to mental health professionals.

"In my opinion, they should not be seen as second class patients.

In April of this year, the first randomized placebo-controlled study of a hormone-reducing drug for pedophilia took place in Sweden. Published in JAMA Psychiatry, it found that the drug reduced both high sexual desire and sexual attraction to children, and that the effects were noticeable within two weeks.

The study is the first to include people who self-identified as pedophiles and were seeking help of their own accord, not just people funneled from the criminal justice system. Whats even more remarkable about the study is that it included a placebo groupthe first pedophilia study to do so. In an editorial about the study, Peer Briken, a professor of sex research at the University Medical Centre Hamburg-Eppendorf in Germany, wrote that it marks a milestone in clinical sexual science and the field of forensic psychiatry.

I think one of the biggest problems is that people just don't understand this as a mental health issue, said Fred Berlin, an associate professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Rightfully, people are concerned about protecting children. And so we just quickly stigmatize people who are attracted to children and often don't even see them as human beings with a problem who might be deserving of help.

"In my opinion, they should not be seen as second class patients.

In 2014, journalist Luke Malone wrote an article about young people, some of them minors, who were discovering that they were attracted to children, and how they were coping with it. It was adapted as an episode of This American Life, one of several high-profile media pieces about pedophiles that explored the complicated existence of being born attracted to childrenand how hard it is to get help.

When Adam, one of the young pedophiles in Malones story, admitted to a therapist what was wrong, she just became extremely cold and harsh, he told Malone. She even, a few times, almost got to the level of shouting. She ended up telling Adams mother.

There is a huge reason [pedophiles] would avoid therapists and doctorsthose people have an obligation to report them to police if they think children might be in danger in the future, said Ethan Edwards, one of the co-founders of the Virtuous Pedophiles, who uses a pseudonym.Especially if they are not specifically trained in the issue, and with the common belief that all pedophiles molest children sooner or later, it is very perilous for a pedophile to seek out a therapist.

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Christoffer Rahm, a psychiatrist, researcher at the Karolinska Institute, and the senior author on the JAMA study from April, once worked at a clinic linked to a Swedish national helpline focused on sexuality, PrevenTell. Rahm ended up meeting some pedophiles who called in; one was a bus driver who brought children to school. The bus driver was struggling with his impulses and fantasies, but had not sexually offended in any way. Rahm looked for research to help determine the best treatment for his patient and found a gap in the literature: There were no rigorous comparisons of different medications, or recommendations about who might do best with therapy. (As far as we know, female pedophiles are rarer, and the research on treatment for them even more sparse.)

Cantor feels it's more than just a gap when it comes to pedophilia. It is a black hole, he said. This is a topic that scientists in the fields of mental health are not just uninterested init is actively repugnant."

Thats what motivated Rahm to conduct his study. If there are people seeking help for this, the best thing would be to manage it in a preventative phase before the damage is done, he said. Of course, society needs to say that any kind of abuse against a child is not okay. But it is counterproductive if these people can't even seek help with a professional.

The medication Rahm studied is Degarelix, approved by the FDA in 2006 for treatment of advanced prostate cancer. This is the first time that it's been used off-label for pedophilia. Its an injection that starts working right away and lasts for about three months. It works by shutting down signals from the brain to the body to produce testosterone.

In qualitative interviews Rahms team did during the study, they found that some of their participants experienced positive effects. They described feeling an inner calm, Rahm said. They felt less pressure, that they had a better intimate life with their partners. Some described that the annoying thoughts around children disappeared so they can focus on other things. And many described that they had lost that enervating impulse to masturbate, and were able to see children as just human beings and not sexual symbols. A majority of the participants in the group that got the active drug said that they would want to continue taking it.

Many of the therapies that have been used for pedophiles have not been validated this way, but deployed through forensic psychology and the criminal justice system. Though Berlin has prescribed hormone-reducing medications to countless patients, he feels that the legal system usually doesnt collaborate with doctors and scientists who are studying the use of these drugs. As a physician, I think that's completely inappropriate, he said.

If someone goes to prison being sexually attracted to children, theres nothing about prison that can get rid of that attraction, or enhance a persons ability to resist temptation later on, Berlin said. It also leads to a mistrust of treatment, because of a history of involuntary use of chemical castration and aversion therapya therapy that associates negative cues with images of young children to dissuade future attraction.

The idea that we can solve this simply through punishment and incarceration is very naive, Berlin said.

