Validation of 'the change or stop testosterone lowering medication (COSTLow)-scale' using delphi method among clinical experts.

Guidelines for pharmacological treatment of patients with paraphilic disorders have been developed by a working group of the World Federation of Societies of Biological Psychiatry (Thibaut et al. 2010 ). With an increasing duration of experience and number of treated patients as well as aging patients, change of or withdrawal from testosterone lowering medications (TLM) has become an important issue. The current study aimed to assess the quality of a structured professional judgement procedure that helps switching or discontinuing especially TLM in patients with paraphilic disorders. We used Delphi method to estimate the quality of ten factors originally proposed by the authors. A total of 30 experts participated in the first stage; 18 experts participated in the second stage. The experts' assessment resulted in an instrument of 15 factors that can be used to structure the process of changing or discontinuing TLM. These factors can be grouped into five broader categories: Age and duration of treatment; therapeutic alliance; psychopathology and risk factors; motivation; compliance; and level of control. The developed scale provides an instrument that can be used to structure the process of changing or discontinuing TLM in patients with severe paraphilic disorders.