No Consensus on Chemical Castration

Although forced chemical castration for repeat child molesters may have the approval of many Californians, there is little science to support the benefits of the new law, according to experts in psychiatry and human sexuality.

The chemical castration law, signed last week by Gov. Pete Wilson and slated to go into effect Jan. 1, mandates weekly injections of the synthetic hormone Depo-Provera, which was approved for use as a female contraceptive in 1992.

The drug lowers the hormone testosterone in men, which subsequently reduces sex drive.

While there are many studies on Depo-Provera as a contraceptive for women, little is known about its medical side effects in men.

In addition, few studies have explored the use of Depo-Provera on recidivism among child molesters, but those studies involved voluntary use as part of a larger therapeutic program--and cannot predict the results of a mandatory program, experts say.

“This [law] hasn’t been done out of collaboration between medical and science people and the criminal justice system,” says Dr. Fred Berlin, the nation’s leading expert on Depo-Provera treatment for pedophiles who directs a clinic at Johns Hopkins University in Baltimore. “Everyone is concerned with the welfare of children, but the Legislature did not say, ‘We are not scientists. Let’s get some [experts] together and ask them what would make sense.’ ”

The Assn. for Treatment of Sexual Offenders, in Beaverton, Ore., is in the process of developing a position paper on the California law, the first of its kind in the nation.

The law might be useful in the sense that “we realize that we can’t treat all criminals--the bank robber, the pedophile, the murderer--the same way,” Berlin says. “Problems like pedophilia are not simply a criminal justice problem. They are a public health problem. Pedophilia is a legitimate psychiatric disorder.”

Adds Judith Becker, a psychologist at the University of Arizona who has counseled pedophiles on Depo-Provera: “This is a medical decision--whether someone should be placed on Depo-Provera. That is what is so disconcerting to me about the California law.”

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The practice of using Depo-Provera on child molesters has traditionally been based on a mental health model.

The research in this country began at Hopkins in 1966 under the direction of psychologist John Money. The drug, manufactured by Pharmacia & Upjohn Inc., was used sporadically in the United States as a treatment for endometrial and kidney cancer.

Since it became available, the drug has been used elsewhere in the world as a female contraceptive, and in 1992, the U.S. Food and Drug Administration approved its use here as a contraceptive.

Berlin has among the largest body of data on the medication. In 1991, he reported that among 626 men on Depo-Provera, fewer than 10% had committed a sex crime in the five years following the treatment. The idea of using Depo-Provera stems from the theory that some forms of child molestation involve an abnormal sexual orientation that is not amenable to punishment or social disapproval. Berlin’s work suggests the drug can work in conjunction with other therapy and voluntary use.

But the California law lacks several of the factors that make the medication useful, Berlin charges.

“The law does not include an evaluation to see if an individual is among the subset group of offenders for whom this might work. I think there is a role for this medication for people whose sexual appetites are of the sorts that can cause suffering. But if one lacks a social conscience or is antisocial, no medicine in the world will help that,” he says.

Moreover, he says, there is no justification for using the drug without other therapy to address behavior.

“Depo-Provera should make it easier for someone who is trying to avoid sexual temptation and wants to succeed. But this drug won’t keep them from having sex if they want to,” Berlin says.

“So often therapy is important to confront your rationalizations and discuss relapse prevention strategies: ‘What changes will help you to succeed? What led you in the past to these behaviors? Is there a support system in place that could help you?’ There needs to be a recognition that these are not simply moral issues.”

The idea that sex drive is related purely to biological predisposition and lacks conscious thought is unfounded scientifically and is threatening to individuals whose sexual behavior might be seen outside the realm of normal, says Daniel C. Tsang, a librarian at UC Irvine who wrote a detailed history of the drug in men for the Journal of Homosexuality.

“My objection is to the idea that you can control sexuality with chemicals. We are more than just our hormones,” he says.

There is nothing in the law that prohibits other therapy, says Jim Branham, a consultant to Assemblyman Bill Hoge (R-Pasadena), author of the law. “From Assemblyman Hoge’s position, if there is evidence that other therapy will help these folks, we would support that.”

The additional therapy could be initiated by the offender, Branham says, or even ordered by the courts or as a condition of parole.

Lawmakers acknowledge that the medication is not a panacea, Branham says.

“I don’t think any of us dream that any law would fix the problem totally. But the evidence is pretty overwhelming that the recidivism drops dramatically with the use of this drug. It doesn’t disappear. There will be some people who continue to have a problem. But if we move the recidivism rate from 70% to under 20%, that is pretty effective and well worth doing,” he says.

Indeed, studies have shown there are several types of people who molest children, Becker says.

“Is there one major motivation to rape or molest children? The answer is no. Child molesters are a very heterogenous group. One should not take a one-size-fits-all approach with sex offenders. Some people may benefit from anti-androgens. Others may do better with cognitive-behavioral interventions. For others, the antidepressants called selective serotonin reuptake inhibitors [SSRIs] may be beneficial.”

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Aside from the primary concern about whether mandatory Depo-Provera injections will deter pedophiles, there is the medical question of what side effects the drug may carry and the ethical imperative that the full effects be understood, no matter how despised pedophiles are as members of society, Tsang argues.

Again, very little is known about the long-term effects. The injections will be given until state authorities deem the offender no longer needs them. In women, Depo-Provera prevents egg follicles from maturing and ovulation from occurring. In men, Depo-Provera acts as an anti-androgen. Androgens are secreted by tissues in the testicles of males and by the adrenal glands.

In women, Depo-Provera is linked to numerous side effects including irregular bleeding, weight gain, headaches, leg cramps, depression, hot flashes, insomnia and blood clots. It may also raise the risk factors for development of osteoporosis.

Its approval in 1992 was criticized by the National Women’s Health Network and Ralph Nader’s Health Research Group. Both organizations said they feared that the drug may be unsafe because of increased rates of breast tumors and uterine cancer observed in lab animals receiving the drug.

Women on Depo-Provera receive an injection of 150 milligrams once every three months. The chemical castration law mandates weekly injections of 500 milligrams.

According to Berlin, the major side effects are hypertension, which can increase the risk of stroke, and the formation of blood clots.

“The medical aspects [of chemical castration] have been ignored,” Tsang says. “You can always round up people who say this works to deter child molestation. But that’s not the way we should approve of the way drugs are used.”