Sex offending is a debilitating public health concern owing to the serious consequences it has for the victims and their family. The evaluation of the biological profile and neurobiological aspects of sexual offenders is essential in order to understand their causal relationships and reduce recidivism. Sexual characteristics are mainly regulated by sex steroids. These hormones have also been found to be associated with aggression and psychiatric disorders, such as anxiety and depression. Testosterone has been thought to be the most suspicious hormone underlying the pathology of sex offenders. Testosterone-lowering agents have been used as a part of the treatment given to sexual offenders; the results are, however, controversial. On the other hand, a sexual offender with hypogonadism is another complex issue faced by the physician that cause difficulties in decision making for treatment. Literature does not report any evidence proving whether or not recidivism increases with T replacement. This review aimed to discuss the endocrinological, neurobiological, and therapeutical aspects of sexual offending. The treatment of sexual dysfunction in sex offenders is another dilemma that the physicians would face more often in the future. The article also discusses the legal, social and health care aspects of this controversy.