Chemical Castration

Creator: Dr. Simi Paknikar
Keywords: Castration, chemical castration, castration sexual offenders, reduce testosterone levels

Author - Dr. Simi Paknikar, MD

Medically Reviewed by Dr. Sunil Shroff, MBBS, MS, FRCS (UK), D. Urol (Lond) on Dec 10, 2019

About

Chemical castration is a procedure wherein medications are administered to suppress or reduce Testosterone levels. Unlike surgical castration, chemical castration is reversible as the gonads are not removed by a surgical incision. By undertaking this, the male loses the function of his testes, thereby resulting in loss of libido and infertility. When it is done among boys before they attain puberty, it interferes with maturity of their sexual function including the change in their voice and masculinity. It has widely been speculated that the famous pop singer Michael Jackson was chemically castrated by his father Joe in childhood to maintain his high-pitched voice. This was reaffirmed by Michael Jackson's doctor Conrad Murray. Maybe this was inspired from the many castrati opera singers. Castrati were men who were castrated at the age of 8 to 9 years to keep their voice at a higher pitch. This practice was prevalent during the Baroque period in Italy until it was outlawed in 1870.(1^✔)

Chemical castration is most commonly used in the world for the treatment of most common cancer among men called the prostate cancer. The prostate gland is dependent on the male hormone (Testosterone) for its growth and once a chemical is given that prevents the formation of testosterone, the gland shrinks in size. In fact many eunuchs have a high pitched voice and a rudimentary prostate gland due to castration having been done, before they attain puberty.

The recent surge in rape cases has reiterated a fresh demand for introduction of chemical castration for rapists in India. Besides, even some wives have requested it for their husbands to reduce their libido! What is chemical castration? When and how is it done? What are the pros and cons of doing chemical castration in sexual offenders? Read on to understand more about this method of castration.(2^✔)

In ancient India, castration was done on strong males to convert them into eunuchs, who were then posted to guard women's quarters. Sexual offenders have been granted the punishment with castration in number of countries often in return for reduced sentences.

Castration is done through two different procedures: In surgical castration, the testes are surgically removed from both the sides. Thus, the effects of this type of castration are permanent. In medical or chemical castration, drugs are administered at regular intervals to reduce the levels of testosterone in the body, thereby reducing sexual drive and resulting in infertility. Thus, though the words 'chemical castration' may sound very scary, the actual procedure involves only administration of medication to a person in a tablet (Cyproterone Acetate) or an injection form (Leuprorelin injection) .

Though chemical castration has been adopted for sexual offenders including pedophiles in several states of USA and some European countries, it still remains a debatable issue in other countries. The first case of chemical castration in Asia was recently approved by a South Korean court, while other countries including Malaysia are pushing for the same punishment.(3^✔, 4^✔)

Castration has not only been done as a form of punishment or ritual, it also has a role in therapy. In 1920's castration was performed on gay men to stop their sexual impulses but was soon given up. As mentioned previously chemical castration is most commonly used for treatment for advanced prostate cancer, to keep the growth of cancer cells in check.

Chemical castration has been rarely used in females too. Lowering the testosterone levels in females can lead to lowering of their sex drive. Such castration will also cause shrinkage of breasts and enlargements of nipples. Other effects include shrinking in bone mass and lip discoloration, reduced body hair and muscle mass.

Chemical Castration in Medicine

Drugs that have an anti-androgenic effect are used to bring about chemical castration.

Testosterone is the male hormone that is responsible for maintaining sexual drive, aggression and function of the testes in males. Drugs that reduce the levels or antagonize the actions of testosterone result in chemical or medical castration. These drugs are said to have anti-androgenic properties (since testosterone is an androgen).

Chemical castration is normally used in:

Treatment of Prostate Cancer: prostate cancer cells normally grow faster in the presence of testosterone. Medical castration reduces testosterone levels, thus keeping the cancerous cells in check. However, the hormonal therapy does not cure the cancer but only shrinks the cancer to some extent. It is used for advanced cases where surgery cannot produce a cure.

