California passed a law in 1996 that mandated chemical castration for repeat child molesters. As of that date several other states have considered passing such laws, those being, Colorado, Florida, Louisiana, Massachusetts, Michigan, Texas and Washington. The most common drugs used for this purpose are Depo-Provera and Depo-Lupron. The purpose of these drugs is to lower the blood serum testosterone levels in the subjected males in the belief that it will lower sexual drive and aggression. The drug reduces the sexual drive by influencing the hypothalamus that stimulates the pituitary to release the hormones that control the production of sperm. Men using the drug can still obtain an erection, ejaculate and engage in sexual intercourse. (Cummings, Buell , 1997) What these laws do not take into consideration is that these men can still engage in non-criminal and criminal sexual behavior while on these drugs. In effect, these current laws have allowed politicians to prescribe drugs rather than the medical fields. While their use might placate societies need for punitive retribution, as a blanket solution it not only falls short of the mark but also is contrary to medical ethics when used to further political needs. Dr. Barry Maletzky stated:

"Castration as part of a court-imposed sentence cannot be distinguished from corporal punishment and, as such, has lacked a serious support base in this country, despite the frenetic and vengeful clamor among cursory observers to cut it off. We lack follow-up studies of castration and it is unlikely now that they will be done. It would be of interest to learn how castratos now go about their lives and how they regard their prior surgical decisions about their lives and how they regard their prior surgical decisions (or more likely their European governments' decisions)" (Maletzky, 1997).

The use of antiandrogen medroxyprogesterone acetate drugs (commonly called Depo-Provera) is not without risk. It is a health risk for offenders who have existing diabetes, obesity and pulmonary disease. Hormonal agents such as cyproterone acetate widely used in Europe have reduced testosterone levels but have the side effects which may include breast enlargement, tumors and edema (Cooper, 1981). Women who have taken this drug for menstrual irregularity for periods of two to twelve months have reported malignant breast tumors, venous thromboses and increased hemorrhagic tendency (Zbytovsky & Zapletalek, 1979).

Dr. Fred Berlin pointed out that the mandatory nature of the California bill never had the backing of the medical or scientific community (Berlin 1997). He also stated there is no provision for the particular offender to have done through assessment to determine the nature of his individual pathology. The nature of the bill neither allows for informed consent nor does it assure that those going through chemical castration belong to a group of offenders who might in fact benefit from such a procedure. The intervention does not stop offenders who chose not to change their behavior. The 1980's saw the use of antiandrogen medications as having potential to reduce the sexual libido and the risk of re-offense by such proponents as Money and Bennett (Money & Bennett, 1981). Wincze, Bansal, and Malamud (1986) paired the repetitious compulsive behavior of the sex offender to other addictive behaviors. They likened the smell or sight of alcohol being a strong trigger toward relapse for the alcoholic as being similar to the sight and sound of children as the physiological trigger in pedophiles. They further found that in a small sampling of sex offenders, there was reduced genital response. They then hypothesized that it would then act to prevent relapse to the offender's stimulus cues. (Laws, 1989) While some sex offenders have repetitious deviant sexual fantasies that interfere with their concentration, and some may not be conducive to behavioral techniques to adapt to healthy fantasies, the use of antiandrogen medroxyprogesterone acetate drugs is not the only medication that can have effective results. Kafka (Kafka, 1994) reported success with such selective serotonin reuptake inhibitors such as Prozac and Anafranil for men with paraphilia disorders. The theory behind the use of these particular drugs was the effect beneficial effects that it has on other obsessive-compulsive disorders. Even with the use of the serotonin reuptake inhibitors (SSRI's), use of such treatment is under the supervision of a physician.

The use of these drugs require evaluation prior to use, they need to be prescribed by a physician after appropriate medical assessment, should be available only after other alternatives are ruled out and should be part of a more comprehensive treatment plan. It should also include informed consent. During the period of time in which the California bill was proposed few treatments provided paired use of drug treatment with behavior modification. Paykel (Paykel, 1979) did make mention of a dual approach and it was it proposed by Marks (Marks, 1981a). Two categories of offenders are thought to be candidates for temporary use of the category of medications in which Depro-Provera falls based on some research studies. The two categories identified were the rapists and the homosexual pedophile. Although Maletzky pointed out that the following sampling could not be replicated a trend which identifies that homosexual pedophiles may require longer treatment had surfaced. Maletsky provided the following sampling.

 Use of depo-Provera in Sexual Offenders: Characteristics of Medicated and Non medicated Populations

Factors	Medicated (N=85)	Non-Medicated (N=4,915)
Avg. age (yrs.	30.1	32.5
Avg. duration of offending behavior (yrs.)	13.3	7.2
% with past convictions	45.7	33.22
Avg. number of victims	2.4	1.3
% with primary or auxiliary diagnosis of pedophilia	29.4	16.9
% who have raped	45.7	2.4

Maletsky, 1991, p 185

Also mentioned are "offenders with central nervous system impairment, lack of impulse control and offending behaviors of grave risk" (Maletzky, 1991, p. 192) In these cases a recommended period of drug treatment is three to four months, with the drug adjusting testosterone levels to approximately half . Provera cannot be estimated based on body size or typical dosage but is based on the individual offender on a case by case basis. The goal of such use of medication is to prevent offenses until behavioral modification can come into play. This of course requires that the offender openly and freely committed to learn behavior modification techniques. Maletzky cautions that the use of anti-testosterone drugs requires guidelines when used for sex offender treatment. These being:

 "1. Antitestosterone agents should be employed only if there is

a. substantial risk of repeated offenses in the period during which behavior therapy has been initiated but has not yet been effective or

b. a risk that any single offense will produce substantial harm to a victim as, for example, an act of child molestation as opposed to an act of exhibitionism.

