March 2, 2001 -- Increasingly severe sex offender laws nationwide are convincing some criminals to take drastic measures in an effort to prove they are fit for society — even resorting to a treatment so brutal it disappeared from the criminal justice system decades ago.

At least 15 repeat sex offenders in California alone have asked for surgical castration as a way of avoiding indefinite incarceration, according to the Los Angeles Times. Over the last three years, two offenders — including a pedophile freed three months ago — have walked free from state mental hospitals after undergoing the surgery.

California is one of at least seven states with laws that mandate continued civil confinement of convicted offenders even after their prison terms expire. Although opponents challenged the constitutionality of the laws for years, claiming they violate "double jeopardy" rules, the measures are here to stay.

In January, the U.S. Supreme Court all but ruled out the possibility that civil confinement ever could be challenged in federal court as double jeopardy.

California is also one of a handful of states that mandate castration — either chemical or surgical — for repeat offenders before being released. Texas was the first state to offer castration to repeat offenders on a voluntary basis.

'Cruel and Unusual Punishment'?

In some cases, surgical castration has convinced judges and state officials that repeat offenders no longer pose a threat. In Florida, an offender's sentence was cut short in 1999 after he was castrated. Repeat offenders in other states, including Illinois, Ohio and Arkansas, have either requested or received the surgery as a way to bargain for a reduced sentence.

Across the nation, law enforcement officials are experimenting with other ways to tinker with offenders' libidos to help them control their behavior. In Colorado, for example, state prison officials are administering anti-depressants to offenders to study the drugs' effects on reducing their sexual appetites.

But of all the treatments available, surgical castration is the most severe and controversial. The operation involves removal of the testes, where 95 percent of testosterone is produced.

For many who oppose it, surgical castration is a barbaric way to manage the behavior of high-risk offenders. Civil rights groups such as the American Civil Liberties Union have lobbied against the surgery in exchange for reduced sentences, calling it "cruel and unusual punishment."

Questioning the Effectiveness of Castration

Despite the severity of castration, not everyone — including leading medical experts — is even convinced of its effectiveness.

A substantial percentage of surgically castrated offenders retain some sexual functioning, according to the Association for the Treatment of Sexual Abusers, a nonprofit international group of researchers and clinicians. The ATSA is opposed to surgical castration procedures, it says, because less invasive medication therapy can achieve the same results, if not better.

But surgical castration has been proven to reduce the sex drives of many offenders, according to several studies. A German study showed a recidivism rate of 3 percent for castrated offenders, compared to 46 percent for non-castrated offenders.

It's important to remember, however, that castration is not a quick fix and doesn't work for everyone, warns Fred Berlin, founder of the sexual disorders clinic at Johns Hopkins University.

Surgery is most likely to work for offenders whose sex drive motivates their crimes, such as pedophiles or those aroused by coercive sex, Berlin says. But offenders who commit sex crimes for other reasons, like those who lack a conscience or abuse drugs or alcohol, probably would not benefit from surgery, he said.

Some victims' rights groups and law enforcement officials also argue that offenders could nullify the surgery later by boosting their testosterone levels through gels and patches. "It's not a panacea," Berlin said.

A Problem of Politics and Medicine

So, if surgical castration won't work for all offenders and medication can be just as effective in reducing libidos of castration candidates, why resuscitate the archaic practice?

Berlin says the motivation is often more political than than medical, and the result is a less-than-informed approach to solving a complicated problem.

"To some people, this deserves to happen to these folks," Berlin said. "Forcing it on people who haven't been evaluated properly and may only be taking it out of desperation, in my judgment, is not proper medical practice."

In the end, a reasonable approach to managing offenders' behavior should be reached through the collaboration of doctors, politicians and law enforcement officials, Berlin says.

For those who are deemed good candidates for castration, successful integration back into society should involve continued therapy and treatment for related problems such as depression or alcoholism, he said. To assure that castrated offenders are not boosting their testosterone, their hormone levels could be periodically checked as terms of their release, he added.