Chemical castration

Chemical castration is castration via anaphrodisiac drugs, whether to reduce libido and sexual activity, to treat cancer, or otherwise. Unlike surgical castration, where the gonads are removed through an incision in the body,[1] chemical castration does not remove organs, nor is it a form of sterilization.[2] Chemical castration is generally considered reversible when treatment is discontinued, although permanent effects in body chemistry can sometimes be seen, as in the case of bone density loss increasing with length of use of DMPA.

In May 2016, The New York Times reported that a number of countries use chemical castration on sex offenders, often in return for reduced sentences.[3]

Effects

On males

When used on males, these drugs can reduce sex drive, compulsive sexual fantasies, and capacity for sexual arousal. Life-threatening side effects are rare, but some users show increases in body fat and reduced bone density, which increase long-term risk of cardiovascular disease and osteoporosis. They may also experience gynecomastia (development of larger-than-normal mammary glands in males); full development is less common unless chemical castration is combined with feminizing oestrogen therapy.[4]

On females

Further information: Oophorectomy

When used on females, the effects are similar, though there is little research about chemically lowering female's sex drive or female-specific anaphrodisiacs, since most research focuses on the opposite, but anti-androgenic hormone regimens would lower testosterone in females which can impact sex drive or sexual response.[5][6][7] These drugs also deflate the breast glands and expand the size of the nipple. Also seen is a sudden shrinking in bone mass and discoloration of the lips,[8][9] reduced body hair,[10] and muscle mass.[11]

Treatment for sex offenders

The first use of chemical castration occurred in 1944, when diethylstilbestrol was used with the purpose of lowering men's testosterone.[12] The antipsychotic agent benperidol was sometimes used to diminish sexual urges in people who displayed as then thought inappropriate sexual behavior, and were likewise given by depot injection. But benperidol does not affect testosterone and is therefore not a castration agent. Chemical castration was often seen as an easier alternative to life imprisonment or the death penalty because it allowed the release of the convicted.[13]

In 1981, in an experiment by P. Gagne, 48 males with long-standing histories of sexually deviant behaviour were given medroxyprogesterone acetate for as long as 12 months. Forty of those subjects were recorded as to have diminished desires for deviant sexual behaviour, less frequent sexual fantasies, and greater control over sexual urges. The research recorded a continuation of this more positive behaviour after the administration of the drug had ended with no evidence of adverse side effects and recommended medroxyprogesterone acetate along with counselling as a successful method of treatment for serial sex offenders.[14]

Leuprolide acetate is an LHRH agonist that is most commonly used in chemical castration today.[15] This drug has been observed as having higher rates of success in reducing abnormal sexual urges and fantasies, but is often reserved for those offenders who are at a high risk of reoffending due to the drug's intense effects.[16]

Psychotherapy has also recently been used in conjunction with chemical castration in order to maximize and prolong the beneficial results.[17] Schober et al. reported in 2005 that when cognitive behavioral therapy combined with leuprolide acetetate was compared to cognitive behavioral therapy alone, the combination therapy produced a much more significant reduction of pedophilic fantasies and urges as well as masturbation.[18] Chemical castration therapy reduces an individual's libido which then makes some offenders more responsive to the introduction of psychotherapy.[19] This combination therapy is most often utilized in those who are at a high risk of offending.[17]

Scientific critique

Spaying is observed to cause female animals to stop mating in the same species as castration causes male animals to stop mating. However, in animal species where females continue their mating behaviour after being spayed, the males also continue to mate after being castrated. So there are scientists who argue that it makes no biological sense to assume that any treatment that emulates castration would remove sex drive in men but not in women. These scientists argue that these observations, along with the fact that humans are animals and subject to evolution, show that it is flawed to think that male sexuality would be treatable by medication if female sexuality is not.[20][21]

