Chemical Castration for Sexual Offenders: Physicians' Views

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. For the first time in Asia, in July 2011, Korea introduced using chemical castration on sexual offenders. Under the current law, perpetrators of sexual crimes against minors aged less than 16 yr are subject to chemical castration. There have been growing calls for tougher punishment against sexual offenders and stronger preventive measures in the aftermath of a series of violent crimes victimizing women and children. Recently, a Cabinet meeting approved a revised bill, under which Korea will expand chemical castration to include those convicted of sexual crimes against minors under age 19, and retroactively apply the laws governing sexual offender personal information disclosure. Using hormonal drugs to reduce sexual violence recidivism is known as chemical castration. The first reported attempt of hormonal manipulation to reduce pathological sexual behavior occurred in 1944, when diethylstilbestrol was prescribed to lower testosterone levels (1). Medroxyprogesterone acetate and cy-proterone acetate have been used throughout the United States, Canada, and some European countries to diminish sexual fantasies and sexual impulses in sexual offenders (2). A more recent and promising development in the treatment of paraphil-ias is using luteinizing hormone releasing hormone (LHRH) agonists such as leuprolide acetate and goserelin. In 1996, Cali-fornia became the first state in the United States to authorize the use of either chemical or surgical castration for certain sexual offenders who were being released from prison into the community. This legislation was extremely controversial at the time (3); however, eight additional states have subsequently passed laws that provide some form of castration for sexual offenders under consideration for parole or probation. Currently , similar debates on the legislation and expansion of chemical castration have taken place in Korea. Testosterone is the major hormone associated with libido and sexual function, and several studies have reported that violent sexual offenders have higher levels of androgens than do nonviolent comparison groups and androgen levels correlate positively with both prior violence and the severity of sexual aggression (4-6). However, a clear cause-and-effect relationship between testosterone levels and sexual offending remains uncertain (7). Nevertheless, various comprehensive theories of sexual offending have incorporated hormonal factors despite surprisingly little evidence (8), and both surgical and chemical castration undoubtedly reduce sexual interest, sexual performance , and sexual reoffending (9). Surgical castration reportedly produces definitive results, even in repeat pedophilic offenders, by reducing …