Psychiatry Research 110 (2002) 239247

0165-1781/02/$ - see front matter 2002 Elsevier Science Ireland Ltd. All rights reserved.
PII: S0165- 1781

02
.
00109- 9
Testosterone, sexuality and antisocial personality in rapists and
child molesters: a pilot study
Anu S. Aromaki *, Ralf E. Lindman , C.J. Peter Eriksson
a, a b

Department of Psychology, Abo Akademi University, FIN-20500 Turku, Finland

a

Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
b
Received 20 November 2000; received in revised form 15 January 2002; accepted 20 April 2002
Abstract
Morning and afternoon levels of saliva testosterone levels in Finnish imprisoned rapists (ns10) and child molesters
(ns10) were compared to those in randomly selected control subjects (ns31). The associations of saliva testosterone
with sexual behavior and antisocial personality traits were explored in all groups. The sexual offenders and control
subjects did not differ in the between-subjects main effect estimated for the averaged morning and afternoon
testosterone levels. Seven rapists and three child molesters met the criteria for antisocial personality disorder (ASP).
In the sexual offenders, a summed ASP index was positively correlated with mean saliva testosterone. Sexual activity
as estimated from self-reports of sexual intercourse and masturbation was significantly related to testosterone in both
rapists and child molesters but not in the control males. The implications of these results are discussed. 2002
Elsevier Science Ireland Ltd. All rights reserved.
Keywords: Sexuality; Sexual offence; Saliva testosterone; Antisocial personality; Aggression
1. Introduction
Many facets of human sexuality seem to be
linked to testosterone, such as sexual arousal,
sexual intercourse (Cooper and Swamy, 1994),
and sexual fantasies (Bancroft and Wu, 1983).
Sexual interest and ejaculation also seem to be
androgen-related (Salmimies et al., 1982) as are
spontaneous erections (Kwan et al., 1983; Carani
et al., 1996). Their dependence on testosterone has
*Corresponding author. Tel.: q358-2-2154-406; fax: q358-
2-2154-833.
E-mail address: anu aromaki@hotmail.com
(A.S. Aromaki).
been affirmed by studies of hypogonadal males
whose diminished sexual desire or behavior can
be restored with testosterone treatment. Whether
these aspects of sexuality are related to testosterone
in males whose hormones fall within the normal
range of variability has not been clearly estab-
lished. The literature on testosterone and self-
reported sexual activity shows inconsistent results
in normal men, with correlations ranging from
none to weak (e.g. Brown et al., 1978; Raboch
and Starka, 1972, 1973; Persky et al., 1978; Rubin
et al., 1979; Schiavi et al., 1997). Even negative
correlations have been reported (Kraemer et al.,
1976; Schiavi et al., 1991).
240 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
Testosterone has also been linked to male
aggression. Several studies have found positive
correlations between testosterone and history of
violent behavior (e.g. Kreuz and Rose, 1972;
Ehrenkranz et al., 1974; Virkkunen et al., 1994).
Although effect sizes have not been impressive,
correlations have generally exceeded chance levels
(Archer 1991, 1994). Higher testosterone levels
have also been linked to antisocial personality
disorder (ASP) (Dabbs and Morris, 1990; Aromaki
et al., 1999).
The correlations found, on the one hand,
between testosterone and aggressive behaviors, and
then again between testosterone and sexual desire,
make it particularly relevant to investigate testos-
terone levels in sexual offenders. The available
hormone data on sexual offenders are inconclusive
with regard to differences in mean basal levels.
Although Rada et al. (1976) found that plasma
testosterone levels did not significantly differ
between rapists, child molesters and controls, a
violent group of rapists had the highest levels of
testosterone compared to the other groups. In
another study (Rada et al., 1983), the same results
were obtained with the exception that this time the
highest mean levels of testosterone were observed
in a group of violent child molesters, although the
outcome was not statistically significant. One com-
parative study of pedophiles and nonviolent non-
sexual offenders indicated lower testosterone levels
in child molesters (Bain et al., 1988). In a recent
study (Dabbs et al., 1995b) high testosterone was
found to be associated with crimes of sex and
violence, so that the highest risk-ratios for high-
testosterone men were observed for rape, child
molestation, and homicide, in that order. Since few
studies of testosterone have included both rapists
and child molesters, we wanted to examine: (1)
the mean levels of salivary testosterone in samples
of Finnish rapists and child molesters (expecting
the testosterone levels to be higher for rapists than
for other groups); (2) the relationship of testoster-
one levels to antisocial behaviors (expecting a
positive correlation); and (3) the relationship of
antisocial personality to the likelihood to commit
sexual offenses (expecting more antisocial behav-
iors among sexual offenders). Exploratory analyses
were aimed at clarifying the relationship between
testosterone levels and self-reported sexual activity.
