Pedophilia is characterized by sexual interest in prepubescent children. Its etiology is multifactorial, and its pathophysiology includes intricate interactions of androgens and neurobiological processes. Androgens and testosterone, especially, play an influential role in sexual maturation and behavior, and their imbalances during critical periods of development may contribute to the development of pedophilic disorder. Various structural neurobiological studies have identified abnormalities in the brains of pedophiles, especially those regions implicated in sexual cue processing and impulse control. Further, evidence shows that prenatal exposure to androgens could influence the differentiation of sexual behavior, the susceptibility to develop pedophilic urges, and the probability of committing sex offenses. Furthermore, the genetic and epigenetic causes that involve the androgen receptors are also implicated in the etiology of pedophilia and even show associations with both the presence and severity of sexual offenses. Currently, therapy for pedophilia with a high risk of offending relies on androgen deprivation therapy in combination with antidepressants and cognitive-behavioral psychotherapy. Therefore, it is important to understand the link between this disorder and androgens. In this regard, this chapter will highlight how hormonal influences might interact with genetic, epigenetic, and neurobiological factors while shaping this complex condition.