Chemical castration. Decades ago, it was used as a ‘treatment’ for homosexuality which was then considered a mental illness. Nowadays, it is becoming a topic of discussion in relation to sex offenders. If successful, chemical castration could lower recidivism rates among sex offenders or even prevent sex offending among those who are aware of their urges before they act on them. However, there are also multiple ethical concerns to take into account. Should it be considered a treatment or a punishment? Is consent necessary? Let’s find out in this article!
This article will cover:
· What is chemical castration and how it works
· Positive and negative outcomes
· Ethical concerns
How does chemical castration work?
To understand how chemical castration works, it is important to first explain how male hormones (androgens) are produced. The main androgen is testosterone; the majority of androgens are produced in testicles. The production and release of androgens are controlled by gonadotropin-releasing hormone (GnRH) produced in the hypothalamus. GnRH stimulates the release of the luteinizing hormone (LH) from the pituitary gland which in turn stimulates the production of androgens in the testicles. This is also referred to as the HPG axis – hypothalamus, pituitary gland, gonad. To regulate the secretion of hormones, the system has a feedback loop, meaning that the hypothalamus receives information about the levels of hormones in one’s blood and adjusts the release of GnRH accordingly [8].
Chemical castration aims to decrease levels of androgens [8]. This is done by administering the so-called gonadotropin-releasing hormone agonists. They work by stimulating the LH which initially leads to increased levels of testosterone. However, once LH levels are too high, the pituitary gland stops producing it and thus it no longer sends signals to testicles to produce testosterone. As a result, testosterone levels are decreased to a minimum.
When we hear and read the word castration, we may immediately jump to a misconception: castration equals sterilisation. However, chemical castration is not a form of sterilisation as it is generally reversible when treatment is discontinued [8]. The most commonly used substance is leuprolide (Lupron). It can be administered as oral medication, via injections or implant under the skin.
Positive and negative outcomes
A decrease in sex drive would normally be considered an undesirable side effect. However, in this case, it is the primary goal because it is thought to potentially lower the offender’s risk of recidivism.
A study investigating the effectiveness of chemical castration among Korean sex offenders found a decrease in frequency and intensity of sexual drive, masturbation and sexual fantasies [5]. However, they also observed an increase in testosterone levels and sex drive two months after cessation of the treatment suggesting that continuous treatment might be necessary. Nonethless, a decrease in sex drive does not automatically translate to a lower risk of reoffending.
Based on data from multiple studies, Lösel and Schmucker [7] concluded that treated sex offenders displayed approximately 37% less sexual recidivism than untreated ones. Moreover, chemical or surgical castration was more effective in decreasing recidivism than psychosocial treatments. This finding was supported by the meta-analysis of Kim [4] and colleagues.
Additionally, a study by Landgren and colleagues [6] showed that GnRH agonists may be effective in decreasing the risk of committing child sexual abuse in men with pedophilic disorder. However, this study only observed short-term effects. Furthermore, Turner [10] suggests that GnRH agonists are effective in reducing paraphilic thoughts and behaviours when combined with psychotherapy. Similar findings were reported by Garcia and colleagues [1]. In fact, chemical castration is currently administered together with psychotherapy most of the time.
These studies provide preliminary data showing that chemical castration might decrease recidivism among sex offenders. However, it is not guaranteed to completely prevent other offenses as sex drive is not the only contributing factor that needs to be addressed. The disadvantage seems to be that discontinuation of hormonal therapy increases sex drive again. Therefore, more data is necessary to investigate the long-term efficacy of this treatment.
What are some side-effects?
Possible side effects of chemical castration include erectile dysfunction, shrinkage of testicles or penis, fatigue, hot flashes, breast tenderness or growth of breast tissue (gynecomastia) [8, 10]. In the long-term, it may lead to osteoporosis, depression, infertility, anaemia, weight gain, loss of muscle mass, diabetes and increased risk of heart attack or stroke.
Ethical considerations
Reducing recidivism among sex offenders is an important public concern. However, chemical castration is met with several ethical issues that are important to address.
