Updated 29 November 2013

Is chemical castration a solution?

CyberShrink weighs in on the hot debate surrounding calls for the castration of sex offenders.


North West Premier Thandi Modise has repeated her controversial call for repeat rapists to be chemically castrated. 

Herself being a victim of rape at the age of 15, she was addressing students and community members during the launch of the 16 Days of Activism of No Violence Against Women and Children at the Mahikeng Campus of the North West University.

While the idea has been current for centuries, and may seem emotionally satisfying from the point of view of victims and their friends and relatives, there has been growing discussion and moves in a number of countries towards allowing or requiring some form of castration for sex offenders.

However, the discussion has become unhelpfully muddy and in urgent need of calm and clarity. Health24's CyberShrink takes a look at some of the main points.

What is chemical castration?

Over-emotional terminology doesn't help. In the past, actual physical surgical removal of the testicles might have been performed as the only available way to influence male hormone levels. But now there are several medicinal ways to achieve the same effect, reversibly, even though it doesn't necessarily remove all sexual desire or performance in every case. 

What is called "Chemical Castration", involves no physical mutilations, only the administration of drugs which would in effect neutralise the activity of relevant sex hormones.

Drugs used

A variety of drugs may be used - Depo Provera, for one, otherwise used for birth control, or anti-androgen drugs like Cyproterone, and Lupron. France has experimented with using a drug meant for prostate cancer, Leuproreline, and others have tried Tamoxifen, used to treat breast cancer. 

A GnRH agonist can be given as a nasal spray, and affects testosterone production via the pituitary gland. But individuals respond differently to each of these drugs.

Does it work? 

If used as recommended medically, do the drugs actually reduce sexual desire and activity? More importantly, used in sexual criminals, does it significantly reduce the rate of re-offending? Based on a number of studies, the answer seems to be “yes”.

People who engage in such sexual offences are notoriously likely to re-offend. Yet those studying the effects of "chemical castration" have reported a drop in the rate of re-offending from 40 to 70 % to less than 5 %. This would be a most useful and desirable outcome, protecting many potential victims, and indeed protecting the repeat offender from further crimes and punishment.

It seems foolish, then, NOT to offer such treatment to sex offenders on release from jail. Comparing the significant cost and rather low demonstrated efficacy of Probation Services, it should probably be offered free of charge to the offender. 

But it's not that practical

Ensuring that they continue taking drugs would be a significant and problematic issue. Unlike physical castration, the medications need to be taken regularly to have continuing effects, though there is some evidence of a continuing benefit after the medications are stopped.

If given orally it'd be hard to know whether or not it was being taken and there is no easy or convenient test for this, such as might provide, through random urine or blood tests, reliable estimates of testosterone levels or effective drug levels. If the drug were administered in a long-acting depot injection, it could be given during probation visits.

The medications might need to be taken for life, or at least long-term, while the period of probation would usually not extend for as long as the potential risk might persist. 

Chemical castration is no quick fix, and often not a fix at all. There are major ethical and legal isues to work through and even then it can't be done or even maintained by nurses at a clinic because it needs specialist doctors to prescribe and monitor.

It's also expensive, and ineffective in many cases. When someone rapes due to power issues, for instance, they may not be much influenced by hormone treatment and you'll find that some men who have been physically castrated may later try to rape someone else.

There is also the major danger of over-simplified solutions - they lull individuals and society into a false sense of security and may lead to increased danger when other common-sense preventives are ignored. 

The bizarre ‘right to reproduce’ argument 

I've been amazed at some of the ridiculous complaints from people claiming to be experts on human rights (though we never hear them being exercised by the rights of the human victims of the offenders they care about so keenly). 

Some of these meddlesome "ethicists" (a species usually lacking any other useful qualifications, who feel free to opine and preach without ever feeling ethically obliged to carry responsibility for the results of their advice) have complained that even the offering of such interventions would improperly interfere with a criminal's "right to reproduce".

The existence of a "right to reproduce" can be very seriously challenged. If it exists, an enormous number of very decent people have that right infringed by fate and factors outside their own control, without the ethicists bothering. It seems to me that a life prison sentence already rather seriously impairs one's freedom to reproduce, in a way that only the most loony of solutions might remedy.

Even if such a "right" existed, it would surely have to be considered greatly outweighed by the rights of the offender’s victims not to be raped or sexually abused. Just as your "right to smoke" (invented and marketed by tobacco companies) ends at my nose, so does your right to reproduce end with my right NOT to reproduce with you.

It's also too easy to overlook the fact that some sex offenders are so troubled by their undesirable sexual urges that they earnestly ask for such interventions, and indeed some are known to have physically castrated themselves in prison in an attempt to seek freedom from libidinal cravings of which they desperately want to be rid.

Not so clear from available research, is the really long-term physical and physiological impact of remaining on anti-androgens or similar medication. Side-effects and serious complications need to be better understood.

It's also not entirely clear whether long-term suppression of sexual desire by drugs would prevent all varieties of rape or sexual abuse. We know that not all acts of rape and abuse are entirely or even largely sexually motivated. 

Read: Rape linked to manhood in South Africa

Though sex may be used as the weapon, the act may be more motivated by anger, revenge and aggression, or the sheer enjoyment of the power to force someone else to do what you wish. Reduced testosterone levels may reduce aggression, too, but may not necessarily reduce all other motivations for an assault.

How useful does such an intervention need to be before we decide it should be implemented? Even imprisoning rapists is not very effective in changing future behaviour, and it is very expensive. That said, if we demand perfection before action, we would never act. 

Prof M. A. Simpson is Health24's CyberShrink

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