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,"Can Castration Be a Solution for Sex Offenders? Man Who Mutilated Himself in Jail Thinks So, but Debate on Its Effectiveness Continues in Va., Elsewhere" by Candace Rondeaux for the Washington Post, July 5, 2006 chemical castration does not remove organs and is not a form of sterilization.
Chemical castration is generally 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 depot medroxyprogesterone acetate (DMPA). In men, chemical castration reduces sex drive and the capacity for sexual arousal, side effects of some drugs may include depression, suicidal ideation, hot flashes, anemia, infertility, increase in body fat and higher risks of cardiovascular diseases and osteoporosis. In women, chemical castration acts by decreasing testosterone levels in order to lower their sex drive, side effects include the deflation of breast glands, expansion of the size of the nipple and shrinking of bone mass.
Several papers have discussed studies of chemical castration as a treatment for paraphilic disorders and hypersexuality. These conditions (commonly diagnosed in sex offenders) are believed to contribute toward offenders' recidivism. Studies showed reduction of criminal behavior, with several critics arguing for bias in study design. Medroxyprogesterone acetate-based drugs for this treatment remains an off-label use.
Effects On males When used on males, these drugs can reduce sex drive, 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, respectively. Males 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 estrogen therapy.
Some drugs, such as medroxyprogesterone acetate, cyproterone acetate, and LHRH agonists can decrease serum testosterone and estradiol in the body, thus impairing the metabolism of glucose and lipid. These drugs can also cause depression, hot flashes, infertility, and anemia, aside from cardiovascular diseases and osteoporosis. The risk of side effects caused by chemical castration drugs can increase depending on the length of time under which they are administered. A 2004 study in which eleven men were chemically castrated ended with one committing suicide after one year of treatment; in another 2020 study, increases in suicidal ideations was reported by 8% of its treatment group, which led to the hospitalization of two of the 25 subjects who had been administered degarelix.
On females
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. 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, reduced body hair, and muscle mass.Can drugs help sex offenders? by Clare Murphy for the BBC, 13 June 2007
As treatment for cancer A major medical use of chemical castration is in the treatment of hormone-dependent cancers, such as prostate cancer, where it has largely replaced the practice of surgical castration. Chemical castration involves the administration of antiandrogen drugs, such as cyproterone acetate, flutamide, or gonadotropin-releasing hormone agonists.
In 2020, a man in Canada who was receiving antiandrogen drug treatment for colon cancer murdered his doctor over the belief that he was being chemically castrated due to his race.
As treatment for sex offenders
Various drugs (including both hormonal-based and psychoactive drugs) have been studied and used to treat sex offenders.
The first reported use of hormonally-based medications to reduce pathological sexual behavior occurred in 1944, when diethylstilbestrol was used with the purpose of lowering men's testosterone. Cyproterone acetate (CPA, trade name Androcur) was used in experiments to reduce the libido of sex offenders starting with Ursula and Leonhard Laschet of West Germany in the 1960s. By 1975, evidence suggested that the drug was tolerated with side effects of fatigue, gynecomastia, depression. In comparison to drugs studied later for chemical castration, CPA has comparable effectiveness to medroxyprogesterone acetate in suppressing sexual urges and function but appears to be less effective than GnRH modulators like leuprorelin and has more side effects. CPA is approved to treat abnormal sex drive in 20 countries, including Australia and the United Kingdom where it is a documented on-label use. The European Medicines Agency advises that use of "should only be used for reduction of sex drive in sexual deviations in men when other treatment options are not suitable." This warning is for the small but serious side-effect risk of meningioma developing after cumulative doses. Australia and the United Kingdom have issued similar warnings. The first experimental use of a depot injection to improve compliance with medications to curb sexual behavior is recorded in a 1973 study by Leopold H. Field of the United Kingdom, using antipsychotic agent benperidol (trade names Anquil, Frenactil) rather than a hormonal agent. Benperidol had previously been attempted for lowering libido in sex offenders, but nausea had prevented compliance in those taking the medication orally. The subjects were 28 sex-offenders who victimized children. Reported effects of the benperidol depot injection included "abolition of sexual desire and inability to obtain an erection either as the result of fantasy of masturbation". In 1981, in an experiment by Canadian Pierre Gagné, 48 males admitted to Sherbrooke Hospital with histories of criminal sexual behaviour were given injections of medroxyprogesterone acetate (MPA, or DMPA in depot injection, trade name Depo-Provera). Durations for the administration were up to twelve months with dosage levels tapered after four or five months. Forty of those subjects were recorded as having diminished desires for deviant sexual behaviour, as well as less frequent sexual fantasies and greater control over sexual urges. The research paper recorded a continuation of this improved behaviour after the administration of the drug had ended, with no evidence of adverse side effects, and so recommended medroxyprogesterone acetate along with counselling as a successful method of treatment for serial sex offenders. Medroxyprogesterone acetate is the drug specifically named by legal codes of U.S. states with compulsory chemical castration. Leuprolide acetate (LA, leuprorelin and leuprolidetrade; trade names Lupron, Eligard, Lucrin, and Lupaneta) is an LHRH agonist used for chemical castration. The drug was originally used to treat advanced prostate cancer. Studies of the drug for treatment of individual sex offenders are recorded as early as the 1990s, with larger scale studies starting in the 2000s. 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 including the notable phenomenon known as the "flare", in which testosterone levels temporarily surge by approximately 50% within the first 1 to 2 weeks of therapy.
