Changing or stopping testosterone-lowering medication in men convicted of sexual offenses: clinical evaluation of the COSTLow-R scale.

This article focuses on the evaluation of the Change or Stop Testosterone-Lowering Medication Scale-Revised (COSTLow-R Scale), a tool designed to assist forensic professionals in deciding whether to change or discontinue testosterone-lowering medication (TLM) in men convicted of sexual offenses (MCSO). The retrospective study conducted in a forensic-psychiatric outpatient institution in Hesse, Germany, analyzed 72 MCSO patients, finding that decisions to stop TLM were significantly associated with higher patient compliance for monitoring side effects, prior psychotherapeutic treatment, and a trustful therapeutic alliance before starting TLM. Forensic professionals regarded the COSTLow-R Scale as a helpful, structured instrument that supports clinical decision-making, although they emphasized the importance of multidisciplinary reflection over sole reliance on total scores. Despite limitations such as a small sample size, the study suggests the COSTLow-R Scale has practical utility in forensic outpatient settings and warrants further research and refinement.