A unique case of iatrogenic hebephiliac behavior emerging late in life in a patient with Gordon Holmes Syndrome

Background: Pedophilic or hebephiliac behavior is defined iatrogenic when emerging for the first time as a side effect of medications. To date, pedophilic or hebephiliac behavior emerging after testosterone replacement therapy (TRT) has never been described. Case presentation: a patient diagnosed with Gordon-Holmes syndrome (GHS), a genetic condition characterized by cerebellar ataxia and hypogonadotropic hypogonadism (HH), at the age of 55 developed hebephiliac attitudes after starting TRT. A multidisciplinary approach integrating psychiatric evaluation, general (IQ) and specific (social cognition) neuropsychological assessment, and structural brain MRI was important to characterize the patient’s clinical and functional profile. Discussion: We discuss how the co-occurrence of HH, requiring hormone replacement therapy, combined with the patient’s borderline IQ explains the sexual offenses against pre-adolescents in light of the Insufficient but Non- Redundant Parts of Unnecessary but Sufficient Conditions (INUS) model of causation. In other words, both the administration of TRT and the borderline IQ are configured as INUS causes for understanding the illegal behavior.