6.1.6 Bio treatment/ Hormone Therapy & Maletsky 2006

Question 1

Who is testosterone lowering medication focused towards?

Answer 1

reducing sex drive of sexual offenders (peodophilia + paraphilia) via reduction of male sex hormone to decr recidivism in sexual offenders

Question 2

What does testosterone lowering medication use?

Answer 2

Anti- androgens
> Androgens found naturally in male + fems via testosterone
> Anti androgens decr testosterone, predominantly in men, as male sex drive based off of high lvls of testosterone

Question 3

Why might this method be more ethical than other biological treatments.

Answer 3

Avoids castration so is less painful, not permanent unlike castration

Question 4

2 examples of TLM (Testosterone lowering medication)

Answer 4

1) CPA
2) MPA

Question 5

Describe how CPA works to reduce criminal behaviour.

Answer 5

• Binds to receptors against T competitor (dihydrotestosterone), T present but non funcitoning at androgen receptor sites, incl brain, blocking intercellular T- uptake + metabolism
• Only available in Canada
  Side effect: Kidney/ Liver dysfunction, weight gain
• Decr sexual desire by end of 1st week, maximum effects by 3rd/4th week

Question 6

Describe how MPA works to reduce criminal behaviour.

Answer 6

• Administered via depo-provera injection (often used as birth control). Fem hormone (oestrogen) , decr T functioning by lutenising hormones in men. Injected intramuscularly every 7-10 days, 300-400 mg
• Side effects: Osteoperosis, weight gain, depression, breast enlargement (so lowers self esteem/ body dysmorphia- may be emasculating)
• Can be v effective, but if treatment stopped, T lvls return to pre-treatment, so sexually deviant behav likely to ensue

Question 7

DESSERT- Diff treatment

Answer 7

P- Surgical castration as alt
E- removal of male testes in its entirety, all sexual desires (normal + abnormal) removed
E- S for hormone therapy, castration may be deemed too invasive as its irreversible but hormone therapy is reversible, so sexually deviant offender will not have the inavsive long term treatment

Question 8

DESSERT- Expense

Answer 8

P - Hormone therapy is available on the NHS
E - This means that it should be available and accessible to all
E - However Maletzky found that 41% of people who were recommended treatment didn’t receive it due to lack of availability in area

Question 9

DESSERT- Supporting studies

Answer 9

P-Malestky (2006)
E-Studied effectiveness of MPA on reducing recidivism for offenders deemed suitable for med compared to those deemed suitable for MPA who didnt take. Out of original 275, found those who took MPA less likely to reoffend, but those who didnt take had 31% reoffend, 60& of the recidivism crimes being sexual eg paedophilia, rape.
E- S, incr credibility of hormone therapy for reducing recidivism in sexual crimes due to MPA decr T therefore sexual drive + atypical sexual behavs.

Question 10

DESSERT- Side effects

Answer 10

P-Yes
E-CPA- Kidney/ liver dysfunction, MPA- Breast enlargement (due to incr oestrogen/ fem hormone), weight gain for CPA + MPA
E-W, map lead to body dysmporhia, declining mental health and bullying/ embarrassment so crims may stop taking meds to reduce side effects but this can incr recidivism as sexually deviant behavs will return to T lvls returning to normal.

Question 11

DESSERT- Ethics

Answer 11

P- Informed consent
E- Hormone therapy invasive as it lowers T lvls, therefore requiring fully informed consent devoid of coersion. But if offender is imprisoned, they may be administered TLM as legal requirement, neglecting the offender’s consent.
E- W, lowers ethical nature of TLM due to invasiveness and lack of bodily ownership/ freedom for offenders.

Question 12

DESSERT- Reason/mask

Answer 12

P - Hormone treatment masks symptoms
E - It doesn’t tackle the cause of the offence
E - Therefore there is a risk of recidivism once the treatment is done

Question 13

DESSERT- Time

Answer 13

P- Fairly quick
E-Mpa + CPA decr sexual desires by end of 1st week, best results by 3rd/4th week
E-W, effective but only a short-term solution for offenders and once treatment is stopped, T levels return to normal alongside sexually deviant behav. Whereas AM programmes/ CBT teaches offender life skills to decr their aggressive urges post treatment.

Question 14

Maletsky- Aims?

Answer 14

To investigate whether MPA reduces sexual recidivism versus no treatment
To investigate the measure for recommending MPA and evaluate those recommended it

Question 15

Maletsky- Sample?

Answer 15

• 275 men
• From Oregon
• 60% of the offences committed by the men were of sexual nature

Question 16

What drug did Malestky use?

Answer 16

MPA

Question 17

Malestky- 3 conditions of study?

Answer 17

1) Men who needed MPA and received it (79/134 released)
2) Men who needed MPA and didn’t receive it (55/134 released)
3) Men who didn’t need MPA (141/ original 275- not released from jail)

Question 18

Maletsky- Procedure?

Answer 18

Retrospective data gathered through looking back over 275 inmates after their release to look at recidivism rate to compare those on the MPA programme with those not on treatment
The dose of MPA was an injection every two weeks
Data was collected from supervising officers with questionnaires about whether new offences had been committed, violation of parole had occurred, or any re-arrests of sexual nature

Question 19

Maletsky- results?

Answer 19

Out of them 134 were deemed suitable for MPA and of that only 59% received medication whereby some were down to local area not having the resources
Almost 70% of homosexual paedophiles received MPA, compared to 46% of men with heterosexual paedophilia
0% of sexual offenders re-offended with treatment whereas 58.8% re-offended without

Question 20

Malestky- Conclusions?

Answer 20

MPA reduces recidivism
However may not be effective for everyone as some could not receive due to limited local resources
Majority of MPA recommendations were for most shocking crimes
Deciding who ‘needs’ the medication was not a valid measure