Chemical castration
Chemical castration is the administration of medication to men to suppress testosterone production, and thereby suppress the desire for and the ability to engage in sexual activity that requires an erection. Unlike surgical castration, where the testicles or ovaries are removed through an incision in the body,[1] chemical castration does not actually castrate the person, nor is it a form of sterilization.[2] [3]
Chemical castration is sometimes reversible when usage is discontinued, although permanent effects in body chemistry can sometimes be seen, as in the case of bone density loss and other severe health issues, increasing with length of use of Depo Provera.[4] Chemical castration has, with increasing frequency, been used as an instrument of punishment[5] and public and/or judicial policy despite concerns over human rights violations and possible side effects.[6][7]
In the United States, chemical castration is rarely somethng that is ordered by a judge, and the law enforcement industry (police, jails, prisons) has to authority to require it. Instead it is agreed to "voluntarily" by the subject as the means to avoid something worse that can legally be done to him. For example, a common scenario is that the man agreeing to "voluntary" chemical castration does so to stay out of prison, through parole, probation, or charges not being filed and other forms of coercion.
Although chemical castration is presented as a humane alternative to lifelong imprisonment or surgical castration, the American Civil Liberties Union opposes the coerced administration of any drug, including antiandrogen drugs for sex offenders. They argue that forced chemical castration is a "cruel and unusual punishment", and therefore should be constitutionally prohibited by the Eighth Amendment of the Constitution of the United States . They also stated that it interferes with the right to procreate and could expose users to various health problems.[6] 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.[8]
Some have argued that, based on the Fourteenth Amendment of the Constitution of the United States, 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.[7] 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 (Depo Provera) had not yet gained acceptance as being safe and reliable and also due to the difficulty of obtaining informed consent under these circumstances.[7]
Chemical castration is mandatory for child sex offenders in several countries including Poland, Macedonia, South Korea, Moldova, Indonesia and Russia. It has also been used in nine US states. [9]
Indiscriminate use
Sexual offenders, much research has shown, have the lowest rate of reoffending of any type of criminals other than murderers. (See the Wikipedia article on sex offenders, http://en.wikipedia.org/wiki/Sex_offender.) There has yet to be discovered a way of reliably predicting who is likely to reoffend. Certainly corrections, parole, and probation departments, often underfunded and unable to hire and retain quality staff, are poorly prepared to make such determinations. Their attitude seems to be a blanket approach: "treat" them all, and we'll get the problem ones. This is akin to saying that locking everyone up would stop crime.
Depo-Provera
Depo-Provera is a branded progestogen-only contraceptive, depot medroxyprogesterone acetate ('DMPA) long acting reversible hormonal contraceptive birth control drug that is injected every 3 months. It is an aqueous suspension for depot injection of the pregnane 17α-hydroxyprogesterone-derivative progestin medroxyprogesterone acetate.
One possible side-effect
While it has long been known that Depo-Provera causes bone loss, it has recently been discovered that the osteoporotic effects of the injection grow worse the longer Depo-Provera is administered, may remain long after the injections are stopped, and may be irreversible. For these reasons, on November 17, 2004 the United States Food and Drug Administration and Pfizer agreed to put a black box warning on Depo-Provera's label.[10] However, the World Health Organization (WHO) advises that the use of Depo-Provera should not be restricted.[11][12]
It is unclear whether the bone density loss associated with Depo-Provera use is reversible, and if so, how completely. Three studies have suggested that bone loss is reversible after the discontinuation of Depo-Provera.[13][14][15] Other studies have suggested that the effect of Depo-Provera use on post-menopausal bone density is minimal,[16] .[17] Use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density.[18] However, as of 2006, no study has directly examined fracture risk in post-menopausal women who have used Depo-Provera; therefore, the risk is unknown. There does not appear to be any studies on long term usage with men.