2. Method
2.1. Participants
Three groups of men were studied. A group of
incarcerated sexual offenders consisting of two
subgroups: a group of rapists (ns10) and a group
of child molesters (ns10) were compared to a
group of control males (ns31) who were recruited
from the streets, shopping malls, cafes, or places
of work. Among 42 men who were approached,
31 agreed to participate. For the present study, all
incarcerated sexual offenders in Finland (1998)
were identified from prison documents. Offenders
who had raped an adult woman or molested a
child were invited to take part in the study. When
the study was started in 1998, there were 65
incarcerated sex offenders in the country. Of these,
20 prisoners volunteered as participants. The most
common reasons for refusal were claimed inno-
cence (31%), fear of condemnation or retaliation
from other prisoners (23%), and previous experi-
ences of DNA or psychological examinations
which made them reluctant to undergo more bio-
logical testing (11%). The remaining refusals were
for diverse unclassified reasons. The prisoners
were Finnish, except for one rapist subject who
was of foreign ethnic origin.
2.1.1. Mental health and medication
A comprehensive survey showed that 56% of
all Finnish prisoners reported some psychiatric
symptoms, mostly insomnia, anxiety and depres-
sion (Joukamaa, 1991). In the age group repre-
sented by our subjects (3039 years), anxiety
(56%) and depression (51%) were the most fre-
quent symptoms. Medication among the present
sexual criminals was consistent with national
symptom prevalence in that use of antidepressants
or neuroleptics was reported by 10 of our 20
prisoners (Table 1).
2.1.2. Ethical considerations
The study was planned to provide minimal
interference in the participants daily life. Formal
241 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
Table 1
Mental and physical health: medication by symptoms
Medication Prisoners Controls
Psychosis
Neuroleptics 4
Depression
Selective serotonin uptake inhibitors 3
Tricyclic antidepressants 2
Anxiety
Bentsodiatsepine derivates 1
Buspirone 1
Mania
Lithium 1
Hypertension 1
Angina pectoris 2
Allergy 2
Diabetes 1 1
Hypertestosteronemia 1
Inflammation 1
Gout 1
Hypothyreosis 1
permission to study sex offenders was granted by
the Ministry of Justice in Finland. Every subject
was personally instructed to read a form which
specified his duties before he gave his formal
consent. All data were kept confidential.
2.2. Procedure
2.2.1. Demographics
All participants completed a self-administered
questionnaire which included questions about their
sociodemographic background, marital status, level
of education, length of incarceration, and family
background. Questionnaire data could not be
obtained from one rapist and one child molester.
These prisoners were either illiterate or unable to
comprehend the questions because of foreign
nationality.
2.2.2. Sexual behavior
A modified version of the Derogatis Sexual
Functioning Inventory (Derogatis and Melisaratos,
1979) was administered to assess sexual arousal
on a number of variables believed to be related to
testosterone: masturbation, intercourse, sexual fan-
tasies, kissing, and petting. These were scored in
terms of their frequency of occurrence. In order to
optimize the validity of the subjects answers, we
summed the occurrence of masturbation and sexual
intercourse for the statistical analysis of sexual
activity. Men could be tempted to overreport
orgasms during intercourse and underreport ones
during masturbation (Mantzoros et al., 1995). In
addition, the subjects were asked about their sexual
orientation and the number of lifetime sexual
partners.
2.2.3. Personality
Antisocial personality (ASP), impulsivity and
aggressivity were diagnosed by a modified version
of the Structured Interview for DSM-IV Personal-
ity (Pfohl et al., 1997). An index allowing quan-
titative analysis of ASP was obtained as the
unweighted sum of reported childhood conduct
problems and adult antisocial behaviors. This index
ranged from zero to 22 diagnostic symptoms.
