Atlas›Domain XVI · Historical, discredited & harmful›Guide 069
Guide XVI-069

Testicle-transplant experiments

Eugen Steinach, Robert Lichtenstern1918Vienna
A 33 · L 54 · M 1318 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the historical account of Eugen Steinach's and Robert Lichtenstern's experiments as given by the Embryo Project Encyclopedia (2017), Hansson et al. (Urologia Internationalis, 2020), the Magnus-Hirschfeld-Gesellschaft and Greif (2019); current professional and international positions as stated by the APA's 2021 resolutions, the UK Memorandum of Understanding on Conversion Therapy (version 2, revision A) and the UN Independent Expert's report A/HRC/44/53 (2020).

The testicle-transplant experiments were an early twentieth-century attempt, centred in Vienna, to "cure" homosexuality in men by surgery on the body. The physiologist Eugen Steinach held that the hormone-producing tissue of the gonads, not heredity or the mind, shaped sexual characteristics and desire; from this he and the urologist Robert Lichtenstern argued that replacing a homosexual man's testicular tissue with tissue from a heterosexual man would change his orientation. Their 1918 paper, "Umstimmung der Homosexualität durch Austausch der Pubertätsdrüsen" (roughly, "Re-tuning of homosexuality through exchange of the puberty glands"), reported a claimed conversion. [source: Embryo Project Encyclopedia; Hansson et al. 2020; Greif 2019] The idea was taken up at Magnus Hirschfeld's Berlin institute, where staff held that homosexual men's testicles contained "female" cells, and patients were referred for the operations; the operations were later shown to be "unsuccessful". [source: Magnus-Hirschfeld-Gesellschaft, Rimmele]

This is a harmful and abandoned practice, listed here for history and safety. It belongs to the family of conversion practices (sexual orientation and gender identity change efforts, SOGICE). The professional and international consensus is that such efforts do not change sexual orientation or gender identity and are associated with serious harm: the APA (2021) reports "no evidence of sexual orientation change" and harms reported by former participants; the UN Independent Expert concluded that none of the approaches reviewed can claim "conversion" as an outcome and that the practices are degrading, inhuman and cruel in essence. [source: APA press release 2 March 2021; A/HRC/44/53 paras 20, 70, 83] The UN report itself lists the "removal of sexual organs" among historical medical conversion practices (para 22).

For the psychotherapist, the change mechanism in this guide is the therapist's own work: understanding how sexuality was medicalised, recognising the legacy of bodily "cure" beliefs in clients and families today, and offering affirming, non-directive, trauma-informed care to people subjected to, drawn to, or affected by change efforts. The guide teaches none of the practice. [synthesis]

2. Framework

Historical phases of the practice (outline)