Some criminologists argue that the appearance of a lower recidivism rate in male sex offenders who take chemical castration treatment than in those who do not can be explained by factors other than biological effects of the medication. One hypothesis is that men who accept the negative effects of hormonal treatment in exchange for shorter prison sentence are distinct in that they value freedom from incarceration higher than men who rather stay in prison for a longer time than face the side effects of chemical castration. These criminologists explain apparently lower recidivism as an artifact of men who accept chemical castration being more engaged in hiding the evidence for reoffending, and that paroling such offenders constitute a risk of releasing criminals who commit as many new crimes as others but are better at hiding it. These criminologists also argue that police investigators treating castrated men as less likely to reoffend than non-castrated men may cause an investigation bias and self-fulfilling prophecy, and that men who sell some of their prescribed medicines on the black market for drugs get a hidden income that improve their ability to afford measures to hide recidivism that is not available to men without such prescriptions.[22][23][24]

Some neurologists acknowledge that testosterone plays a role in sexual arousal but that reducing sex drive will likely not reduce inappropriate sex behaviour. These researchers argue that since a weaker internal signal in the brain means a higher requirement for external stimulation to create a feedback loop that tires the brain circuits out as in orgasm and lead to satisfaction, a reduction of the internal stimulation from hormones would make the required external stimulation stronger and also more specific, as weaker signals involve narrower ranges of other brain functions in their loops. These scientists therefore argue that the biological (as opposed to sociological) effect of reduced testosterone is to make it more difficult and not easier to use masturbation without pornography or other socially acceptable substitutes to manage remaining sex drive in a former offender, and that many community persons (both male and female) find that a lower initial arousal makes it more difficult to orgasm by masturbation without pornography or with non-preferred stimulation.[25][26]

Argentina

In March 2010, Guillermo Fontana of CNN reported that officials in Mendoza, a province in Argentina, approved the use of voluntary chemical castration for rapists, in return for reduced sentences.[27]

Australia

In 2010, a repeat child sex offender who had been subject to chemical castration was accused of inappropriately touching and kissing a young girl. He was found not guilty by a jury, which was not informed of the context of his previous offenses.[28]

Europe

The drug cyproterone acetate has been commonly used for chemical castration throughout Europe. It resembles the drug MPA used in America.[12]

In the United Kingdom, computer scientist Alan Turing, famous for his contributions to mathematics and computer science, pleaded guilty in 1952 to a charge of gross indecency for having a homosexual relationship and accepted chemical castration as a term of his probation, thus avoiding imprisonment.[29] At the time, homosexual acts between males were illegal and homosexual orientation was widely considered to be a mental illness that could be treated with chemical castration.[29] Turing experienced side effects such as gynecomastia (breast enlargement)[30] and bloating of the physique.[29] He died two years later, with the inquest returning a verdict of suicide,[31] although recent research has cast doubt on this result.[32] In 2009 British Prime Minister Gordon Brown issued a public apology for the "appalling" treatment of Turing after an online petition gained 30,000 signatures and international recognition.[33] He was given a posthumous Royal Pardon in December 2013.

In the 1960s, German physicians used antiandrogens as a treatment for sexual paraphilia.[12]

In 2008, an experimental intervention program was launched in three Portuguese prisons: Carregueira (Belas, Sintra), Paços de Ferreira and Funchal. The program developers note the voluntary nature of the program a crucial factor in its success. They initially planned to cover ten inmates per prison, contemplating a possible enlargement to other prisons in the future. The program also included a rehabilitation component.[34]

On September 25, 2009, Poland legislated forcible chemical castration of child molesters.[35] This law came into effect on June 9, 2010; therefore in Poland "anyone guilty of raping a child under the age of 15 can now be forced to submit to chemical and psychological therapy to reduce sex drive at the end of a prison term".[36]

On April 30, 2010, a man in the United Kingdom found guilty of attempting to murder a 60-year-old woman in order to abduct and rape her two granddaughters agreed to undergo chemical castration as part of the terms of his sentence.[37]

On March 6, 2012, Moldova legislated forcible chemical castration of child molesters; the law came into effect on July 1, 2012.[38]

