- Published: November 14, 2012
As a follow up to my blog post from October 31, I decided to continue to investigate opinions on chemical castration among sex offenders. In a letter to the editor in the New England Journal of Medicine, Dr. Berlin gave his opinion on the use of medroxyprogesterone acetate (MPA), a drug which I discussed in my post two weeks ago. In his evaluation of the California legislation in 1997, Berlin wrote: “There is no requirement for an individual assessment of the parolee to determine the medical necessity for the treatment, which is administered involuntarily, without informed consent." He strongly disagreed with this law, saying: 1) all parolees should receive a medical assessment; 2) the state should provide psychological therapy for patients undergoing this treatment; and most importantly, 3) this treatment should not be mandated. Berlin explains that people do not choose pedophilia, so “[i]t is as much a public health problem as it is a matter of criminal justice.”
While I mostly agree with Berlin’s recommendations, two of his opinions are at odds with one another—if pedophilia is not a choice, then shouldn’t the use of drugs be mandatory? Otherwise, why would a pedophile chose to voluntarily diminish his sex drive if he has no choice but to continue engaging in pedophilic behavior? Because the effects of MPA are hard to control, as I explained earlier, losing the entirety of one’s sex drive is not a prospect to look forward to. I still don’t completely agree with the idea of mandating pharmaceuticals, especially without physician oversight, but the medical and legal communities can’t afford to be naïve—not all patients are going to volunteer to be “chemically castrated.” I think mandatory administration of drugs should be determined on a case-by-case basis, and much more research needs to be done on these drugs. And, as I said before, the use of MPA to control sex offenders should probably be banned entirely for the time being.
Fortunately, there are still other options besides MPA to control sex hormones. In Nottinghamshire, Dr. Don Grubin administered Leuprorelin to 100 sex offenders on a voluntary basis. According to Drs. Saleh and Guidry in their article “Psychosocial and Biological Treatment Considerations for the Paraphilic and Nonparaphilic Sex Offender” (2003), Leuprorelin, or leuprolide acetate, has generally benign side effects, and works by inhibiting luteinizing hormone (LH) and follicle stimulating hormone (FSH) secretion. Pedophiles have been found to have higher levels of LH than nonpedophilic paraphiliacs and criminals who were not sex offenders. Thus, Leuprorelin serves to target this disorder in the hypothalamic-pituitary-gonadal (HPG) axis. Unfortunately, leuprolide acetate has an initial biphasic effect, where testosterone surges immediately after first use of the drug. An antiandrogen such as flutamide must be administered to counteract these effects. The advent of safer drugs seems promising, but other options must be explored in addition to or in lieu of drugs, such as psychotherapy and counseling. Above all, psychiatrists need to be consulted prior to treatment, and hopefully, as scientists discover more about the way these libido-decreasing drugs work, we will be able to provide more individualized treatment options to different types of sex offenders.