  • Laboratory theory (1910s). After moving to Vienna in 1912, Steinach transplanted gonads in animals and concluded that sexual development was shaped flexibly by hormones. [source: Hansson et al. 2020] He later reported finding "male" cells in the ovaries of a goat he regarded as "homosexual" (dated 1919 by the Magnus-Hirschfeld-Gesellschaft).
  • First human claim (during the First World War, published 1918). Steinach and Lichtenstern reported a case, dated 1916 by Hansson et al., of a man who had lost his testicles to tuberculosis and was described as "cured" after transplantation and later married. [source: Hansson et al. 2020; Embryo Project] A 2025 history in História, Ciências, Saúde – Manguinhos notes that even the authors reported the man still showed behaviour they regarded as "effeminate": at most a partial claim, from a single case. [source: Lima 2025]
  • Spread and referral (late 1910s to 1920s). Several surgeons, among them Richard Mühsam, performed castration with implantation of donor testicular tissue on homosexual men; Hirschfeld's institute referred patients and no criticism of the operations by institute staff was recorded. [source: Magnus-Hirschfeld-Gesellschaft] In Austria the claimed "cure" was also used in law-reform debate as evidence that homosexuality was a pathological disorder. [source: Greif 2019] The number of men operated on is not established [uncertain].
  • Doubt and abandonment (1920s). Many contemporary researchers doubted Steinach's claims (e.g. Gaupp, Klinische Wochenschrift, 1922, as cited by Greif 2019); the operations were later judged unsuccessful. [source: Greif 2019; Magnus-Hirschfeld-Gesellschaft] Hirschfeld's own later doubt is reported in secondary accounts [uncertain: not verified].
  • Overlap with rejuvenation. The same endocrine theory fed the 1920s vogue for the "Steinach operation" for rejuvenation, which Morris Fishbein criticised in 1927 for lacking controlled studies; gland products were marketed commercially, including a testicular-extract preparation co-created by Hirschfeld and sold in Brazil in the 1930s. [source: Hansson et al. 2020; Embryo Project; Lima 2025]
  • Afterlife. Bodily "cures" persisted: a 1938 Brazilian proposal to treat homosexuality with male hormones (Lima 2025); castration of an "unknown number" of convicted homosexual men under Nazism, which "did not offer a 'cure'" (Oosterhuis 1997; see the Domain XVI family on eugenic, carceral and political abuses); and today's UN report, which still records medication, hormone or steroid approaches among current medical conversion practices (A/HRC/44/53 para 46).

Phases of the psychotherapist's work

Session number and length follow the client's needs and the setting [synthesis].

  1. Orientation and historical literacy. Goal: know the history and current positions well enough to respond accurately. Move on when you can name what was done, why it failed and what the bodies now say. [synthesis]
  2. Recognition and assessment. Goal: identify whether the client was subjected to, is drawn to, or is affected by change efforts (talk-based, religious, medical, hormonal or surgical), and assess risk, including suicide risk. Move on when exposure, current pressures and risk are mapped. [synthesis; harms: A/HRC/44/53 paras 56-58]
  3. Safety and safeguarding. Goal: address immediate risk, protect minors, stop ongoing exposure. Move on when a safety plan is in place and safeguarding duties are discharged. [synthesis]
  4. Processing and repair. Goal: reduce shame, self-hatred and trauma symptoms; rebuild relationships to body, faith, family and health care. Move on when the client's own goals, not a predetermined outcome, are being met. [source: UK MoU; synthesis]
  5. Advocacy and follow-up. Goal: connect the client with affirming services, support routes and, where wanted, legal or complaint routes; address colleagues' or institutions' practice. [synthesis; legal context: RNS 2015; Amnesty USA 2026]

3. Guiding principles

  • Sexual orientation and gender identity are not disorders. Practical meaning: never frame a client's orientation or identity as something to treat. [source: UK MoU; APA 2021]
  • No agenda favouring one orientation or identity. Practical meaning: hold no preferred outcome; check your own and your setting's assumptions. [source: UK MoU]
  • Exploration is legitimate; change attempts are not. Practical meaning: help clients explore, resolve conflict and "live more comfortably" with who they are, without attempting change. [source: UK MoU; APA 2021]
  • Bodily "cures" are a recurring pattern. Practical meaning: listen for gland, hormone, supplement or surgical ideas about sexuality and route medical questions to medical care. [source: Hansson et al. 2020; A/HRC/44/53 para 46; synthesis]
  • Harms are serious and include suicidality. Practical meaning: assess suicide risk routinely with anyone exposed to change efforts. [source: Blosnich et al. 2020 via Williams Institute; A/HRC/44/53 paras 56-58]
  • Children are especially vulnerable. Practical meaning: treat change efforts directed at a minor as a safeguarding matter. [source: A/HRC/44/53 paras 58, 71, 74]
  • Affirm, normalise, contextualise culture. Practical meaning: validate and normalise while respecting cultural and religious difference. [source: APA Guidelines for Psychological Practice with Sexual Minority Persons, as quoted in APA press release 2021]
  • Never provide, supervise or refer to change efforts. Practical meaning: decline, explain why, and offer affirming alternatives. [source: UK MoU; synthesis]
  • Historical honesty about the profession. Practical meaning: acknowledge that physicians and sexologists, including sexual-reform advocates, endorsed these operations. [source: Magnus-Hirschfeld-Gesellschaft; synthesis]
  • Safe messaging. Practical meaning: discuss suicide without method detail or glamorising; give crisis resources. [synthesis]
  • Name people with care. Practical meaning: speak of the men operated on by role, never by name; their histories are not case material. [synthesis]
  • No medication advice. Practical meaning: never advise starting, stopping or changing a medicine or hormone; refer to the prescriber. [synthesis]