On June 5, 2012, Estonia passed a law that allows voluntary chemical castration as a part of complex treatment for less serious sex offenders as an alternative of imprisonment. However, the treatment is rarely used in practice.[39]

In October and November 2013, North Macedonia authorities were working on developing a legal framework and standard procedure for implementation of chemical castration that would be used for convicted child molesters. The castration is intended to be voluntarily, where as for the child molesters that repeat the criminal act it should be mandatory.[40]

India

After the outrage following the gang rape of a woman in Delhi, the Government has submitted a draft proposing chemical castration along with an imprisonment of up to 30 years for rape convicts as part of the anti-rape law in India. The ministry is preparing a detailed bill and the recommended changes are under review.[41][42] Government is also planning to re-define the Juvenile Act and lower their age. One of the accused in the rape case is a juvenile and aged a few months less than 18 years. A view has been expressed by a section that only those below 15 years should be described as juvenile.[43]

Indonesia

In 2016, the Indonesian President Joko Widodo introduced a presidential regulation to allow chemical castration to be handed down as a punishment to child sex offenders and pedophiles. The regulation alters the contents of the 2002 Law on Child Protection.[44]

Israel

In May 2009, two brothers from Haifa—convicted child molesters—agreed to undergo chemical castration to avoid committing further crimes.[45]

New Zealand

In New Zealand, the antilibidinal drug cyproterone acetate is sold under the name Androcur. In November 2000 convicted child sex offender Robert Jason Dittmer attacked a victim while on the drug. In 2009 a study into the effectiveness of the drug by Dr David Wales for the Corrections Department found that no research had been conducted in New Zealand into the effectiveness and such trials were "ethically and practically very difficult to carry out."[46]

Russia

In October 2011, the Russian parliament approved a law that allows a court-requested forensic psychiatrist to prescribe the chemical castration of convicted sex offenders who have harmed children under the age of 14.[47]

South Korea

In July 2011, South Korea enacted a law allowing judges the power to sentence sex offenders who have attacked children under the age of 16 to chemical castration.[48] The law also allows for chemical castration to be ordered by a Ministry of Justice committee. On May 23, 2012, a serial sex offender legally called Park in the court case was ordered by the committee to undergo this treatment after his most recent attempted offense. On January 3, 2013, a South Korean court sentenced a 31-year-old man to 15 years in jail and chemical castration, the country's first-ever chemical castration sentence.[49][50] In 2017, the sentencing was extended to include all forms of rapes and sexual assault cases against women, including attempted rape.

United States

In 1966, John Money became the first American to employ chemical castration by prescribing medroxyprogesterone acetate (MPA, the base ingredient now used in DMPA) as a treatment for a patient dealing with pedophilic urges. The drug has thereafter become a mainstay of chemical castration in America. Despite its long history and established use, the drug has never been approved by the FDA for use as a treatment for sexual offenders.[12]

California was the first U.S. state to specify the use of chemical castration for repeat child molesters as a condition of their parole, following the passage of a modification to Section 645 of the California penal code in 1996.[51][52] This law stipulates castration for anyone convicted of child molestation with a minor under 13 years of age if they are on parole after their second offense. Offenders may not reject the intervention,[51][52][53][54] although they may elect surgical castration instead of ongoing DMPA injections.[55]

The passage of this law led to similar laws in other states such as Florida's Statute Section 794.0235 which was passed into law in 1997.[56] As in California, treatment is mandatory after a second offense.