Talk therapy should focus on managing a person's sexual interests, with an explicit acknowledgment that those interests will likely never change. In the past, therapy sometimes focused on searching for trauma, because of the belief that a history of abuse led someone to abuse. The truth is a bit more complicated. Having been sexually abused in your own childhood could be a factor in committing sexual abuse as an adult, but is not necessarily a factor in pedophilia.

This is what Ive heard over and over, Cantor said. They knew. They always knew it. All their past therapists were telling them to focus on trauma, what happened in their childhood. But their genuine experience of it was that they were born this way.

We need to move on to the next generation of research and quality development.

Cantor said that once that basic framework of therapy changes from changing ones sexuality to managing it, people adapt very quickly. It makes more sense to his patients, and theyre able to better commit. If a person has looked at child porn or committed sexual abuse in the past, a therapist would help them examine how and why their self-control broke down, and how to set up their life so that it doesnt happen againnot how to stop being attracted to children.

For some people, this process could be paired with sex-drive reducing drugs. Some people find they would rather live in that state than with those nagging sex drive that they can't express and can do anything to do anything about, Cantor said.

Yet even in those states that have issued mandates for sex offenders to receive hormone-reducing drugs as punishment, it can be incredibly difficult for non-offending pedophiles who want it to get medication. I get letters from people around the country all the time wanting access and they can't even get access to it, Berlin said.

Rahm doesnt advocate for medication to be used for every pedophile for lifehis study explores whether this specific drug could help. He said a person may only want and need it for a few months. It could help a person through a difficult time, or be combined with the start of a behavioral therapy practice. We need to move on to the next generation of research and quality development, Rahm said. We need to evaluate our treatments and to get evidence-based treatments out there so we know what we're doing.

The word castration has a dark history, and dark connotations. It's often been wielded involuntarily: In Germany the number of involuntary castrations of sex offenders increased as a result of the Nazi German Act, with at least 2,800 sex offenders were castrated between 1934 and 1944. In the United States, Black men accused of raping or sexually assaulting white women could find themselves subject to castration. For reasons like these, Rahm is torn about calling Degarelix chemical castration." While he thinks researchers and clinicians should accurately describe what the drug is doing and its side effects, he worries that referring to it as castration could scare people away, or disregard the consent and autonomy of patients who want it.

Rahm said that every person who participated in their study did so voluntarily, and was informed in detail about any possible side effects from taking Degarelix. They had the option to quit the study at any moment. Hes also currently running another placebo-controlled study on a non-pharmacological option: therapy geared specifically towards pedophiles that they can access anonymously, through the dark web.

The mere existence of Rahm's studies is important, outside of the details of the findings. Doing placebo-controlled studies on pedophilia was previously thought to be impossible, because of the ethical implications of not giving an active treatment to a group of people attracted to children.

In Brikens editorial, he wrote that because the medication they used was fast-acting, and they allowed anyone with pedophilia into the studynot just those who were high-risk for offendingit helped make the placebo group ethically possible. Briken concluded that Rahm's study was the most important contribution to the field of pharmacotherapy of pedophilic disorders since the original study of hormone reducing drugs in 1998, and offers a starting point for a more comprehensive approach to pedophila treatment.

In Germany, Prevention Project Dunkelfeld, which offers therapy and medication, has 10 locations throughout Germany, and a person can get help while remaining completely anonymous.

The demand for their work is high: After a BBC documentary on the Dunkelfeld Institute aired, the Guardian reported that Dunkelfelds hotline was overwhelmed with calls from British pedophiles. One British man was so desperate, he moved to Germany to be able to access a Dunkelfeld programme, the Guardian wrote. In an email exchange with the Guardian, the man, who wished to remain anonymous, wrote: 'So far, all I have ever received from the NHS is doors slammed in my face.'"

There's not as well-known a center for pedophiles in the U.S. to go to. Richard Kramer, the educational director at B4U-ACT, an online community for pedophiles, said he figured out he was attracted to pubescent boys in his 20s. (His attraction is to boys around the age of 12 or 13, which is technically called hebephilia.) I was very ashamed about it and thought that I was seriously defective as a human being, Kramer said, who is using a pseudonym. I really wasn't able to find any information about it. I didn't want to go to the library for fear that people would see what I'm looking up.

When he began reading information online, he said, everything he encountered was very negative. It said that I would be a monster, I would have hundreds of victims, and that my entire life would be centered around an elaborate plot to deceive parents and to manipulate children into abusing them, he said. So I thought, well, this is what they think about me. I have no interest in seeing them and seeing a therapist.