 2. Such agents should be employed for as short a time as possible. Their use should be tapered once evidence is gained that behavior therapy is becoming effective.

3. Such agents should be given at the lowest dose necessary to produce the required reduction of sexual drive

4. Such agents should be employed in cases in which continued monitoring of plethysmograph recordings and plasma testosterone levels can occur.

5. Such agents should not be employed as the sole therapeutic approach.

6. Such agents should only be employed in cases in which competent consent can be obtained or in which a guardian can approve their administration." (Maletzky, 1991, p 191)

 Of further concern is the use of antitestosterone drugs with juvenile offenders. Several researchers reported disturbing side effects. Hawker and Mayer (1981) found a weight gain in nearly 50% of the subjects; sperm production returned to normal levels, there was hyperinsulinemic response to glucose load and gastrointestinal functioning and gall bladder functioning was called into question. Gagne (1981) reported levels of fatigue, weight gain, hot and cold flashes, phlebitis, nausea, vomiting, headaches and sleep disturbances. Berlin and Menicke (1981) reported nightmares, hypoglycemia, leg cramps. Antitestosterone treatment did however, in low dosages during a short period of less than 3 months, suppress sexually deviant behavior while other behavioral/cognitive treatments were started (Barbaree, Marshall, Hudson, 1993). Bradford reports the use of clomipramine for a sexually obsessive-compulsive 17-year-old who was a high risk for offense. The adolescent had been referred for fetishism and had clear lust-murder fantasies directed at 10 year old girls. The individual had been placed on an antitestosterone drug with the result of the side effect of breast enlargement. He had remained untreated after the discontinuation of the drug. Within a 2 to 3 week period after the use of clomipramine, which had little side effects, the individual reported reduction in sexual fantasies. A follow up penile plethysmorgraph test confirmed reduced overall arousal including rape arousal and other pedophilic patterns. (Bradford, Pawlak, 1987)

 The use of chemical castration should only be available to those who want the treatment or can be actually helped by it (ATSA, 1997). While the use of chemical castration has it's place with some sex offender cases there are much more human treatment programs for the majority of sex offenders who chose to change their behaviors.

ATSA statement. (1997, February 7). Anti-androgen therapy and surgical castration.

Barbaree, Howard E., Marshall, William L., Hudson, Stephen M. (Eds) (1993) Juvenile sex offender. New York, N.Y.: Guilford Press.

Berlin, F.S. (1997, April 3). "Chemical castration" for sex offenders. [Letter to the editor]. New England Journal of Medicine 336(14), p 1030.

Berlin, F.S., Menicke, C.F. (1981) Treatment of sex offenders with antiandrogen medication: conceptualization, review of treatment modalities and preliminary findings. American Journal of Psychiatry, 138, pp 601-607

Bradford, J.M., Pawlak, A (1987) Sadistic homosexual pedophilia: treatment with cyproterone acetate: A single case study. Canadian Journal of Psychiatry, 32, pp 22-33

Cumming, Georgia, Buell, Maureen (1997) Supervision of the sex offender. Brandon, VT: Safer Society Press.

Cooper, A.J. (1981) Placebo-controlled trial of the antiandrogen cyproterone acetate in deviant hypersexuality. Comprehensive Psychiatry, 22, pp. 458-465

Freeman-Longo, Robert, Blanchard, Geral T. (1998) Sexual abuse in america: epidemic of the 21st century. Brandon VT: Safer Society Press.

Gagne, P., (1981) Treatment of sex offenders with medroxyprogesterone acetate. American Journal of Psychiatry, 138, pp 644-646

Hawker, P.A., Mayer. W.J. (1981) Medroxyprogesterone acetate treatment for paraphilic sex offenders. In J.R. Hayes, T.K. Roberts, K.S. Solway (Eds.), Violence and the violent individual. New York, N.Y.: S.P. Medical and Scientific Books. Pp 353-373

Laws, D. Richard (Ed.) (1989) Relapse prevention with sex offenders. New York, NY: Guilford Press.

Money, J., Bennett, R.G. (1981) Postadolescent paraphilic sex offenders: Antiandrogenic and counseling therapy follow-up. International Journal of Mental Health, 10, pp 122-133.

Kafka, M. (1994) Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Annuals of Clinical Psychiatry. Vol. 6, No. 3.

Maletzky, B. (1997). Castration: A personal foul. Sexual Abuse: A Journal of Research and Treatment, 9(1) pp.1-5

Maletzky, B. (1991) Treating the sexual offender. Newbury Park, CA: Sage Publications, Inc.

Marks, I/M. (1981a) Cure and care of neuroses. New York, N.Y.: John Wiley

Paykel, E.S. (1979, June). Sexual offender research. Paper presented to the Society for Psychotherapy Research, Oxford.

Wincze, J.P., Bansal, S., & Malamud, M. (1986) Effects of medroxyprogesterone acetate on subjective arousal, arousal to erotic stimulation, and nocturnal penile tumescence in male sex offenders. Archives of Sexual Behavior, 15, pp. 293-305

Zbytovsky, M., Zapletalek, M. (1979) Cyproterone acetate in the therapy of sexual deviations. Acta Nervosa Scandinavica Supplement (Praha), 21, 162