At least seven other states, including Georgia, Iowa, Louisiana, Montana, Oregon, Texas and Wisconsin, have experimented with chemical castration.[12] In Iowa, as in California and Florida, offenders may be sentenced to chemical castration in all cases involving serious sex offenses. On June 25, 2008, following the Supreme Court ruling in Kennedy v. Louisiana that the execution of child rapists where the victim was not killed was ruled unconstitutional,[57] Louisiana Governor Bobby Jindal signed Senate Bill 144, allowing Louisiana judges to sentence convicted rapists to chemical castration.[58][59][60] Alabama passed such a law in 2019.[61]

Objections

The American Civil Liberties Union of Florida opposes the administration of any drug that is dangerous or has significant irreversible effect as an alternative to incarceration; however, they do not oppose the use of antiandrogen drugs for sex offenders under carefully controlled circumstances as an alternative to incarceration.[58] Law professor John Stinneford has argued that chemical castration is a cruel and unusual punishment because it exerts control over the mind of sex offenders to render them incapable of sexual desire and subjects them to the physical changes caused by the female hormones used.[62]

Some people have argued that, based on the 14th Amendment, the procedure fails to guarantee equal protection: although the laws mandating the treatment do so without respect to gender, the actual effect of the procedure disproportionately falls upon men.[12] In the case of voluntary statutes, the ability to give informed consent is also an issue; in 1984, the U.S. state of Michigan's court of appeals held that mandating chemical castration as a condition of probation was unlawful on the grounds that the drug medroxyprogesterone acetate had not yet gained acceptance as being safe and reliable and also due to the difficulty of obtaining informed consent under these circumstances.[12]

Treatment of cancer

A major medical use of chemical castration is in the treatment of hormone-dependent cancers, such as some prostate cancer, where it has largely replaced the practice of surgical castration.[63][64]

Chemical castration involves the administration of antiandrogen drugs, such as cyproterone acetate, flutamide, or gonadotropin-releasing hormone agonists.

