Louis J Gooren1. 1. VU University Medical Center, 1081 HV Amsterdam, The Netherlands. louisjgooren@gmail.com
Abstract
CONTEXT: Blood testosterone codetermines the threshold for erotosexual imagery and sexual activity. Androgen deprivation may therefore have a place in the treatment of unacceptable sexual behavior. Although androgen deprivation can be effective for sex offenders, their basic human rights must be respected; otherwise such treatment constitutes a violation of their physical integrity and is ethically unacceptable. As experience in treating prostate cancers demonstrates, androgen deprivation may have serious side effects. Endocrinologists are qualified to advise on and monitor androgen deprivation, but they are placed in an atypical position because the indication for such treatment is not dictated by endocrine disease. OBJECTIVE: The aim of this study was to provide an ethical framework for advising on androgen deprivation treatment of sex offenders and dealing with side effects. EVIDENCE ACQUISITION AND SYNTHESIS: A literature search was conducted in PubMed, Psychinfo, and references from the multiple systematic reviews and meta-analyses published on this topic. An attempt has been made to provide an appreciation of the ethical aspects of androgen deprivation in sex offenders, the efficacy of treatment, the potential risks of treatment, therapeutic options, and recommendations for monitoring treatment. CONCLUSIONS: Provided that the human rights of sex offenders are respected and informed consent is given, androgen deprivation within a comprehensive framework of psychotherapeutic treatment can make a meaningful contribution to the prevention of recidivism by enabling better control of sexual impulses. Knowledge of side effects and their treatment has been mostly gleaned from experience with prostate cancer patients, and this should be made available to sex offenders undergoing androgen deprivation.
CONTEXT: Blood testosterone codetermines the threshold for erotosexual imagery and sexual activity. Androgen deprivation may therefore have a place in the treatment of unacceptable sexual behavior. Although androgen deprivation can be effective for sex offenders, their basic human rights must be respected; otherwise such treatment constitutes a violation of their physical integrity and is ethically unacceptable. As experience in treating prostate cancers demonstrates, androgen deprivation may have serious side effects. Endocrinologists are qualified to advise on and monitor androgen deprivation, but they are placed in an atypical position because the indication for such treatment is not dictated by endocrine disease. OBJECTIVE: The aim of this study was to provide an ethical framework for advising on androgen deprivation treatment of sex offenders and dealing with side effects. EVIDENCE ACQUISITION AND SYNTHESIS: A literature search was conducted in PubMed, Psychinfo, and references from the multiple systematic reviews and meta-analyses published on this topic. An attempt has been made to provide an appreciation of the ethical aspects of androgen deprivation in sex offenders, the efficacy of treatment, the potential risks of treatment, therapeutic options, and recommendations for monitoring treatment. CONCLUSIONS: Provided that the human rights of sex offenders are respected and informed consent is given, androgen deprivation within a comprehensive framework of psychotherapeutic treatment can make a meaningful contribution to the prevention of recidivism by enabling better control of sexual impulses. Knowledge of side effects and their treatment has been mostly gleaned from experience with prostate cancerpatients, and this should be made available to sex offenders undergoing androgen deprivation.