Independent diagnoses were obtained from three
psychologists with extensive professional experi-
ence of clinical testing (one employed by prison
authorities, one by the prison mental hospital) who
were given access to the questionnaire data. The
raters diagnostic consistency was estimated by
Spearmans rho correlations, which indicated
excellent congruity (mean rhos0.96; range 0.94
0.97; P-0.001).
2.2.4. Biochemical data
Testosterone was assessed from two saliva sam-
ples. These were taken at approximately 09:00 and
15:00 h. Saliva was preferred to blood sampling
for several reasons. Sample collection is noninva-
sive and easily administered. Up to 78% of salivary
testosterone is in a biologically active form, but
only 14% is in serum (Sannikka et al., 1983;
Khan-Dawood et al., 1984; Vittek et al., 1985).
Moreover, since salivary and plasma levels of
testosterone are significantly intercorrelated
(Khan-Dawood et al., 1984), salivary levels pro-
vide a reliable indication of the level of testoster-
one in serum (Sannikka et al., 1983).
The control subjects were told to abstain from
alcohol for at least 24 h prior to saliva sampling.
They were given written instructions on how to
collect the saliva sample. In the prison environ-
242 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
ment, a nurse instructed the subjects and ensured
that the proper procedure was followed. All sub-
jects were instructed not to brush their teeth, and
not to eat or drink anything for an hour before the
sampling procedure. The oral cavity was flushed
with water before collecting whole saliva. The
subjects were told to let the saliva flow at its
natural pace and to spit it into a sterile disposable
polypropylene centrifuge tube of 15 ml in volume.
The tubes were locally stored in a freezer, trans-
ported in dry ice until centrifuged and stored at
y80 8C until analyzed. Steroid analyses were
carried out at the National Public Health Institute,
Helsinki, Finland.
2.2.5. Hormonal determinations
Saliva testosterone concentrations were deter-
mined by the radioimmunoassay (RIA) technique,
using kits produced by Orion Diagnostica, Turku,
Finland. Within-assay and between-assay variabil-
ity was less than 10%. Our control saliva values
are very comparable to the normal levels reported
in a multicenter evaluation (Dabbs et al., 1995a).
2.3. Analyses
2.3.1. Statistical methods
Power analysis by the nQuery Advisor (Elash-
off, 2000) was employed prior to statistical anal-
ysis. A priori tests at aF0.05 indicated that
one-way analysis of variance would have 85%
power to detect a difference in means correspond-
ing to an effect size of 0.25, given the estimated
variability data. The SPSS 9.0 program was used
in the statistical analyses. For testosterone, post-
hoc power computed by SPSS (40%) deviated
from the nQuery estimates due to smaller-than-
assumed differences between the observed means.
Results reported for post-hoc comparisons as sig-
nificant refer to aF0.05 by Scheffe.
3. Results
3.1. Demographics
Apart from the fact that the child molesters were
significantly older than either rapists or controls
(F(2,48)s11.71, P-0.001), there were few dif-
ferences in demographics between the sexual
offenders and the control group (Table 2). The
effects of the age differences were controlled by
ANCOVA when appropriate. The associations
between testosterone and demographics were
explored by Pearson or Spearman correlations in
the pooled population. No significant effects were
found, although correlations in the predicted direc-
tion were found for age at first intercourse (rs
y0.22, ns) and present subject age (rsy0.25,
ns). Among sexual offenders alone, correlations
were somewhat higher, although still non-signifi-
cant: for present age (rsy0.37, ns) and age at
first intercourse (rsy0.38, ns.). Only among the
child molesters was a significant correlation found
between present age and testosterone (rsy0.72;
P-0.05).
3.2. Personality measures
3.2.1. Antisocial personality disorder
Seven rapists and three child molesters met the
criteria for ASP while none of the control subjects
did. In order to increase the robustness of the
analyses, group differences in symptom prevalence
were investigated by ANOVA on ranks rather than
parametric ANOVA. Significant differences were
found between the groups (x s19.77, d.f.s2,
2
P-0.001) indicating that the rapists exhibited
significantly more ASP symptoms than either child
molesters or control subjects, and child molesters
more symptoms than the controls.
