Taming the Beast Within

Photo Illustration by Darren Braun

The Institute for Sexual Wellness is located on the backside of a luxury apartment building in Quincy Center, facing the T stop and a municipal parking lot. There’s no sign out front, and the discreet location is difficult to find. The center’s founder, Renee Sorrentino, says this is by design. Sorrentino is a Boston University- and Harvard-trained forensic psychiatrist who treats chronically disturbed men—convicted pedophiles, rapists, exhibitionists, and voyeurs—for their deviant compulsions.

Many people doubt that convicted sex offenders can ever truly be cured, which has prompted states from Virginia to Oregon to pass laws making it even more difficult for them to get out of jail. But Sorrentino says deviant sexual disorders are like other mental diagnoses and can often be managed with meds and therapy. And she claims that she has a treatment for even the direst cases: chemical castration. Sorrentino believes that the procedure—a monthly injection of the drug Lupron—can radically curb men’s harmful desires, allowing them to return to quasi-normal lives. Widespread use of chemical castration could also protect potential victims, she says, because it would effectively neutralize the insidious compulsions that prompt men to act on their fantasies. Right now, she is one of only three doctors in Massachusetts who provide this treatment.

Sorrentino’s caseload of 100 patients is just a fraction of those who might benefit from chemical castration. In Massachusetts alone, there are more than 11,000 state-registered sex offenders, plus about 1,350 inmates serving time for sex crimes, and several hundred more sex offenders who have served out their sentences but are being held indefinitely in civil commitment facilities until they are deemed fit for release. Few ever are. It’s this last group—especially those convicted of abusing children—that is most problematic, and most dangerous. Yet with 30 patients currently on the experimental drug, Sorrentino has high hopes for Lupron, and for her patients, whom she casually refers to as “my guys.” Gaining public support for the treatment, however, is another matter.

Since opening her practice a decade ago, Sorrentino has become increasingly comfortable speaking about topics that make people squirm—deeply disturbing sexual fantasies, child molestation, prison. The petite brunette sits in her office, which is decorated with aboriginal art and burgundy tufted leather chairs. Thirteen framed diplomas and certificates crowd the pale-blue wall behind her. She says that her decision to treat patients with deviant sexual disorders—clinically known as paraphiliacs—was likely influenced by her father, a neuroendocrinologist who wrote his Ph.D. thesis on how the deprivation of hormones can influence behavior. She points to a photo on the file cabinet to her right: It’s a black-and-white shot of her father at work in his laboratory. A closer look reveals that he is, in fact, castrating a rat.

References to male castration date back to Greek mythology, but castration as a treatment for sexual disorders has roots in the late 19th century, when Swiss doctors first began performing the surgery. This method was used throughout the U.S. and Europe until the introduction of oral hormonal treatments, such as estrogen pills, in the 1940s and anti-libido medications in the 1960s. Deemed more humane than surgery, these medications were never considered a cure-all, and most had significant physical side effects, including feminization in men. Today, American doctors often prescribe antidepressants to paraphiliacs to help them suppress their compulsive tendencies. Paraphiliacs also commonly participate in a rehabilitation program called the Good Lives Model, which can include one-on-one and group-therapy sessions that involve training in personal responsibility, sexual-impulse control, and empathy. The program also offers biofeedback methods that measure their reaction to sexual stimuli.

Lupron is still a relatively new treatment, but psychiatric journals have deemed it promising—though not without significant risks. Sorrentino first witnessed the power of hormone therapies like Lupron when she took a forensic psychiatry clerkship at the Sexual Behaviours Clinic in Ottawa. The patients she saw in Canada were high-risk, which she says “tends to translate to people that have some sexual sadism, some arousal to violence and interest in kids, and have recidivated.” For men with seemingly incurable urges, Lupron has been shown to lower their testosterone, reduce their sex drive, and mitigate deviant desires. The urges are still there; they’re just not a 24/7 obsession.

To explain how it operates, Fabian Saleh, director of the Sexual Violence Prevention & Risk Management Program at Beth Israel Deaconess Medical Center, compares the drug to appetite suppressants. He says Lupron enables “carefully selected patients [to] gain control over their lives so they are not consumed day in and day out with wanting to have sex with a child.” Each doctor has his or her own analogy; Sorrentino suggests Lupron’s mechanism is akin to the volume being lowered on a radio. Either way, they both contend that Lupron’s effects are impressive. “In this field, you don’t often see profound changes. But when you do, it’s memorable,” Sorrentino says. “People get better with psychology, but it’s different than people getting better with an antibiotic.”

There are side effects, however. Patients on Lupron often experience hair loss, weight gain, and the development of breasts. Sorrentino regularly measures their sexual arousal levels and administers bone density scans, because suppression of testosterone can lead to osteoporosis in men. Yet they tell Sorrentino this is better than feeling unwanted urges.

Lupron is also expensive. On top of an $800 fee for the monthly dose, which in some cases is covered by MassHealth, treatment requires a daylong assessment by a doctor like Sorrentino or Saleh to determine whether a patient is eligible. Patients must often pay for the balance of the assessment themselves, which can run between $1,500 and $2,500. They are also required to cover the cost of all follow-up tests. Sorrentino’s Lupron patients need constant monitoring: Blood tests, for instance, check their testosterone levels to ensure they’re not secretly taking Viagra to counteract Lupron’s effects. Other men who are compulsively promiscuous may tell her they’re not sexually active when, in fact, they are. These instances are rare, Sorrentino says, but they’re also when a polygraph machine can come in handy.