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Building your own historical literacy

  • Purpose: to answer questions accurately and to recognise the bodily-"cure" thread that runs from Steinach's theory to present-day hormone and supplement ideas. Use before working with clients affected by change efforts. [synthesis]
  • Steps: (1) Learn the outline in section 2: the endocrine theory, the 1918 claim, referral at Hirschfeld's institute, contemporary doubt, abandonment. [source: Embryo Project; Magnus-Hirschfeld-Gesellschaft; Greif 2019] (2) Read the current positions: APA 2021 resolutions, the UK MoU, A/HRC/44/53. (3) Note that reformers as well as opponents of homosexual rights supported the operations, so the history resists a simple villain story. [source: Magnus-Hirschfeld-Gesellschaft; Greif 2019] (4) Keep a short, sourced summary you can share. [synthesis]
  • Example language (illustrative): "In Vienna around 1918 some doctors believed desire lived in the glands and tried surgery to change it. It didn't work, and it was abandoned."
  • Watch for: overstating certainty (case numbers are not established); presenting the history as sensational. Working when you can explain it calmly in a few sentences. [synthesis]

4.2 Responding when a client raises the history

  • Purpose: to support LGBTQ+ clients who encounter this history (reading, heritage work, family archives) and find it distressing or meaningful. [synthesis]
  • Steps: (1) Ask what drew them to it and what it stirs. (2) Offer accurate context. (3) Explore personal resonance: medical mistrust, internalised pathology, pride in survival. (4) Where useful, link to LGBTQ+ heritage and community resources. [synthesis]
  • Example language (illustrative): "What was it like to read that doctors once tried to operate this away? Where do you feel that today?"
  • Watch for: retraumatisation in survivors of current change efforts; intellectualising. Working when the client can hold the history without it defining them. [synthesis]

4.3 Screening for exposure to change efforts

  • Purpose: to find out whether a client has experienced any attempt to change or suppress orientation or identity. Blosnich et al. (2020) found about 7% of non-transgender LGB adults in a US sample had experienced conversion therapy, 81% from a religious leader and 31% from a health care provider. [source: Williams Institute summary of Blosnich et al. 2020] Use at intake with LGBTQ+ clients and with clients voicing conflict about orientation or identity.
  • Steps: (1) Ask open questions about attempts by family, faith leaders, counsellors, doctors, programmes or self-directed efforts. (2) Ask about bodily or medical approaches (hormones, supplements, procedures) as well as talk-based ones. [source: A/HRC/44/53 paras 22, 46] (3) Ask about age at exposure, duration and coercion. (4) Record carefully. [synthesis]
  • Example language (illustrative): "Has anyone ever tried to change or stop who you're attracted to, or how you understand your gender, including doctors or faith leaders, or you yourself?"
  • Watch for: shame causing under-reporting; clients not labelling what happened as "therapy". Working when the client names experiences they had not linked before. [synthesis]

