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'''Chemical castration''' is the administration of medication designed to reduce libido and sexual activity. Unlike surgical castration, where the testicles or ovaries are removed through an incision in the body,<ref name=WashPost>[http://www.washingtonpost.com/wp-dyn/content/article/2006/07/04/AR2006070400960_pf.html "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</ref> chemical castration does not actually castrate the person, nor is it a form of sterilization.<ref name=Social-Justice-1999>[http://findarticles.com/p/articles/mi_hb3427/is_/ai_n28737308 "Chemical castration - breaking the cycle of paraphiliac recidivism"] Social Justice,  Spring, 1999  by Christopher Meisenkothen.</ref> <ref>[http://en.wikipedia.org/wiki/Chemical_castration Chemical castration from Wikipedia]</ref>
'''Chemical castration''' is the administration of medication designed to reduce libido and sexual activity. Unlike surgical castration, where the testicles or ovaries are removed through an incision in the body,<ref name=WashPost>[http://www.washingtonpost.com/wp-dyn/content/article/2006/07/04/AR2006070400960_pf.html "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</ref> chemical castration does not actually castrate the person, nor is it a form of sterilization.<ref name=Social-Justice-1999>[http://findarticles.com/p/articles/mi_hb3427/is_/ai_n28737308 "Chemical castration - breaking the cycle of paraphiliac recidivism"] Social Justice,  Spring, 1999  by Christopher Meisenkothen.</ref> <ref>[http://en.wikipedia.org/wiki/Chemical_castration Chemical castration from Wikipedia]</ref>


Chemical castration is generally considered reversible when usage 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 [[Depo Provera]].<ref>{{cite web|url=http://www.pfizer.com/files/products/ppi_depo_provera_contraceptive.pdf|title=Patient Labeling|publisher=Pharmacia and Upjohn Company, Division of Pfifer}}</ref> Chemical castration has, with increasing frequency, been used as an instrument of punishment<ref>{{cite web|url=http://in.reuters.com/article/2014/05/16/uk-indonesia-crime-idINKBN0DW0FA20140516|title=
Chemical castration is generally considered reversible when usage 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 Depo Provera.<ref>{{cite web|url=http://www.pfizer.com/files/products/ppi_depo_provera_contraceptive.pdf|title=Patient Labeling|publisher=Pharmacia and Upjohn Company, Division of Pfifer}}</ref> Chemical castration has, with increasing frequency, been used as an instrument of punishment<ref>{{cite web|url=http://in.reuters.com/article/2014/05/16/uk-indonesia-crime-idINKBN0DW0FA20140516|title=
Indonesia mulls chemical castration after string of pedophile cases|publisher=Thomson Reuters}}</ref>  
Indonesia mulls chemical castration after string of pedophile cases|publisher=Thomson Reuters}}</ref>  
and public and/or judicial policy despite concerns over human rights violations and possible side effects.<ref name="aclufl">[http://www.aclufl.org/about/newsletters/1997/chem.cfm Chemical Castration: A Return to the Dark Ages] Florida, August 1997, [http://www.law.fsu.edu/journals/lawreview/downloads/252/spalding.pdf PDF]</ref><ref name=JAAPL>[http://www.jaapl.org/cgi/reprint/31/4/502.pdf "Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety"] Charles L. Scott, MD, and Trent Holmberg, MD</ref>
and public and/or judicial policy despite concerns over human rights violations and possible side effects.<ref name="aclufl">[http://www.aclufl.org/about/newsletters/1997/chem.cfm Chemical Castration: A Return to the Dark Ages] Florida, August 1997, [http://www.law.fsu.edu/journals/lawreview/downloads/252/spalding.pdf PDF]</ref><ref name=JAAPL>[http://www.jaapl.org/cgi/reprint/31/4/502.pdf "Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety"] Charles L. Scott, MD, and Trent Holmberg, MD</ref>
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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.<ref name=JAAPL /> 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 [[Depo Provera|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.<ref name="JAAPL" />
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.<ref name=JAAPL /> 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 [[Depo Provera|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.<ref name="JAAPL" />


