Original communication
Treatment outcomes of chemical castration on Korean sex offenders

https://doi.org/10.1016/j.jflm.2013.06.003Get rights and content

Abstract

After the recent enactment of the chemical castration legislation for sex offenders in Korea, we sought to report primary treatment outcomes for 38 patients at the National Forensic Hospital since 2011. After chemical castration, these patients experienced reductions in frequency and intensity of sexual drive, frequency of masturbation and sexual fantasies. The incidence of adverse effects was similar to that of previous reports. Serial hormonal evaluations showed an association between testosterone level and degree of paraphilic and non-paraphilic sexual thoughts. A notable finding was an unexpected upsurge of testosterone levels with intense sexual drive and fantasy observed during the first 2 months after cessation of treatment. This suggested the need for a temporary anti-androgen therapy or close surveillance during this period. When proper precautions are taken, chemical castration may be an effective treatment strategy for paraphilic and non-paraphilic sex offenders.

Introduction

Attempts at using hormonal manipulation to control pathological sexual behaviour and to prevent sexual offenses have been reported since the 1940s.1 Recently, androgen-deprivation treatment (ADT), commonly referred to as chemical castration, has been employed as a supportive measure in addition to psychotherapy for treatment of sex offenders in many Western countries.2 Sexual offences are crimes that violate the integrity of the community and are of concern to the general public. As a result, legislation to prevent repeat offences has often been driven by both the public and the media. Despite evidence that chemical castration with or without psychotherapy can successfully reduce recidivism rates,3 the criminal justice systems in many countries are reticent to endorse this legislation given concerns regarding preservation of human rights, adverse effects and cost.3, 4 In response to ongoing public demands for implementation of community safety measures, the Ministry of Justice of Korea enacted a legislation in 2011 requiring chemical castration of sexual offenders whose victims are minors under the age of 16. Two chemical agents have been approved for sex offender treatment including an anti-androgen, cyproterone acetate (CPA), and a gonadotropin-releasing hormone (GnRH) agonist, leuprolide acetate (LA). While chemical castration has been mandatory for sex offenders since 2011, prior detainees at the National Forensic Hospital who were under consideration for parole or probation were candidates for voluntary treatment. In this study, we sought to report preliminary data on psychobehavioural and clinical outcomes of short-term ADT in Korean sex offenders.

Section snippets

Participants

This prospective cross-sectional analysis included 121 patients at the National Forensic Hospital who were imprisoned for sexual offenses. After a detailed explanation of the therapeutic effects and possible risks of chemical castration, 61 patients volunteered to receive ADT in an attempt to self-alleviate excessive sexual aberrancy. Participation was completely voluntary and was not a condition of parole or probation. None of the subjects had received prior ADT or had contraindications to

Patient demographics

Baseline psychiatric diagnoses of the 38 patients who underwent ADT are shown in Table 2. All subjects were male, and the mean age was 33.4 (range 17–51) years. Six (16%) patients were under the age of 19 years at the time that they committed sexual assault; 21 (54%) patients had been convicted of sexual abuse of a child under the age of 13; three (6%) patients had been convicted of incest.

Effects of ADT on sex hormone levels

LA 3.75 mg subcutaneous depot injections were administered to patients for 3 consecutive months, followed

Discussion

ADT has been shown to reduce sexual interest, performance of sexual acts and rates of recidivism.10, 11 Independent of the strong influence that psychiatric factors play with respect to criminal sexual offences, these findings suggest that the biology of sexual drive and arousal is primarily mediated by testosterone.12, 13, 14, 15 We report similar results in that sexual drive and fantasy were suppressed after ADT despite a variety of baseline psychiatric disorders. Indeed, our expectation is

Conclusion

Progress has been made in the treatment of paraphilic and non-paraphilic sexual disorders that can be applied to sex offenders as a group. However, with deeper insight into hormonal manipulation, tailored modifications in treatment regimens for each individual will increase treatment success rates. ADT is an effective method for reducing sexual drive in Korean sex offenders with minimal side effects.

Ethical approval

None declared.

Funding

None.

Conflict of interest

All authors have no conflict of interests to declare.

Acknowledgements

On behalf of the Ministry of Justice, Korea, authors gratefully acknowledge the support and guidance of F.S. Berlin in support with establishing ‘chemical castration’ protocols.

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