4.4 Responding to a request to change orientation

  • Purpose: to respond to a client who asks you to change their sexual orientation, without attempting change. [source: UK MoU; APA 2021]
  • Steps: (1) Thank them and take the distress seriously. (2) Say plainly that you will not try to change orientation and why (no evidence of change; documented harm). [source: APA 2021; A/HRC/44/53] (3) Offer to explore the distress: its sources (family, faith, community, internalised stigma, safety), the client's values, and the options for living with integrity. [source: UK MoU] (4) Keep outcomes open; the client's choices about identity, disclosure, relationships and faith are theirs. [synthesis] (5) Assess risk (4.7).
  • Example language (illustrative): "I won't try to change who you're attracted to: the evidence is that it doesn't work and can harm people. I'd very much like to understand what makes this so painful and help you find a way to live that fits your values."
  • Watch for: the client seeking another provider of change efforts; feeling rejected. Working when the focus shifts from changing to understanding the conflict. [synthesis]

4.5 Exploring gender-identity questions without a predetermined outcome

  • Purpose: to support clients exploring gender identity. The APA (2021) opposes efforts to change gender identity; the UK MoU supports exploration, conflict and distress work with no agenda, and notes clinical suitability assessments before medical intervention are not conversion therapy. [source: APA 2021; UK MoU]
  • Steps: (1) Explore experience, history and meaning at the client's pace. (2) Do not steer toward or away from any identity. (3) Leave medical questions to the relevant clinical service. (4) Name pressure from others when present. [source: UK MoU; synthesis]
  • Example language (illustrative): "There's no answer I'm hoping you'll reach. Let's understand what you're experiencing."
  • Watch for: your own outcome preferences; pressure from family or institutions. Working when the client feels free to explore. [synthesis]

4.6 Exploring bodily-"cure" beliefs

  • Purpose: for a client who believes glands, hormones, supplements or surgery could change orientation, echoing Steinach's endocrine theory. [source: Embryo Project; Lima 2025; synthesis]
  • Steps: (1) Ask where the idea came from and what change would mean to them. (2) Share the historical record: the operations were abandoned as unsuccessful. [source: Magnus-Hirschfeld-Gesellschaft] (3) Never advise on any medicine, hormone or supplement; encourage them to talk to their own doctor before taking anything and raise any harmful products with the prescriber or GP. [synthesis] (4) Explore the shame underneath. [synthesis]
  • Example language (illustrative): "A century ago doctors tried exactly this and it failed. I'm not the person to advise on any product, but your doctor is. Can we look at what makes changing feel necessary?"
  • Watch for: online purchases of unregulated products; self-harm intent hidden as a "cure". Working when the client involves a doctor and the focus turns to self-acceptance. [synthesis]

4.7 Suicide-risk assessment and safety planning

  • Purpose: exposure to change efforts is associated with nearly double the rate of suicidal thinking and attempts among LGB adults (Blosnich et al. 2020), and the UN report records suicidal thoughts and attempts among reported consequences. [source: Williams Institute; A/HRC/44/53 para 57] A later reanalysis disputed the causal interpretation [uncertain: not verified]. Use with every client exposed to, or seeking, change efforts.
  • Steps: (1) Ask directly about suicidal thoughts, plans, intent and past attempts, following current standard practice. (2) Build a written safety plan (warning signs, coping, people, professional contacts, lethal-means safety limited to storage and removal). (3) Give crisis resources: 988 Suicide & Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (4) Escalate to emergency services if risk is imminent. (5) Review at each session while risk persists. [synthesis]
  • Example language (illustrative): "People who've been through attempts to change them sometimes think about ending their lives. Have you had thoughts like that?"
  • Watch for: sudden calm after distress, withdrawal, rejection events (expulsion from family or faith community). Working when the client uses the plan and contacts. [synthesis]

4.8 Psychoeducation on evidence and harm

  • Purpose: to give clients and families accurate information. [source: APA 2021; UK MoU; A/HRC/44/53]
  • Steps: (1) Ask what they already believe. (2) Share in plain language: orientation and identity are not disorders; change efforts do not work; they are linked to distress, self-hatred, trauma symptoms and suicidality; in a UN-cited survey of 940 people, 98% reported damage. [source: UK MoU; A/HRC/44/53 paras 56-57] (3) Invite questions; give sources. [synthesis]
  • Example language (illustrative): "Every major professional body that has looked at this has reached the same view: these efforts don't change orientation, and many people are hurt by them."
  • Watch for: defensiveness in family members who arranged change efforts. Working when the information opens rather than shuts down conversation. [synthesis]