See also

• Leuprorelin
• Neutersol
• Nonsurgical neutering alternatives
• Triptorelin

References

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4. Kanhai, Robert C.J.; Hage, J. Joris; van Diest, Paul J.; Bloemena, Elisabeth; Mulder, J. Wiebe (January 2000). "Short-Term and Long-Term Histologic Effects of Castration and Estrogen Treatment on Breast Tissue of 14 Male-to-Female Transsexuals in Comparison With Two Chemically Castrated Men". The American Journal of Surgical Pathology. 24 (1): 74–80. doi:10.1097/00000478-200001000-00009. PMID 10632490.
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16. Turner, Daniel; Briken, Peer (January 2018). "Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review". The Journal of Sexual Medicine. 15 (1): 77–93. doi:10.1016/j.jsxm.2017.11.013. PMID 29289377.
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18. Beech, Anthony R.; Harkins, Leigh (November 2012). "DSM-IV paraphilia: Descriptions, demographics and treatment interventions". Aggression and Violent Behavior. 17 (6): 527–539. doi:10.1016/j.avb.2012.07.008.
19. Garcia, Frederico Duarte; Delavenne, Heloise Garcia; Assumpção, Alessandra de Fátima Almeida; Thibaut, Florence (10 April 2013). "Pharmacologic Treatment of Sex Offenders With Paraphilic Disorder". Current Psychiatry Reports. 15 (5): 356. doi:10.1007/s11920-013-0356-5. PMID 23572328.
20. Aunger, Robert; Curtis, Valerie (2015). Gaining Control: How human behavior evolved. OUP Oxford. ISBN 978-0-19-100284-7.
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22. Horne, Christine; Lovaglia, Michael J. (2008). Experiments in criminology and law: a research revolution. Rowman & Littlefield. ISBN 978-0-7425-6027-7.
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30. Sullivan, Andrew (11 September 2009). "An Apology To Alan Turing". The Atlantic. Archived from the original on 11 September 2009. Retrieved 20 October 2013. [...] One of the known side effects of these hormone injections was the development of breasts, known as gynecomastia, something which plagued Turing for the rest of his life. [...]
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32. bbc.co.uk - Alan Turing: Inquest's suicide verdict 'not supportable', 23 June 2012
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35. "Poland okays forcible castration for pedophiles". Reuters. 2009-09-25.
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42. "Congress anti-rape law draft proposes chemical castration". IBNLive.
43. "Congress anti-rape draft bill proposes 30 years jail, chemical castration - The Times of India". The Times Of India. 30 December 2012.
44. Cochrane, Joe (2016-05-25). "Indonesia Approves Castration for Sex Offenders Who Prey on Children". The New York Times. ISSN 0362-4331. Retrieved 2016-05-26.
45. Tali Libman (25 May 2009). "Losing a battle to win the war". Haaretz.
46. Francis, Clio (11 July 2011). "Chemicals don't always stop sex offenders". The Dominion Post. Retrieved 23 September 2011.
47. "Russia introduces chemical castration for pedophiles". RT. 4 October 2011.
48. "S. Korea enacts 'chemical castration' law to punish paedophiles". Reuters. 24 July 2011.
49. "South Korean court orders first chemical castration". The Hindu. Chennai, India. 3 January 2013.
50. "Court issues 1st chemical castration sentence". Korea Herald. 3 January 2013.
51. "XII. SEX OFFENDERS: Children and minors". California State Senate. Archived from the original on 2005-03-22. Retrieved 2006-11-23. The web page notes the Chemical Castration clause as a repeal and an addition to Section 645.
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53. "Codes Display Text". leginfo.legislature.ca.gov. Retrieved 17 June 2018.
54. Macready, N. (21 September 1996). "Chemical castration for paedophiles approved". BMJ. 313 (7059): 707. doi:10.1136/bmj.313.7059.707a.
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56. Spalding, Larry Helm (1998). "Florida's 1997 Chemical Castration Law: A Return to the Dark Ages" (PDF). Florida State University Law Review. 25 (2): 117–139. Archived from the original (PDF) on 2010-06-13.
57. Rossmeier, Vincent (June 26, 2008). "Jindal approves castration for sex offenders". Salon. Salon Media Group. Archived from the original on November 16, 2013. Retrieved October 20, 2013. On Wednesday, the Supreme Court ruled that it's unconstitutional to execute someone for a case of child rape "where the victim's life was not taken." [...]
58. Larry Helm Spalding (1998). "Florida's 1997 Chemical Castration Law: A Return to the Dark Ages". 25:117. Florida State University Law Review: 124. Archived from the original on September 17, 2017. Retrieved March 15, 2016. Furthermore, the ACLU of Florida opposes any attempt to offer a defendant the opportunity to avoid incarceration by taking a drug that is dangerous or that has a significant irreversible effect on an individual’s cognitive capacity or an important physical function, such as the ability to conceive children. The ACLU of Florida does not oppose the use of antiandrogen drugs under certain controlled circumstances as an alternative to incarceration for convicted sex offenders. Because the ACLU of Florida respects individual autonomy and supports the principle that punishment should be no more restrictive of liberty than necessary, an individual’s choice of whether to accept an antiandrogen drug is entitled to considerable respect. In addition, because this choice arises in the inherently coercive context of sentencing, and because of the capacity for abuse of this sentencing option, such treatment should be available only under the most carefully controlled circumstances. Cite journal requires |journal= (help)
59. "Code 2009 Index". coolice.legis.state.ia.us. Retrieved 16 September 2017.
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62. Stinneford, John F. (20 July 2006). "Incapacitation through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity". SSRN 918271. Cite journal requires |journal= (help)
63. "About hormone therapy for prostate cancer". cancerresearchuk.org. 2017-08-30.
64. "The ADT Book". Life on ADT.

Further reading

• Daley, Matthew V. (2008). "A Flawed Solution to the Sex Offender Situation in the United States: The Legality of Chemical Castration for Sex Offenders" (PDF). Indiana Health Law Review. 5 (1): 87–122.
• Giordano, Kevin (1 March 2000). "The Chemical Knife". Health & Body. Salon. Archived from the original on 15 March 2002. Retrieved 6 February 2019.
• Larrubia, Evelyn (19 September 1999). "In Need of Therapy". Los Angeles Times. Retrieved 6 February 2019.