A big part of being successful in therapy is having the support of family and friends, something that pedophiles can lack. They often are going through difficult treatments alone, and are unable to talk about it to others. You cant tell co-workers, or ask a boss for time off for your appointments. You have two choices, said Michael Seto, a forensic psychologist and sexologist at the University of Toronto. You don't do it or you lie about it.

When Kramer was ready to look for a therapist again, he didnt really care what kind of approach they used, but was more concerned about whether they understood enough about pedophiles to not treat him like a criminal. His goals didn't involve a struggle to control his impulses, but to manage the shame and sense of isolation from others because he couldnt be honest.

We have to insist that people who have this orientation not act upon it, Berlin said. If we think about that, that can be quite a burden. Its not surprising that some of these folks might be in need of mental health assistance, because of the effect of experiencing these attractions on their sense of self-esteem and self-worth.

Happy, mentally healthy people do not molest children.

Some pedophiles are attracted to adults and children; some, only children. For those who are exclusively attracted to children and dedicated to non-offending, Kramer said, there needs to be a space for helping them grieve over not being able to have romantic and sexual relationships. How do they deal with loneliness? he said. There are other concerns, some almost mundane: How, for instance, do they deal with answering questions friends and co-workers ask about their personal lives? Hes had friends who asked him if he was gay, and he said he wasnt sure how to answer.

I'm not exactly gay, but I'm definitely not straight and I'm definitely not asexual, he said. How do you respond to that?

Gary Gibson founded the ASAP as one potential solution to this problem. Through an involvement with the Association for the Treatment of Sexual Abusers (ATSA), Gibson has been curating a list of therapists to whom he can refer pedophiles. The list is now around 400 names long. ASAP primarily focuses on non-offending pedophiles, but they will also help people who have offended and want to stop. People are just desperate out there, Gibson said.

He has worked with pedophiles who were so desperate for help that they underwent physical castrations. One man traveled to Mexico to have the operation done; when he returned, he tried to find a doctor to supervise his recovery and medications. I could not find a doctor who would take him on, Gibson said. They didn't want him in the office. I did find a therapist to work with him, and I kind of lost contact with him. Im worried about what happened to him.

Until recently ASAP has been handled almost entirely by Gibson, but ASAP is currently undergoing a significant expansion. It has increased its office and volunteer staff, is making a new, online database of mental healthcare providers, and creating a 24/7 helpline. Gibson said his dream is to get a multimillion dollar grant to create a mentor program for teenagers, aged 13 to 17, who are learning that theyre pedophiles. Ive applied three times, he said. Maybe the third time's the charm, because Ive been denied twice.

The goal is to help every non-offending person attracted to children find therapy if they want or need it, said Robert Hillman, a lifelong virtuous (non-offending) pedophile, and the new president of ASAP. Hillman said that the mantra is: All pedophiles are born non-offending, and the aim is to help keep it that way. Happy, mentally healthy people do not molest children," he said.

People do the most desperate things when they feel the most desperate, Cantor said. A lot of what these groups and therapy provide is helping people lead a life that is worth protecting. When they have a life worth protecting, thats when people get the energy and the willpower to control themselves, because they dont want to risk the life that they have.

What Hillman and Gibson want is the opportunity for any person attracted to children to chart their own path, and figure out what works best for them. That may include an experimentation with medication, and it may not. ASAP doesnt control their therapiststhey all operate independently, using different methods of treatment. They're not always successful. One guy has committed suicide that I know of, Gibson said said. But I think that we have probably saved a few lives and saved many children from being abused.

These support groups and therapy networks are providing a lifeline, but alone, they don't guarantee a consistency in treatment, nor fill the gaps in the scientific literature when it comes to which treatments might be best for a certain person. There might be certain hormone-reducing medications that are less risky or work better than others; certain pedophiles that fare better without drugs; certain therapeutic practices that are more helpful than others. Those answers aren't clear-cut.

As with all medications, some people have good experiences and others do not. Pedophiles can identify as ego-dystonic or ego-syntonic. Ego-syntonic people consider pedophilia as part of their identity, and can be okay with fantasizing and masturbating about children (though not with porn), while ego-dystonic people are not. It may be that treatment should be different with those who have different attitudes towards their attraction, even if members of both groups have the same commitment to not offend.