Pfizer and the U.S. Food and Drug Administration (FDA) recommend that Depo-Provera not be used for longer than 2 years, unless there is no viable alternative method of contraception, due to concerns over bone loss.[10] However, a 2008 Committee Opinion from the American Congress of Obstetricians and Gynecologists (ACOG) advises healthcare providers that concerns about bone mineral density loss should neither prevent the prescription of or continuation of Depo-Provera beyond 2 years of use.
Depot Lupron
Depot Lupron is another drug often used for chemical castration. (Lupron is the drug; "Depot" refers to the means of administration - something that is _deposited_ is the body for release over a period of time.) It is FDA approved for use in men with "advanced prostatic cancer"; testosterone fuels prostate cancer and reducing testosterone starves it. It can cause bone loss and other serious side effects.
"Off label" use
Both of the above drugs are being used "off label": for purposes other than those the (U.S.) Food and Drug Administration has approved. There is no medication which has been approved by the FDA for chemical castration in men without advanced prostate cancer; this would require expensive clinical trials. While "off label" use of drugs is not unusual, it is riskier than using medication for the purpose(s) for which it has been tested and approved. Insurance usually will not pay for medication used for an unapproved purpose.
While "off label" use of drugs does not constitute malpractice, it weakens the doctor's position if an allegation of malpractice is made.
Testosterone supplementation
It is quite possible for the chemically castrated man to go to a urologist who does not know about the anti-androgen drug, complain of erection problems, get his testosterone tested, and receive supplementation to return his testosterone to normal or near normal.
See also
References
- ↑ "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 - breaking the cycle of paraphiliac recidivism" Social Justice, Spring, 1999 by Christopher Meisenkothen.
- ↑ Chemical castration from Wikipedia
- ↑ Patient Labeling. Pharmacia and Upjohn Company, Division of Pfifer.
- ↑ Indonesia mulls chemical castration after string of pedophile cases. Thomson Reuters.
- ↑ 6.0 6.1 Chemical Castration: A Return to the Dark Ages Florida, August 1997, PDF
- ↑ 7.0 7.1 7.2 "Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety" Charles L. Scott, MD, and Trent Holmberg, MD
- ↑ Incapacitation through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity by John Stinneford :: SSRN
- ↑ Chemical castration used to treat record number of UK sex offenders
- ↑ 10.0 10.1 Food and Drug Administration (November 17, 2004). Black Box Warning Added Concerning Long-Term Use of Depo-Provera Contraceptive Injection. Archived from the original on December 21, 2005. Retrieved on 2006-05-12.
- ↑ World Health Organization (September 2005). Hormonal contraception and bone health. Family Planning. Retrieved on 2006-05-12.
- ↑ Curtis KM, Martins SL (2006). "Progestogen-only contraception and bone mineral density: a systematic review". Contraception 73 (5): 470–87. doi:. PMID 16627031.
- ↑ Cundy T, Cornish J, Evans M, Roberts H, Reid I (1994). "Recovery of bone density in women who stop using medroxyprogesterone acetate". BMJ 308 (6923): 247–8. doi:. PMID 8111260.
- ↑ Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM (2002). "Injectable hormone contraception and bone density: results from a prospective study". Epidemiology 13 (5): 581–7. doi:. PMID 12192229.
- ↑ Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM (2005). "Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception". Arch Pediatr Adolesc Med 159 (2): 139–44. doi:. PMID 15699307.
- ↑ Orr-Walker B, Evans M, Ames R, Clearwater J, Cundy T, Reid I (1998). "The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women". Clin Endocrinol (Oxf) 49 (5): 615–8. doi:. PMID 10197077.
- ↑ Cundy T, Cornish J, Roberts H, Reid I (2002). "Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception". Am J Obstet Gynecol 186 (5): 978–83. doi:. PMID 12015524.
- ↑ Walsh JS, Eastell R, Peel NF (November 2008). "Depot medroxyprogesterone acetate use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density". Fertil. Steril. 93 (3): 697–701. doi:. PMID 19013564.
