Alabama Gov. Kay Ivey (R) signed a bill that requires anyone convicted of a sex offense involving a child under the age of 13 to start receiving testosterone-inhibiting medication a month before their release from prison.

The “chemical castration” law is a requirement meant to keep perpetrators from committing similar crimes.

Ivey signed the bill Monday — the last day under Alabama law that she could have done so after the state legislature passed it on May 31. Gina Maiola, a spokeswoman for Ivey, said the law will apply to people who commit sex offenses after Sept. 1 of this year.

Most offenders will have to pay for their treatment, which will be administered by the Department of Public Health, until a judge decides the medication is no longer necessary.

Under the law, a judge — and not a doctor — will tell the offender about the effects of the treatment. Offenders can choose at any time to stop getting the medication and return to prison to serve the remainder of their terms. Anyone who stops receiving the castration treatment without approval will be considered guilty of a Class C felony, punishable under Alabama law by up to 10 years in prison and a fine of up to $15,000.

What is the treatment?

“Chemical castration” is a misnomer, as the process leaves the testes intact, can be reversed and does not prevent a man from reproducing. It does not guarantee a man’s sexual urge will be eliminated. (There’s no consensus on whether the process would be effective for women.)

Experts warn that the treatment is not a panacea and should be used with caution. And there are few studies that attempt to determine the success rate of the treatment. A review of several of these studies shows that some found success in offenders who show sexual desire toward children. Others found no significant effect.

State Rep. Steve Hurst (R-Calhoun County), who sponsored the bill, did not respond to a request for comment. He told CBS 42 that some people have told him that mandated chemical castration is inhumane.

“I asked them, ‘What’s more inhumane than when you take a little infant child and you sexually molest that infant child when the child cannot defend themselves or get away, and they have to go through all the things they have to go through?’” Hurst told CBS 42.

Other versions of castration laws

This is not the first time Hurst has proposed some version of a castration law. His bill in 2011 would have required surgical castration — removing parts of the testes — for people convicted of sex offenses involving children under 13 years old, according to the Anniston Star.

More than 57,000 children in the United States experienced sexual abuse in 2016, according to the Rape, Abuse & Incest National Network. In 93 percent of cases, the child knew the perpetrator.

Seven other states and U.S. territories — California, Florida, Guam, Iowa, Louisiana, Montana and Wisconsin — permit some sex offenders to be forced to take testosterone-suppressing drugs as a condition of sentencing, release or supervision, according to the National Conference of State Legislatures. A Republican lawmaker in Oklahoma proposed a bill last year that would have authorized the treatment there, but the measure failed.

What are the effects?

Frederick Berlin, director of the National Institute for the Study, Prevention and Treatment of Sexual Trauma, said testosterone-suppressing drugs produce “low rates of recidivism” in people whose abusive behaviors were driven by their sexual attraction to children. The dosage would depend on the specific hormone-suppressing drug, Berlin said, but all chemical castration drugs would work only as long as the person kept taking it.

Side effects of the treatment can include depression, osteoporosis and anemia. Other possible side effects include anaphylaxis, kidney failure or heart failure, depending on the medication used.

Trent Holmberg, a forensic psychiatrist, said most physicians would not consider an offender to have given informed consent to treatment if a judge, not a doctor, read them the effects of the drug, as the Alabama legislation requires.

Berlin said he would like to see more efforts to offer chemical castration to pedophiles — or people who are sexually attracted to children — before they potentially commit abuse and not just when they are about to be released from prison. Lawyers should also consult with doctors about which offenders could benefit from chemical castration, Berlin said.

“If they’re using this punitively . . . just carte blanche, without a proper assessment, ordering people to take it,” he said, “from the medical and scientific perspective, that makes no sense to me.”

Questions of ethics and constitutionality

Ethicists also have raised concerns about the lack of full and free consent and the potential side effects of involuntary castration, including a higher risk of osteoporosis. Gulzaar Barn, a philosopher at King’s College London, argued in a recent journal article that chemical castration “falls beyond the appropriate remit of the criminal justice system.”

Laws requiring chemical castration have also come up against questions of constitutionality. John Stinneford, a law professor at the University of Florida, argued in a legal paper in 2006 that the treatment is “impermissibly cruel” under the Eighth Amendment’s ban on “cruel and unusual punishments.”

The Supreme Court, however, bases its definition of “cruel and unusual” on an “evolving standards of decency” test, Stinneford told The Washington Post. This process, he said, means if the public hates or strongly fears a group of people, the court is likely to support most punishments inflicted upon them.

Even if chemical castration is allowed, Stinneford said, it might fail at rehabilitating offenders because some of the side effects are so unpleasant. Paroled perpetrators might choose to flee from their supervision to avoid taking the drug, which would make them more of a public threat, Stinneford said.

“It seems more like a symbolic gesture that may actually undermine public safety,” he said, “as opposed to a measure that would actually promote it.”

Randall Marshall, the executive director of the American Civil Liberties Union of Alabama, said his organization also considers chemical castration unconstitutional on other grounds, such as due process and the right to privacy. Altering someone’s body through forced treatment constitutes impermissible medical experimentation, he said.

Similar laws passed in other states to require chemical castration are rarely used, Marshall said. Reducing someone’s sex drive does not necessarily prevent reoffending, he said, because libido is not the only motivating factor behind sexual abuse.

“I think sexual assault has always been more than just about sex,” Marshall said. “It’s about power, it’s about exercising control over someone else and a variety of other things.”

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