3.3. Testosterone
3.3.1. Sexual offenders vs. controls
Traces of hemolysis were found in 32% of the
saliva samples. These were, however, too small to
affect hormone assays. Hormone concentrations
for the testosterone standard curve ranged from
0.11 to 2.20 nmolyl in the morning and 0.12 to
0.93 nmolyl in the afternoon. Repeated-measures
analysis was applied to control the effects of
circadian variation on saliva testosterone levels in
the three subject groups. Rapists, child molesters,
and controls formed the levels of the between-
243 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
Table 2
Demographics, history of incarceration, self-reported sexual characteristics, testosterone levels
Variable Rapists (Ns10) Child molesters (Ns10) Controls (Ns31) P
Age (years)
a
33.0"4.9 46.6"11.6 32.6"9.7 0.000
Range 2745 3171 2261
Marital status (N)
Single 5 3 8
Marriedycohabiting 2 2 22
Divorced 3 5 1
Sexual orientation (N)
Heterosexual 9 6 30
Homosexual 2
Bisexual 1 1 1
Number of lifetime sex partners (N)
-10 3 3 11
1150 2 4 12
51100 1 2 4
)100 4 1 1
First intercourse
Age
b
13.7"2.5 17.0"3.7 16.3"2.3 0.031
Range 1018 1325 1321
Saliva testosterone levels (nmolyl)
Morning 0.63"0.58 0.34"0.17 0.44"0.21 0.118
Afternoon 0.35"0.25 0.27"0.09 0.26"0.10 0.280
Pooled 0.49"0.41 0.30"0.13 0.35"0.13 0.141
Incarceration
Times sentenced 2.8"1.9 3.3"3.3 0.664
Range 16 111
Sentence duration (months) 71.1"71.0 55.4"52.8 0.590
Range 24240 1180
Note: values are means"S.D.
Child molesters older than rapists and controls.
a
Rapists younger than child molesters at reported first intercourse.
b
subjects independent variable while morning and
afternoon hormone concentrations were entered as
a within-subjects factor. Marked circadian declines
emerged in all groups (F(1,45)s22.19, P-0.001)
with no significant interactions. Morning and after-
noon testosterone levels were highly correlated
(rs0.76, P-0.001). Contrary to our predictions,
the between-subjects main effect estimated for the
averaged morning and afternoon testosterone levels
did not reach statistical significance (F(2,45)s
2.05, Ps0.14). Although statistically nonsignifi-
cant when examined separately, all group
differences were in the hypothesized direction.
Thus, the rapist prisoners had higher levels of
mean testosterone (Ms0.49 nmolyl
w
S.D.s0.41
x
)
compared to both the subjects in the control group
(Ms0.35 nmolyl
w
S.D.s0.13
x
; PF0.09), and the
child molesters, who had the lowest levels (Ms
0.30 nmolyl
w
S.D.s0.13
x
; PF0.07).
3.3.2. Antisocial behaviors
Regression analysis was applied to investigate
the relationship between antisocial personality and
testosterone levels. In the sexual offenders, the
ASP index was significantly related to mean saliva
testosterone (rs0.52, P-0.05). A positive corre-
lation was also found in the control subjects which
did not reach statistical significance (rs0.36, Ps
0.075). Plots showing the ASP index as a function
of mean testosterone level are presented in Fig. 1.
244 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
Fig. 1. Sum of reported antisocial behaviors as a function of mean saliva testosterone levels in sexual offenders and controls.
Fig. 2. Frequency of reported sexual activity as a function of mean saliva testosterone levels in sexual offenders and controls.
3.3.3. Sexual behavior
Mean testosterone levels in the control subjects
were uncorrelated with sexual activity as repre-
sented by the combined frequencies of sexual
intercourse and masturbation (rs0.08; Ps0.72;
Fig. 2). Among the sex offenders, however, these
variables appeared to be curvilinearly related in
both rapists and child molesters. Cubic functions
fitted to the data in each group yielded excellent
goodness-of-fit among rapists (R s0.96; F(3,5)s
2
42.79, P-0.01) as well as among child molesters
(R s0.91; F(3,7)s22.67, P-0.01). Given the
2
small number of observations, it is unclear whether
the data on the descending limb represent a valid
245 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
trend or should be regarded as outliers from a
linear trend. Whether the cubic function from a
formal point of view represented a significant
improvement over the linear function was tested
by F-test of change in goodness-of-fit. This
showed a significant advantage for the curvilinear
function over the linear function for the rapists but
not for the child molesters. When the analysis was
repeated using the pooled data from rapists and
child molesters, significant support for the curvi-
linear model over the linear model was found
(F(2,15)s16.67, P-0.001). Among the sex
offenders, no significant relationships were found
between testosterone measures and sexual fanta-
sies, kissing and petting or the lifetime number of
sexual partners.