After about five weeks, Parker said that he felt better from the medication he had ordered online. It was night and day," he said. "I can't tell you what a weight was lifted off of me, or a pressure from under me that was relieved. Whenever I think about it I just lay back in my chair and breathe a contented sigh, knowing that I won't suffer like that again. Both physical urges in my body and intrusive imagery in my mind have disappeared."

He doesnt think that medication should be thought of only as a stop-gap to a person committing sexual abuse. Offending was never a danger for me in the first place, he said. He doesnt take the medication to stop himself from molesting a child, but as a way to improve his quality of life.

When Max Weber, who helps run a peer-support website for pedophiles in Germany, realized his attraction to young girls in his early 20s, he said, he was terrified. My picture of pedophilia at the time was the same wrong impression most parts of society have: that pedophiles were bound to offend, he said.

Weber got treatment at Dunkelfeld, and said he views medication like a pair of eyeglasses. You can put [them] on to help yourself focus on things that you want to change about your life.

To Weber, pedophilia was like being surrounded by deep water; he had to struggle to stand on his toes to avoid drowning. I needed all my strength to cope with it and dont drown in my own fears and self-hate, he said. As a result sexual impulses felt very powerful since, when you are standing on your toes, even the slightest push could throw you over.

He took medication for about nine months. During that time when his sexual feelings were repressed, he regained a foothold on his life, he said, and found that even without medication he is able to be around children without issue. I now know that I am in charge, and no one can make me offend other than myself, he said.

Two years ago, David, a 22 -year-old recent college graduate from New York and a volunteer for a peer-support group including pedophiles, desperately wanted to take hormone-altering medication. I hated myself for having feelings about children, and I just wanted to be like everyone else," he said. "I was also going online and finding articles about how to raise libido, and doing the opposite of all of the advice I found. But I couldnt find a therapist I felt safe coming out to.

Since then, he said that support groups like Virtuous Pedophiles have helped him realize that being attracted to children is not something he chose, and hes not tempted towards any illegal behaviors. In the end, there was no need for me to go through such a treatment with dangerous side effects," he said.

Though he never ended up trying medication, David thinks his experience with peer support reveals something important. Medications can help reduce physical symptoms, he said, but the restthe support, the isolation, the shameall needs to be addressed outside of just taking a pill.

I struggled with serious depression, anxiety, and self-hatred as a teenager starting to understand that I was a pedophile, David said. Becoming less isolated, having people to help when I was hurting, and being able to help others in the same way is what brought me back from that.

Hillman was a patient of Berlins about 25 years ago. I was on the brink of madness from the desires and from the shame and self-hatred and loathing, he said. "It was crushing me and I was not going to survive it. He took hormone-reducing medication with Berlin's help, and said that combined with therapy, it saved his life. Since I was at that time and have always been non-offending, my anti-androgen therapy was not mandatory in any way and thus I started and stopped it several times, because of the affordability issues, Hillman said. But I can attest that the medication did reduce my thoughts and therefore some of my distress.

Then he found the Virtuous Pedophiles group about one year ago, and the support hes culled from the others there has given him a new gusto for life, without medication. Now I am dedicated to living. And I am dedicated to making sure no one else has to waste their life just to be virtuous, he said.

Hillman said that these narratives reveal how all pedophiles are different. Some will benefit from meds and some will not, he said. Some are against medication, some are not.

Rahm hopes to continue studying treatment options for pedophilia, in a rigorous way. In his view of a forthcoming modern pedophile treatment, each person would get an individual assessment and be offered an evidence-based treatment. It would work with helping a pedophile address both their personal feelings and concerns, and also their risk of offending.

In my vision, some people need therapy, some need medication, some need both, and some won't have any effect on any of these. They need something else, Rahm said. This is nothing novel or groundbreaking, he added. I would just like to apply modern psychiatric thinking to this group.

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Paedophilia Is a Mental Health Issue. It's Still Not Treated as One - VICE

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Global Testosterone Replacement Therapy Market is Expected to reach CAGR of XX.XX% During 2020-2024 - Bulletin Line

The 2020 NBA playoff bubble games have been quite an interesting spectacle to witness. With several upsets, multiple 30+ point blowouts, and plenty of intensity, things are getting pretty heated between teams in Orlando.

Kendrick Perkins recently proposed a solution on Twitter, jokingly citing a lack of testosterone as the problem.

Obviously its tough for players to be without their families for so long, and not having women to comfort and fulfill their needs has been a regular topic regarding the restart. In the comment section, multiple players seemed in agreeance with the Fox Sports analyst.

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