4.9 Working with survivors of change efforts

  • Purpose: to treat the effects the UN report lists: loss of self-esteem, self-hatred, shame, PTSD symptoms, chronic stress. [source: A/HRC/44/53 para 56]
  • Steps: (1) Establish safety and choice. (2) Validate that what happened was harmful, without pressing for detail. (3) Use evidence-based trauma or depression treatment as indicated by assessment, adapted to be affirming. (4) Work on internalised stigma and shame. (5) Rebuild connection with affirming community. [synthesis]
  • Example language (illustrative): "What was done to you was based on the false idea that something was wrong with you. Nothing about who you are needed fixing."
  • Watch for: reactivations when therapy resembles the earlier setting (e.g. homework, confession-like disclosure). Working when self-blame eases. [synthesis]

4.10 Body, health care and medical mistrust

  • Purpose: for clients subjected to medicalised change efforts (hormones, medication, procedures) or whose families carry such histories, who may avoid health care. [source: A/HRC/44/53 paras 22, 46; synthesis]
  • Steps: (1) Explore the relationship to body and doctors. (2) With consent, coordinate with an affirming GP or physician for any physical concerns. (3) Prepare for medical appointments (what to say, bringing support). [synthesis]
  • Example language (illustrative): "It makes sense that seeing a doctor feels risky after what happened. Would it help to plan the first appointment together?"
  • Watch for: untreated physical problems; never interpret physical symptoms yourself. Working when the client re-engages with health care. [synthesis]

4.11 Working with religious clients

  • Purpose: to help clients whose faith and orientation or identity feel in conflict. Most US exposures reported by Blosnich et al. came from religious leaders. [source: Williams Institute] Use when conflict centres on faith.
  • Steps: (1) Use the DSM-5-TR Cultural Formulation Interview with its supplementary module on spirituality, religion and moral traditions [uncertain: DSM-5-TR wording not verified]. (2) Where the difficulty itself centres on faith, the DSM-5-TR "Religious or Spiritual Problem" may be recorded as Z65.8, which ICD-10-CM lists under "Other specified problems related to psychosocial circumstances" [source: ICD-10-CM Z65.8 (Unbound Medicine)]. (3) Respect faith as a resource; explore the range of positions within the client's own tradition, including affirming ones. (4) Hold no goal for the client's faith or identity. [source: UK MoU; synthesis] (5) Draw on spiritual and religious competencies (Vieten et al. 2013). [synthesis]
  • Example language (illustrative): "Your faith matters deeply to you, and so does being honest about who you are. I'm not here to choose between them for you."
  • Watch for: your own assumptions about religion; community pressure to attend change ministries. Working when the client can hold both parts in conversation. [synthesis]

4.12 Family work

  • Purpose: to support parents or relatives who sought or are considering change efforts, or who are distressed by a family member's orientation or identity. [synthesis]
  • Steps: (1) Hear the family's fears and hopes. (2) Give psychoeducation (4.8). (3) Explain the harms of rejection and of change efforts, including suicide risk. [source: Blosnich et al. via Williams Institute; A/HRC/44/53] (4) Help the family find ways to express care that do not demand change. (5) Point to affirming family support organisations as they describe themselves. [synthesis]
  • Example language (illustrative): "You love your child and you're frightened for them. The research is clear that pressure to change raises the risk; acceptance protects."
  • Watch for: a young person being sent away or to a programme; escalating conflict. Working when the family shifts from correcting to connecting. [synthesis]