4. Discussion
Our results revealed no significant differences
in the testosterone levels of rapists and child
molesters and none between either of these and
the controls. This is consistent with Rada et al.
(1976, 1983) who also found no statistically sig-
nificant differences between sex offenders and
normal men when violent tendencies were disre-
garded. The lack of statistical power to detect
weak relationships that follows from small samples
has contributed to the uncertainty about the role
of testosterone in aggressive behaviors generally,
and the exploration of differences in testosterone
levels across different kinds of crime has been
especially impeded since crimes of a particular
type may be committed by few individuals (Dabbs
et al., 1995a,b). Despite the fact that our findings
revealed only marginal differences, those that were
found indicated that the rapists had higher testos-
terone just as predicted. Therefore it seems prudent
to conclude that testosterone cannot be ruled out
as a factor involved in sexually aggressive
behaviors.
The present data show a positive association
between testosterone levels and the quantified ASP
index in the sexual offenders. This is very similar
to our earlier findings for male prisoners convicted
of violent nonsexual crimes (Aromaki et al., 1999)
and consistent with observations by Dabbs and
Morris (1990), who found that testosterone corre-
lated with a variety of antisocial behaviors. Our
finding that the overwhelming majority of the
rapists exhibited many of the symptoms associated
with ASP corresponds to the results reported by
Serin et al. (1994) indicating that ASP has a
strong association with sexual aggression.
The absence of a significant relationship in our
control males between salivary testosterone and
sexual activity is consistent with previous reports
based on men whose testosterone levels fall within
the normal range (e.g. Pirke et al., 1974; Persky
et al., 1978; Buena et al., 1993; Schiavi et al.,
1997). A novel and intriguing finding was that
sexual activity in the sexual offenders seemed best
described as an inverted U-shaped function of
testosterone rather than as a linear function as we
had expected. Earlier studies do not provide clear
guidance as to whether these trends should be
regarded as linear or nonlinear since they have not
plotted activity as a function of hormone levels
and seem to have assumed rather than tested
linearity. Given the small number of data points,
we cannot with any certainty rule out either the
curvilinear or the linear model, but further research
into the relationship of testosterone and sexual
activity in sexually atypical individuals is clearly
called for. While self-reports represent the only
accessible source of information on sexual activity,
their accuracy can only be assumed. As an indi-
cator of sexual activity, the stated number of
lifetime sexual partners should be regarded with
particular caution since mens self-reports have
been shown to be based on rough (often exagger-
ated) approximations rather than accurate counts
(Brown and Sinclair, 1999).
The eventuality was considered that testosterone
levels may have been modified in some subjects
by medication. A thorough literature search on the
drugs used by our subjects (Table 1) indicated that
the effects on testosterone were negligible for the
antidepressants and for the neuroleptics either
inconsistent or minimally testosterone-decreasing.
One rapist reported using androcur, a drug that
significantly lowers testosterone production. His
measured testosterone concentration coincided
with the group mean, suggesting that hormone
levels were most likely higher before imprison-
ment, as predicted. There are significant limitations
246 A.S. Aromaki et al. / Psychiatry Research 110 (2002) 239247
to the generalizability of the present results, most
importantly related to the small number of subjects.
The problems associated with self-selection of
subjects are complicated (Rosenthal and Rosnow,
1975) and especially so in the case of rapists who
typically deny the rape for which they have been
convicted and do not accept their sentence (Groth,
1979; Scully, 1988). Although all imprisoned sex-
ual offenders in Finland were offered participation
in the present study, and the subject sample in that
sense was representative, more than a third of
those prisoners refused to participate, claiming
innocence.
5. Conclusions
Antisocial behaviors are present in both rapists
and child molesters and are positively related to
salivary testosterone concentrations. Testosterone
levels may covary with sexual activity in sexual
offenders to a greater extent than in normal men.
Acknowledgments
The authors are indebted to Dr Ullamari Pesonen
at the Department of Pharmacology and Clinical
Pharmacology, University of Turku, for advice on
the effects of medication on hormone levels. The
first author was financially supported by the Finn-
ish Graduate School of Psychology and Ella and
Georg Ehrnrooths Foundation. The second author
was supported by the Research Council for Culture
and Society, Academy of Finland (34145y95).
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