Anti-Androgen Therapy and Surgical Castration

Adopted by the ATSA Executive Board of Directors on February 7, 1997

Utilizing hormonal agents, anti-androgens and surgical castration in the management of sexual abusers continues to be an area of concern and attention for many including researchers, clinicians, program administrators, legislators, sexual abusers, victims of sexual abuse, as well as the general public. The Association for the Treatment of Sexual Abusers holds that:

...Organic treatments have been used to reduce the sexual drive of some sexually aggressive males and other paraphiliacs whose inability to control their behavior leads to repeated occurrences of sexually deviant behavior.

...The role of sexual motivation varies among abusers; therefore, the reduction of sexual drive would be of limited usefulness for some abusers.

...Anti-androgen therapy should be prescribed by a physician only after an extensive offense specific evaluation has been completed.

...Not all abusers are the same and anti-androgen therapy is not appropriate for use with all sexual abusers. It is important to develop ordered and reasonable criteria based on diagnosis, history, motivation and risk when prescribing the medical intervention.

...Anti-androgen medications carry some medical risk; therefore, the treatment should only be administered under ongoing medical supervision.

...Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan. An abuser should be involved in concurrent cognitive-behavioral treatment designed to address other aspects of the deviant behavior in addition to sexual interests. These medications should never be used as a sole method of treatment.

...As with any treatment intervention, appropriate informed consent must be obtained when anti-androgen therapy is implemented.

1 ...The effect of surgical castration is to reduce the availability of androgen by removing the testes where approximately 95% of the testosterone is produced. Although it seems reasonable and has, in fact, been shown that surgical castration may reduce paraphiliac fantasies and behaviors, there are alternative and less invasive treatments available.

...ATSA is opposed to surgical castration procedures based on the availability of anti-androgen medications which can achieve the same, if not better, results.

...A substantial percentage of surgical castrates retain sexual functioning. Even if an abuser's capacity to have an erection or ejaculate is permanently inhibited, the act of sexual aggression many times involves more than the use of the penis and those behaviors would not be affected.

...Replacement androgens can be obtained after the surgical castration procedure, taken as a supplement to restore testosterone levels to pre- castration levels, thus nullifying the effects of the surgical castration.

BIBLIOGRAPHY

Berlin, F.S. & Meinecke, C.G. (1981). Treatment of Sex Offenders with Antiandrogenic Medication: Conceptualization, Review of Treatment Modalities and Preliminary Findings. American Journal of Psychiatry, 138, 601-607.

Bradford, J.M.W. (1995). Pharmacological Treatment of the Paraphilias. In J.M. Oldham & M.B. Riba (Eds.), Review of Psychiatry (pp.755-778). Washington D.C.: American Psychiatric Press.

Bradford, J.M.W. (1985). Organic Treatments for the Male Sexual Offender. Behavioral Sciences and the Law, 3, 355-375.

Bremer, J. (1959). Asexualization: A Followup Study of 244 Cases. New York: MacMillan.

Cooper, A.J., Sandau S., Losztyn S. & Cernovsky, Z. (1992). A Double- blind Placebo Controlled Trial of Mexdroxyprogesterone Acetate and Cyproterone Acetate with Seven Pedophiles. Canadian Journal of Psychiatry, 37, 687-693.

2 Cooper, A.J., (1986). Progesterone in the Treatment of Male Sex Offenders: A Review. Canadian Journal of Psychiatry, 31, 73-79.

Heim, N. & Hursch, C.J. (1979). Castration For Sexual Offenders: Treatment or Punishment? A Review and Critique of Recent European Literature. Archives of Sexual Behavior, 8, 281-304.

Kafka, M.P. (1994). Sertaline Pharmacotheraphy for Paraphilias and Paraphilia-related Disorders: An Open Trial. Annals of Clinical Psychiatry, 6, 189-195.

Meyer, W.J., Cole, C., & Emory, E. (1992). Depo-provera Treatment for Sex Offending Behavior: An Evaluation of Outcome. Bulletin of the American Academy of Psychiatry and the Law, 20, 249-259.

Ortmann, J. (1980). The Treatment of Sexual Offenders, Castration and Antihormonal Therapy. International Journal of Law and Psychiatry, 3, 443-451.

Stermac, L. & Hucker, S. (1988). Combining Cognitive-Behavioral Therapy and Pharmacotheraphy in the Treatment of Pedophile Incest Offenders. Behavioral Sciences & the Law, 6, 257-266.

Sturup, G.K. (1972). Castration: The Total Treatment. In H.L.P. Resnik & M.E. Wolfgang (Eds.), Sexual Behaviors: Social, Clinical and Legal Aspects (pp. 361-382). New York: Little, Brown.