4.13 Safeguarding minors

  • Purpose: the UN Independent Expert regards subjecting children to these practices as ill-treatment that may amount to torture and urges urgent bans on practices targeting children. [source: A/HRC/44/53 paras 71, 74]
  • Steps: (1) Ask about current or planned exposure, including medical, hormonal or residential. (2) Assess risk of harm, including suicide. (3) Follow your jurisdiction's child-protection procedures and mandatory reporting duties; consult your safeguarding lead. (4) Seek the young person's assent and explain limits of confidentiality in age-appropriate terms. (5) Document. [synthesis]
  • Example language (illustrative): "Because I'm worried about your safety, I need to talk to someone whose job is to keep young people safe. I'll tell you what I'm doing."
  • Watch for: sudden withdrawal from therapy; travel abroad for programmes. Working when the young person's safety is secured. [synthesis]

4.14 Intergenerational and heritage work

  • Purpose: for clients whose relatives were subjected to medical "cures", prosecution or castration (e.g. under Nazism, where an "unknown number" of convicted men were castrated). [source: Oosterhuis 1997; synthesis]
  • Steps: (1) Explore what is known and not known in the family story. (2) Support archival or memorial research if the client wants it, through official archives and memorial institutions. (3) Work with grief, anger and silence across generations. (4) Consider commemoration or writing as meaning-making. [synthesis]
  • Example language (illustrative): "Your great-uncle's story was hidden for a long time. What would it mean to you to know more?"
  • Watch for: sensational sources; identification with the relative's suffering becoming overwhelming. Working when the story becomes speakable. [synthesis]

4.15 When a colleague or institution offers change efforts

  • Purpose: to act when a colleague, service or institution offers or refers to change efforts. UK MoU signatories regard these practices as "unethical and potentially harmful". [source: UK MoU]
  • Steps: (1) Do not participate, supervise or refer. (2) Raise concerns directly where safe and appropriate. (3) Consult your professional body's guidance and complaint routes (in the UK, MoU signatories such as BACP [source: UK MoU]; UKCP signed the Memorandum (UKCP statement, May 2021) and withdrew from it on 5 April 2024 [source: UKCP 2021; UKCP 2024]; in the US, state licensing boards) [synthesis]. (4) Where you are also a member of the faith or community body offering change efforts, consider multiple-relationship risks under APA Ethics Code Standard 3.05 [source: APA Ethics Code]. (5) Protect affected clients; document. [synthesis]
  • Example language (illustrative): "I can't be part of efforts to change someone's orientation. Professional bodies consider them harmful, and I need to raise this formally."
  • Watch for: retaliation; local legal changes affecting professional regulation (see 4.17). Working when the practice stops or is formally addressed. [synthesis]

4.16 Examining your own stance

  • Purpose: the MoU requires knowledge of gender and sexual diversity and "no agenda" favouring one identity, and notes conversion approaches can occur covertly in mainstream practice. [source: UK MoU]
  • Steps: (1) In supervision, review cases for subtle steering (e.g. treating attraction as a symptom). (2) Pursue training in gender and sexual diversity. (3) Check intake forms and language. [source: UK MoU; synthesis]
  • Example language (illustrative, supervision): "Am I hoping this client ends up somewhere particular?"
  • Watch for: discomfort you attribute to the client. Working when clients report feeling free to talk. [synthesis]

4.17 Advocacy, referral and legal routes

  • Purpose: to connect clients with affirming services and, where wanted, redress. In 2015 a New Jersey Superior Court jury found that JONAH (Jews Offering New Alternatives for Healing) committed consumer fraud, after the judge ruled that describing homosexuality as a mental illness or disorder violated the state consumer fraud act. [source: Religion News Service 2015] On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain]. Amnesty International USA said the ruling "removes safeguards" for young people [source: Amnesty USA 2026]. Bans exist in a number of countries, and statuses change [uncertain: not verified]; the UN Independent Expert recommends that states ban these practices (A/HRC/44/53 para 87).
  • Steps: (1) Refer to affirming therapists and LGBTQ+ community services. (2) Inform clients of complaint routes to regulators and professional bodies, and suggest legal advice where they want redress. (3) Never pressure a client to complain. (4) Advocate within your organisation for affirming policies. [synthesis]
  • Example language (illustrative): "If you ever want to make a complaint about what happened, I can tell you the routes. It's entirely your choice."
  • Watch for: legal advice beyond your role. Working when the client has options they understand. [synthesis]

