Background: Little attention has been given to efficacious treatment and adherence to treatment of compulsive sexual behavior (CSB). Aims: Randomized controlled trial investigated short-term psychodynamic group therapy followed by relapse prevention group (STPGP-RPGT) and pharmacological treatment (PT) for CSB men on sexual compulsivity and adherence. Method: 135 men, 38 (SD 5 9) years old on average, were randomly assigned to 1) STPGP-RPGT; 2) PT; 3) Both. Participants completed measures at baseline, 25th, and 34th week. 57 (42.2%) participants dropped out between baseline and 25th week, and 68 (50.4%) between baseline and 34th week. 94 (69.6%) did not adhere (80% pills taken or attended 75% therapy sessions). Results: A significant interaction effect was found between time and group (F (4, 128) 5 2.62, P 5 0.038, ES 5 0.08), showing who received PT improved less in sexual compulsivity than those who received STPGP-RPGT (t 5 2.41; P 5 0.038; ES 5 0.60) and PT ţ STPGP-RPGT (t 5 3.15; P 5 0.007, ES 5 0.74). Adherent participants improved more in sexual compulsivity than non-adherent at the 25th week (t 5 2.82; P 5 0.006, ES 5 0.65) and 34th week (t 5 2.26; P 5 0.027, ES 5 0.55), but there was no interaction effect, F (2, 130) 5 2.88; P 5 0.06; ES 5 0.04). The most reported behavior (masturbation) showed greater risk of non-adherence (72.6%). Discussion and conclusions: Adherent participants improved better than non-adherent. Participants who received psychotherapy improved better than those who received PT. Methodological limitations preclude conclusions on efficacy.  Kulcsszavak: compulsive sexual behavior, randomized clinical trial, group psychotherapy, treatment effects, psychodynamic