Drugs used to bring about chemical castration include:

Medroxyprogesterone acetate (MPA): MPA is a long-acting injectable progesterone (a female hormone) that is used as a contraceptive in women. In men, it acts as an anti-androgen. The Depo Provera preparation has to be administered every 3 months.
Cyproterone acetate: Cyproterone Acetate is an anti-androgen that is used to bring about chemical castration.
Luteinizing hormone-releasing hormone (LHRH) analogs: These include drugs like leuprolide, goserelin, triptorelin and histrelin. They bring about an initial release in testosterone, followed by a fall in the levels, with final effects similar to castration. The medications have to be repeated on a regular interval. The side effects of the initial rise can be prevented by administering drugs called anti-androgens like flutamide, bicalutamide, and nilutamide.
Luteinizing hormone-releasing hormone (LHRH) antagonists: These drugs bring about a fall in testosterone levels without causing the initial rise. The LHRH antagonist, degarelix, is used in the treatment of advanced prostate cancer as a monthly injection.
Other drugs like estrogen and ketoconazole may also be used in cases where the above drugs are ineffective. In addition, newer drugs are also being evaluated in the treatment of advanced prostate cancer.(5^✔, 6)

Pros and Cons of Chemical Castration

Some countries favor chemical castration for criminal acts of abuse such as rape and other sexual crimes, whereas some others are still evaluating this form of punishment.

There is a huge debate on whether chemical castration should be an option for such sexual abusers. Chemical castration reduces the aggressive traits of the person, which are often associated with testosterone. Some sexual offenders have requested the injection themselves when offered this choice.(7)

Some factors in favor of this procedure are:

Chemical castration reduces the ability of a person to get sexually stimulated and thereby reduces the chances of repeat sexual offences.
It has been studied that in 97% cases a sex offender after release will go and commit the crime again whereas with chemical castration the offense rate is less than 3%.
If the person undergoes chemical castration, he can be released earlier into the society, thus reducing his imprisonment term.

Experts against chemical castration advise that:

Since the effects of the medications are temporary, they require repeated administration. Thus, the treatment could be very costly.
The sexual abusers will have to regularly follow up with the doctors for repeat medication, which may not always be feasible.

The treatment does not address the criminal aspects of the abusers who indulge in such crimes.

What are the main side effects of Chemical Castration:

Hot flashes
Impotence
Thinning of bone
Diminished muscle mass
Increase in breast size
Weight gain
Mood changes
Possible increase in risk of heart disease

Thus, it may not be ethical to introduce these side effects in an individual.

In United States this form of punishment is implemented in about eight states:

California
Iowa
Georgia
Louisiana
Montana
Oregon
Texas
Wisconsin

California law states that "Sex offenders convicted of an offense against a child under the age of 13 may be treated with Depo-Provera when on parole. If it is their second offense, they may not have the option to reject the treatment."

References:

Effective Testosterone Suppression for Prostate Cancer: Is There a Best Castration Therapy? - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725306/)
Androgens and Estrogens In Benign Prostatic Hyperplasia: Past, Present and Future - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179830/)
Chemical Castration: How a Medical Therapy Became Punishment and The Bioethical Imperative to Return to a Rehabilitative Model for Sex Offenders - (https://wakespace.lib.wfu.edu/bitstream/handle/10339/37658/Vaillancourt_wfu_0248M_10359.pdf?sequence=1)
Chemical Castration for Sexual Offenders: Physicians' Views - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565125/)
Hormone Therapy for Prostate Cancer - (http://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html)
Endocrine Approaches in the Therapy of Prostate Carcinoma - (https://academic.oup.com/humupd/article/11/3/309/758743)
Pros and Cons of Chemical Castration - (http://visionlaunch.com/pros-and-cons-of-chemical-castration/)

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