==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.<!--
  --><ref name="FDA2004-Warning">{{cite web | author=FDA | authorlink = Food and Drug Administration |date=November 17, 2004 |url=http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html | title =Black Box Warning Added Concerning Long-Term Use of Depo-Provera Contraceptive Injection | accessdate =2006-05-12 |archiveurl = http://web.archive.org/web/20051221195621/http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html |archivedate = December 21, 2005}}</ref>
However, the  World Health Organization (WHO) advises that the use of Depo-Provera should not be restricted.<!--
  --><ref name="WHO2005">{{cite web | author=World Health Organization | authorlink =World Health Organization |date=September 2005 |url =http://www.who.int/reproductive-health/family_planning/bone_health.html | title =Hormonal contraception and bone health | work =Family Planning | accessdate =2006-05-12}}</ref><!--
  --><ref name="Contraception2006-Curtis">{{cite journal | author=Curtis KM, Martins SL | title=Progestogen-only contraception and bone mineral density: a systematic review | journal=Contraception | year=2006 | pages=470–87 | volume=73 | issue=5 | pmid=16627031 | doi=10.1016/j.contraception.2005.12.010}}</ref>
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.<ref>{{cite journal |author=Cundy T, Cornish J, Evans M, Roberts H, Reid I |title=Recovery of bone density in women who stop using medroxyprogesterone acetate | journal = BMJ | volume = 308 | issue = 6923 |pages=247–8 |year=1994 | pmid = 8111260 |pmc=2539337 | doi=10.1136/bmj.308.6923.247}}</ref><ref name="Scholes2002">{{cite journal | author=Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM | title=Injectable hormone contraception and bone density: results from a prospective study | journal=Epidemiology | year=2002 | pages=581–7 | volume=13 | issue=5 | pmid=12192229 | doi=10.1097/00001648-200209000-00015}}</ref><ref name="Scholes2005">{{cite journal | author=Scholes D, LaCroix AZ, Ichikawa LE, Barlow WE, Ott SM | title=Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception | journal=Arch Pediatr Adolesc Med | year=2005 | pages=139–44 | volume=159 | issue=2 | pmid=15699307 | doi=10.1001/archpedi.159.2.139}}</ref> Other studies have suggested that the effect of Depo-Provera use on post-menopausal bone density is minimal,<ref>{{cite journal |author=Orr-Walker B, Evans M, Ames R, Clearwater J, Cundy T, Reid I |title=The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women | journal = Clin Endocrinol (Oxf) | volume = 49 | issue = 5 |pages=615–8 |year=1998 | pmid = 10197077 | doi = 10.1046/j.1365-2265.1998.00582.x}}</ref> perhaps because Depo users experience less bone loss at menopause.<ref>{{cite journal |author=Cundy T, Cornish J, Roberts H, Reid I |title=Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception | journal = Am J Obstet Gynecol | volume = 186 | issue = 5 |pages=978–83 |year=2002 | pmid = 12015524 | doi = 10.1067/mob.2002.122420}}</ref> Use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density.<ref>{{cite journal |author=Walsh JS, Eastell R, Peel NF |title=Depot medroxyprogesterone acetate use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density |journal=Fertil. Steril. |volume= 93|issue= 3|pages= 697–701|date=November 2008 |pmid=19013564 |doi=10.1016/j.fertnstert.2008.10.004 |url=}}</ref> 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.
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.<ref name="FDA2004-Warning"/> 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.




Revision as of 20:05, 25 May 2014

Chemical castration is the administration of medication designed to reduce libido and sexual activity. 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 generally considered reversible when usage 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 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]

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]

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.[9] However, the World Health Organization (WHO) advises that the use of Depo-Provera should not be restricted.[10][11]

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.[12][13][14] Other studies have suggested that the effect of Depo-Provera use on post-menopausal bone density is minimal,[15] perhaps because Depo users experience less bone loss at menopause.[16] Use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density.[17] 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.

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.[9] 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.


References

  1. ↑ "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
  2. ↑ "Chemical castration - breaking the cycle of paraphiliac recidivism" Social Justice, Spring, 1999 by Christopher Meisenkothen.
  3. ↑ Chemical castration from Wikipedia
  4. ↑ Patient Labeling. Pharmacia and Upjohn Company, Division of Pfifer.
  5. ↑ Indonesia mulls chemical castration after string of pedophile cases. Thomson Reuters.
  6. ↑ 6.0 6.1 Chemical Castration: A Return to the Dark Ages Florida, August 1997, PDF
  7. ↑ 7.0 7.1 7.2 "Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety" Charles L. Scott, MD, and Trent Holmberg, MD
  8. ↑ Incapacitation through Maiming: Chemical Castration, the Eighth Amendment, and the Denial of Human Dignity by John Stinneford :: SSRN
  9. ↑ 9.0 9.1 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.
  10. ↑ World Health Organization (September 2005). Hormonal contraception and bone health. Family Planning. Retrieved on 2006-05-12.
  11. ↑ Curtis KM, Martins SL (2006). "Progestogen-only contraception and bone mineral density: a systematic review". Contraception 73 (5): 470–87. doi:10.1016/j.contraception.2005.12.010. PMID 16627031. 
  12. ↑ 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:10.1136/bmj.308.6923.247. PMID 8111260. 
  13. ↑ 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:10.1097/00001648-200209000-00015. PMID 12192229. 
  14. ↑ 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:10.1001/archpedi.159.2.139. PMID 15699307. 
  15. ↑ 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:10.1046/j.1365-2265.1998.00582.x. PMID 10197077. 
  16. ↑ 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:10.1067/mob.2002.122420. PMID 12015524. 
  17. ↑ 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:10.1016/j.fertnstert.2008.10.004. PMID 19013564. 

External links

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