ONE. In some countries, chemical castration is offered as a condition for a reduced sentence. In a way, this may be considered a type of coercion []. The sex offender might feel compelled to undergo the treatment to shorten their time in prison. This is related to the issue of informed consent. If (partial) coercion took place, we cannot say for sure that the person provided full consent. In this case, they had no other choice than to choose between chemical castration or imprisonment.
TWO. The same issue applies to cases where chemical castration is compulsory. Some scholars argue that this is unethical and infringes upon the rights of the offender [2]. However, Douglas and colleagues disagree with this. They believe that even if it is not possible to obtain informed consent, it is justified as chemical castration actually gives the offender more autonomy in the future, which is the basic premise of consent.
THREE. Moreover, there is the argument of treatment versus punishment. If no consent were provided, it would be considered punishment. This may also depend on medical involvement [2]. Some argue that the doctor’s focus may shift from the best interest of the patient, i.e., the offender, to what is best for society. One might argue that this is acceptable because we are potentially preventing offenders from harm, but it is not so black and white. Still, the medical professional’s primary goal must be to help the offender to reduce and control their sexual impulses rather than to punish them for it [2].
On the other hand, some scholars believe that public safety comes above the rights of the offender. For example, the recidivism rates among child molesters are high [9], and therefore, for the sake of protecting children, even involuntary chemical castration would be justified. Arguably, imprisonment did not fulfil its main goal, namely the re-socialisation of the offender.
Conclusion…
The bottom line is that chemical castration combined with psychotherapy might be an effective way to reduce recidivism rates among sex offenders. However, there are a number of ethical considerations, such as consent, that need to be taken into account when developing guidelines for this treatment method.
Extra resources:
- Interview with a chemically castrated man: https://www.thecut.com/2015/12/what-its-like-to-be-chemically-castrated.htm
- Interview with Dr Renee Sorrentino (a forensic psychiatrist who specialised in the treatment of sex offenders) - she mentions different types of therapy: https://www.youtube.com/watch?v=6abysqk10MM
References
1. Garcia, F. D., Delavenne, H. G., Assumpção, A. D. F. A., & Thibaut, F. (2013). Pharmacologic treatment of sex offenders with paraphilic disorder. Current psychiatry reports, 15(5), 356.
2. Gooren, L. J. (2011). Ethical and medical considerations of androgen deprivation treatment of sex offenders. The Journal of Clinical Endocrinology & Metabolism, 96(12), 3628-3637. https://doi.org/10.1210/jc.2011-1540
3. Douglas, T., Bonte, P., Focquaert, F., Devolder, K., & Sterckx, S. (2013). Coercion, incarceration, and chemical castration: An argument from autonomy. Journal of Bioethical Inquiry, 10(3), 393-405.
4. Kim, B., Benekos, P. J., & Merlo, A. V. (2016). Sex offender recidivism revisited: Review of recent meta-analyses on the effects of sex offender treatment. Trauma, Violence, & Abuse, 17(1), 105-117. https://doi.org/10.1177%2F1524838014566719
5. Koo, K. C., Shim, G. S., Park, H. H., Rha, K. H., Choi, Y. D., Chung, B. H., ... & Lee, J. W. (2013). Treatment outcomes of chemical castration on Korean sex offenders. Journal of forensic and legal medicine, 20(6), 563-566. https://doi.org/10.1016/j.jflm.2013.06.003
6. Landgren, V., Malki, K., Bottai, M., Arver, S., & Rahm, C. (2020). Effect of gonadotropin-releasing hormone antagonist on risk of committing child sexual abuse in men with pedophilic disorder: a randomized clinical trial. JAMA psychiatry, 77(9), 897-905. doi:10.1001/jamapsychiatry.2020.0440
7. Lösel, F., & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1(1), 117-146.
8. Pieterangelo, A. (January 2021). What is chemical castration? Retrieved on November 30, 2021 from https://www.healthline.com/health/chemically-castrating#side-effects
9. Ratkoceri, V. (2017). Chemical Castration of Child Molesters–Right or Wrong?!. European Journal of Social Science Education and Research, 4(5), 70-76.
10. Turner, D., & Briken, P. (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. https://doi.org/10.1016/j.jsxm.2017.11.013