Indian government is envisaging compulsory treatment of some sex offenders with antiandrogenic drugs, commonly referred to as chemical castration.

Laws in several American states allow compulsory medical treatment of offenders who have committed serious sex offences. Chemical, as well as physical, castration of sex offenders takes place in psychiatric hospitals in theCzechRepublicunder the legal framework of “protective treatment.” Meanwhile, inEnglandthe Department of Health is supporting an initiative to facilitate the prescription of drugs on a voluntary basis for sex offenders in the criminal justice system.

Demand for the prescription of antiandrogens or physical castration for sex offenders is a common reaction by lawmakers and politicians when a high profile sexual crime is committed.

Whether medical or surgical, the procedure requires the participation of doctors. It also shifts the doctor’s focus from the best interests of the patient to one of public safety.

Antiandrogenic drugs and physical castration undoubtedly reduce sexual interest (libido) and sexual performance, and they reduce sexual reoffending.

Physical castration of sex offenders was carried out in several European countries in the first part of the 20th century.

Nowadays drugs are usually used alongside psychological treatment).

The main drugs used are cyproterone acetate (in the United Kingdom, Europe, and Canada); medroxyprogesterone (in the United States); and increasingly the more expensive but possibly more potent gonadotrophin releasing hormone agonists such as leuprolide, goserelin, and tryptorelin.

Although these drugs act in different ways, they all reduce serum testosterone concentrations in men to prepubertal values.

Castration, however—whether chemical or physical—is associated with serious side effects, including osteoporosis, cardiovascular disease, metabolic abnormalities, and gynaecomastia. Physical castration is mutilating and irreversible, and it carries the potential for serious psychological disturbance, although some offenders request it nonetheless.

Is there a clear medical rather than social reason for prescribing powerful drugs.

When the intensity or ability to control sexual arousal is the presenting feature—whether it manifests as frequent rumination and fantasy or strong and recurrent urges—then treatment directed towards the biological drive makes sense.

Treatment protocols can then be based on the medical indication (remembering that drugs other than the antiandrogens, such as selective serotonin reuptake inhibitors, can also be effective, particularly when sexual rumination is the presenting problem) rather than on risk.

When drugs work the clinical effect is often dramatic, with offenders reporting great benefit from no longer being preoccupied by sexual thoughts or dominated by sexual drive. These drugs can also allow offenders to participate in psychological treatment programmes where previously they may have been too distracted to take part. Given the transparency of benefits and risks, there is no obvious reason why an offender should not be able to make an informed choice about drugs. [Source BMJ, 2010]

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