to get some kind of therapy and medication to make them normal

Hi, Psychologist here. Does society have strong evidence that therapeutic interventions are reducing rates of, say, the most common disorders of anxiety and depression? Considering that the rates of these are going up, I don’t think we can assume there’s a hugely successful therapy to help those attracted to CSA images to change. Psychology is not a very good science principally because it offers few extremely effective answers in the real world.

In terms of medication androgen antagonists are generally used. This is because lowering testosterone generally leads to a lower sex drive. Here is an article about those drugs, including an offender who asked for them: https://www.theguardian.com/society/2016/mar/01/what-should-we-do-about-paedophiles

TW: the article contains discussion of whether offenders are even psychologically disordered, when set within a historical cultural context of child-marriage. This paragraph is two above the illustration of people trapped within concentric circular walls, and starts “In the 2013 edition …”.

Collis began to research the treatment and decided that it was essential to his rehabilitation. He believes he was born a paedophile, and that his attraction to children is unchangeable. “I did NOT wake up one morning and decide my sexual preference. I am sexually attracted to little girls and have absolutely no interest in sex with adults. I’ve only ever done stuff with adults in order to fit in with what’s ‘normal’.” For Collis, therefore, it became a question of how to control this desire and render himself incapable of reoffending.

[…]

Many experts support Aaron Collis’s self-assessment, that paedophilia is an unchangeable sexual preference. In a 2012 paper, Seto examined three criteria – age of onset, sexual and romantic behaviour, and stability over time. In a number of studies, a significant proportion of paedophiles admitted to first experiencing attraction towards children before they had reached adulthood themselves. Many described their feelings for children as being driven by emotional need as well as sexual desire. As for stability over time, most clinicians agreed that paedophilia had “a lifelong course”: a true paedophile will always be attracted to children. “I am certainly of the view,” Seto told me, “that paedophilia can be thought of as a sexual orientation.”

Brain-imaging studies have supported this idea. James Cantor, a psychiatry professor at the University of Toronto, has examined hundreds of MRI scans of the brains of paedophiles, and found that they are statistically more likely to be left-handed, shorter than average, and have a significantly lower density of white matter, the brain’s connective tissue. “The point that’s important for society is that paedophilia is in the brain at all, and that the person didn’t choose it,” Cantor told me. “As far as we can tell, they were born with it.” (Not that this, he emphasised, should excuse their crimes.)

[…]

Clinical reality is a little more complicated. “There’s no pretence that the treatment is somehow going to cure them of paedophilia,” Grubin told me. “I think there is an acceptance now that you are not going to be able to change very easily the direction of someone’s arousal.” Grubin estimates that medication is only suitable for about 5% of sex offenders – those who are sexually preoccupied to the extent that they cannot think about anything else, and are not able to control their sexual urges. As Sarah Skett from the NHS put it: “The meds only take you so far. The evidence is clear that the best treatment for sex offending is psychologically based. What the medication does is help people have a little bit of control, which then allows them to access that treatment.”

Some research on success rates:

Prematurely terminating treatment was a strong indicator of committing a new sexual offense. Of interest was the general improvement of success rates over each successive 5-year period for many types of offenders. Unfortunately, failure rates remained comparatively high for rapists (20%) and homosexual pedophiles (16%), regardless of when they were treated over the 25-year period. [https://pubmed.ncbi.nlm.nih.gov/11961909/]

Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. [https://journals.sagepub.com/doi/abs/10.1177/0306624X231165416 - this paper says that suppressing the sex drive with medication was the most successful treatment]

Men with deviant sexual behavior, or paraphilia, are usually treated with psychotherapy, antidepressant drugs, progestins, and antiandrogens, but these treatments are often ineffective. Selective inhibition of pituitary–gonadal function with a long-acting agonist analogue of gonadotropin-releasing hormone may abolish the deviant sexual behavior by reducing testosterone secretion. [https://www.nejm.org/doi/full/10.1056/nejm199802123380702 - this paper supports that lowering testosterone works best]