4.18 Repair at the level of the profession

  • Purpose: to acknowledge, where relevant, that physicians, sexologists and therapists endorsed and carried out change efforts, including the Vienna and Berlin operations. [source: Magnus-Hirschfeld-Gesellschaft; Greif 2019; synthesis]
  • Steps: (1) When a client's mistrust centres on the profession, acknowledge the history honestly rather than defend it. (2) Distinguish current professional positions from past ones, citing them. (3) Invite feedback on whether your work feels safe. [synthesis]
  • Example language (illustrative): "Our profession did real harm here, and you're right to be wary. Please tell me if anything in our work feels like that."
  • Watch for: guilt-driven over-disclosure by the therapist. Working when trust grows. [synthesis]

5. Handling problems

  • Client insists on change efforts. Repeat your position calmly, keep the door open for exploration, and assess risk; if they leave to seek change elsewhere, offer to stay available and give crisis resources. [source: UK MoU; synthesis]
  • Client believes a medical or hormonal "cure" exists. Share the historical record without ridicule; direct medical questions to their doctor; never comment on specific products or doses. [synthesis]
  • Stuck in shame. Slow down; normalise; use compassion-focused or trauma-informed methods as assessment indicates. [synthesis]
  • Overwhelm when recalling change efforts. Pause, ground, return to safety; do not require detailed accounts. [synthesis]
  • Rupture: "You're just pushing a gay agenda." Acknowledge, clarify that you hold no outcome for them, invite their own goals. [source: UK MoU on "no agenda"; synthesis]
  • Non-attendance after disclosure. Make one supportive contact with crisis resources (988 US; Samaritans 116 123 UK and Ireland); escalate if risk was high. [synthesis]
  • Family pressure in session. See family members separately where safe; prioritise the client's safety; safeguarding if a minor. [synthesis]
  • Therapist's own discomfort or faith conflict. Take it to supervision; refer on to an affirming colleague if you cannot keep an open stance, without abandoning the client. [synthesis]
  • Distress at the history itself (heritage work). Pace exposure to historical material; avoid sensational sources. [synthesis]
  • Uncertain law. Laws on change efforts are changing (e.g. Chiles v. Salazar, 2026, as SCOTUSblog and NPR report it); check current official sources before advising on legal routes [synthesis].

Harm account

What was actually done

In Austria and Germany in the late 1910s and 1920s, homosexual men underwent surgery intended to change their sexual orientation. Following Steinach's theory that the hormone-producing tissue of the testicles governed desire, the operations combined castration with implantation of testicular tissue taken from men presumed heterosexual. Steinach and the urologist Robert Lichtenstern published a claimed conversion in 1918; several surgeons, among them Richard Mühsam, performed such operations, and Magnus Hirschfeld's Institute for Sexual Science in Berlin referred patients. [source: Embryo Project; Hansson et al. 2020; Magnus-Hirschfeld-Gesellschaft] Contemporary researchers doubted the claims and the operations were later judged unsuccessful. [source: Greif 2019; Magnus-Hirschfeld-Gesellschaft] The total number of men operated on is not established here [uncertain: not verified]. The same endocrine reasoning recurred in a 1938 Brazilian proposal to treat homosexuality with male hormones and in the castration of convicted homosexual men under Nazism. [source: Lima 2025; Oosterhuis 1997]