Psychotherapy has also recently been used in conjunction with chemical castration in order to maximize and prolong the beneficial results. 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. Chemical castration therapy reduces an individual's libido which then makes some offenders more responsive to the introduction of psychotherapy. This combination therapy is most often utilized in those who are at a high risk of offending.
Scientific critique Some criminologists argue that the lower recidivism rates seen in male sex offenders who undergo chemical castration might not be due to the medication's biological effects. Instead, one hypothesis is that men who agree to chemical castration — often in exchange for a shorter prison sentence — may simply be more motivated to stay out of prison than those who refuse the treatment. These men might also be more skilled at hiding any new offences, making it appear as though they reoffend less when they actually do not. Additionally, there could be investigation bias, in that police and parole officers might assume castrated men are less dangerous and therefore be less thorough when investigating them and thus causing a self-fulfilling prophecy (in the assumption that castrated men are less dangerous), which could artificially lower the apparent recidivism rate. Some criminologists even suggest that offenders may sell their prescribed medications on the black market, giving them extra income to fund ways to conceal their criminal behaviour more effectively than untreated offenders.
Separately, some neurologists acknowledge that testosterone plays a role in sexual arousal but argue that simply lowering sex drive may not reduce inappropriate sexual behaviour. They explain that when internal sexual arousal signals are weaker (because of reduced testosterone), individuals may require stronger and more specific external stimuli to achieve satisfaction. This could make it harder for former offenders to manage their remaining sex drive through ordinary masturbation without pornography or other preferred stimuli. In other words, reducing sex drive biologically might inadvertently increase the need for risky or socially unacceptable outlets rather than solving the underlying behavioural problems.
While chemical castration through anti-androgens may be viewed as uniquely providing retribution for sex offenses, incapacitation of offenders is possible by lowering their libido with psychiatric medication rather than anti-androgens. In the United Kingdom, a program offering treatment for sex offenders ("Medical Management of Problematic Sexual Arousal") evaluated groups of patients using the Sexual Compulsivity Scale (SCS), a psychometric score of libido shown to predict risky sexual behavior. Patients were divided into an unmedicated group, a group treated with anti-androgen cyproterone acetate (CPA), and another treated with selective serotonin reuptake inhibitor-class antidepressant drugs (including fluoxetine and sertraline). While medicated patients had lower SCS scores than unmedicated ones, the SSRI-treated group had lower scores than the CPA-treated group. Guidelines for National Institute for Health and Care Excellence (NICE) note that fluoxetine is not licensed in the United Kingdom for the treatment of hypersexuality and use for this indication is off‑label. , a randomized controlled trial sponsored by Nottingham Trent University is underway to investigate and evaluate fluoxetine for this purpose ("Fluoxetine Assisted Sexual Arousal Reduction" or FASAR).
Chemical castration for sex offenders by country
Africa
South Africa In July 2022, a proposed policy of chemical castration for rapists was introduced at the national policy conference of the ruling party, the African National Congress, by the party's Women's League.