What it looked like to the men. The men operated on were homosexual men seen by surgeons in Vienna and Berlin; the Magnus-Hirschfeld-Gesellschaft records that Hirschfeld referred patients and that surgeons, among them Richard Mühsam, castrated them and implanted testicular tissue from "heterosexual" men, with the stated aim of reversing their orientation [source: Magnus-Hirschfeld-Gesellschaft]. The Embryo Project reports that the donor tissue came from undescended testes surgically removed from other men [source: Embryo Project 2017]. Hansson and colleagues describe the first reported case as a young man whose own testes had already been removed because of tuberculosis and whom the operators reported as "cured", noting that he later married a woman; this was the operators' own claim, never independently verified [source: Hansson et al. 2020; Embryo Project 2017]. Steinach backed the theory by claiming to have found distinctive "female" cells only in the testes of homosexual men, a claim that later damaged his scientific standing [source: Hodgson 2025]. For the men themselves, the operation meant the permanent loss of their own testes in exchange for a graft that the Magnus-Hirschfeld-Gesellschaft records as unsuccessful; no criticism of the operations by the Institute's own staff is recorded [source: Magnus-Hirschfeld-Gesellschaft]. Contemporary scientists doubted Steinach's related claims, citing placebo and autosuggestion effects [source: Embryo Project 2017].

How it caused harm

The operations removed healthy organs from men on the basis of a false theory that their orientation was a glandular defect. They did not produce the promised change; even the first published case was described by its authors as only partially altered. [source: Lima 2025; Magnus-Hirschfeld-Gesellschaft] The sources here do not document specific surgical complications [uncertain: not verified]. A wider harm was ideological: the claimed "cure" was used in Austrian legal debate as evidence that homosexuality was a pathological disorder, reinforcing its medicalisation. [source: Greif 2019] Today the UN Independent Expert describes conversion practices, including historical removal of sexual organs, as degrading, inhuman and cruel in essence, with reported consequences including self-hatred, shame, PTSD symptoms, depression, anxiety, suicidal thoughts and suicide attempts. [source: A/HRC/44/53 paras 22, 56-57, 83] The Independent Forensic Expert Group convened by the IRCT concluded such treatment "may amount to torture depending on the circumstances". [source: A/HRC/44/53 para 62]

Recognising it today

Testicle transplantation for orientation is no longer practised, but its logic survives in medical and quasi-medical change efforts the UN report still records, chiefly medication, hormone or steroid approaches (A/HRC/44/53 para 46), and in talk-based and religious change efforts, which the UK MoU notes may be offered covertly within mainstream practice. Signs in a client's history: any professional, faith leader or programme treating orientation or gender identity as something to be cured, suppressed or reversed; products marketed to alter desire; family-arranged treatment of a minor. [source: A/HRC/44/53; UK MoU; synthesis] In heritage work, the history may surface through family stories of medical treatment, prosecution or castration. [synthesis]

What to do instead and how to help those harmed

Professional bodies support exploration without predetermined outcome, help to "live more comfortably" and toward self-acceptance, and affirming practice that validates and normalises sexual and gender diversity. [source: UK MoU; APA 2021] For survivors: trauma-informed, affirming therapy; suicide-risk assessment with crisis resources (988 in the US; Samaritans 116 123 in the UK and Ireland); coordinated, affirming medical care. For families: psychoeducation and support for acceptance. For minors: child-protection and mandatory reporting routes. Legal routes exist in some places: a New Jersey jury found JONAH liable for consumer fraud in 2015 [source: Religion News Service 2015]. On 31 March 2026 the US Supreme Court ruled 8–1 in Chiles v. Salazar that Colorado's conversion-therapy law, as applied to a counsellor's talk therapy, regulates speech based on viewpoint; it reversed the lower courts, which had not applied sufficiently rigorous First Amendment scrutiny, and sent the case back (SCOTUSblog; NPR). Its effect on other states' laws is [uncertain]. Religion News Service reported Exodus International's June 2013 closure and its president's apology (see 074). Signpost survivors to affirming LGBTQ+ and survivor organisations as those organisations describe themselves. [synthesis]

Sources

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