Atlas›Domain XVI · Historical, discredited & harmful›Guide 068
Guide XVI-068

Surgical and chemical castration

1938Netherlands
A 30 · L 55 · M 1519 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: surgical and hormonal ("chemical") castration used against homosexual men, as historians, the USHMM and the UK government's 2009 apology and 2013 pardon record it, for the psychotherapist's own work with its legacy, read through the 2021 American Psychological Association resolutions on sexual orientation and gender identity change efforts, the UK Memorandum of Understanding on Conversion Therapy (Version 2, Revision A), and the 2020 report of the UN Independent Expert on sexual orientation and gender identity (A/HRC/44/53). This guide does not teach, describe or endorse any castration practice.

Surgical and hormonal castration of men because they were homosexual is a historical harmful practice and part of the wider family of conversion practices. Its premise was that same-sex desire was a disorder or a crime that could be removed by destroying or suppressing sexual function. Documented examples include castration of homosexual men in Nazi concentration camps (USHMM), castration of detained sex offenders in the Netherlands between 1938 and 1968 in which homosexual men were heavily over-represented (historians cited below), and the hormone treatment imposed on Alan Turing after his 1952 conviction for "gross indecency", for which the UK government apologised in 2009 and which led to a royal pardon in December 2013 [source: Al Jazeera 2013; USHMM; Public History Amsterdam 2015]. The UN Independent Expert records that past medical approaches to changing orientation included "the removal of sexual organs" and that current medicalised forms rely on medication and hormone or steroid therapy [source: A/HRC/44/53, para. 46].

There is no change mechanism to describe: professional and international bodies state that conversion practices do not change sexual orientation or gender identity and are associated with serious harm. The APA's 2021 resolution states there is "no evidence of sexual orientation change"; the UN Independent Expert states that no approach can claim "conversion" as an outcome and that such practices are "by their very nature degrading, inhuman and cruel"; the UK Memorandum calls conversion therapy "unethical and potentially harmful" [source: APA press release 2021; A/HRC/44/53, paras. 20, 70, 83; UK MoU v2]. Change in this guide means the client's change: recognition, safety, the working-through of shame and loss, practical redress, and self-acceptance [synthesis].

This guide is distinct from court-ordered or consented anti-androgen treatment for people convicted of sexual offending, which is a forensic and medical matter outside this guide and is not a conversion practice; and distinct from gender-affirming medical care chosen by trans people, which the UK Memorandum explicitly says it does not prohibit [source: UK MoU v2; distinction otherwise synthesis]. Cross-refer to row 057 (castration and hormone experiments on homosexual men under Nazism) for the camp experiments in detail.

2. Framework

This is a harmful practice, not a therapy. The framework below describes the phases of the psychotherapist's own work; the historical phases of the practice are given in outline in the Harm account [synthesis].

Historical phases in outline (for orientation only):

  • Early to mid-20th century: homosexuality criminalised and pathologised in many European states; castration of men in detention or under legal pressure, framed as voluntary but given in exchange for release or reduced detention (Netherlands from 1938; Nazi Germany from 1940 and by commandant order from 1942) [source: USHMM chapter 8; Public History Amsterdam 2015].
  • 1950s Britain: hormone treatment of men convicted of homosexual offences, the best-documented case being Alan Turing (1952) [source: Al Jazeera 2013]. How widely others were treated is [uncertain: not verified].
  • Late 20th century to now: decriminalisation, removal from diagnostic manuals, apologies, pardons and disregards; medicalised change efforts persist in some settings, alongside reports of pressure toward surgery [source: A/HRC/44/53, paras. 22-23, 46, 49; Stonewall 2017].

Phases of the psychotherapist's work [synthesis unless tagged]:

  1. Recognition and engagement. Goal: the client can name what happened, at their own pace, in a setting that is explicitly affirming. Move on when the client has a working account and a sense that the therapist is not shocked, disbelieving or curious for its own sake.
  2. Assessment and safety. Goal: suicide risk, physical sequelae, current coercion and safeguarding are assessed; medical routing is arranged for any physical concern. Move on when risk is managed with a safety plan and no one is currently at risk of a change effort.
  3. Processing and repair. Goal: shame, grief, anger, body and intimacy concerns and relationships are worked through. Move on when distress has eased enough that the client wants to look outward.
  4. Redress, advocacy and meaning. Goal: practical redress (pardons, disregards, legal advice), testimony or commemoration if wanted, family work. End or space sessions when the client's goals are met.

Format: individual work is the norm; couple, family or group work only at the client's request [synthesis]. Session numbers are set by clinical need and the client's goals, not by a protocol [synthesis]. Phases overlap; risk assessment continues throughout.

3. Guiding principles

  • Orientation and gender identity are not disorders. Practical meaning: never treat the client's orientation as a problem to solve [source: UK MoU v2; A/HRC/44/53, para. 21].
  • No agenda favouring one orientation or identity. Practical meaning: you are "free from any agenda" about outcome, including when a client asks for change [source: UK MoU v2].
  • Never provide, supervise or refer to a change effort. Practical meaning: a request for castration, hormonal suppression or any other change method is explored, not acted on [source: UK MoU v2; A/HRC/44/53, para. 76; synthesis].
  • Do no harm. Practical meaning: health professionals act unethically when they "treat" what is not a disorder [source: A/HRC/44/53, para. 21].
  • Believe and pace the account. Practical meaning: let the client choose how much detail to give; never ask for physical or procedural detail beyond what medical routing needs [synthesis].
  • Survivors are named only by themselves. Practical meaning: protect identity in notes, supervision and any testimony work [synthesis].
  • Accuracy over drama. Practical meaning: give history as historians and official bodies state it; avoid sensational language that re-traumatises [synthesis].
  • Distinguish contexts. Practical meaning: do not conflate conversion castration with forensic anti-androgen treatment or gender-affirming care; ask the client what their experience was [synthesis].
  • Medical matters go to medical professionals. Practical meaning: never advise starting, stopping or changing any medicine or hormone; route physical concerns to a GP, endocrinologist or sexual-health clinic [synthesis].
  • Suicide risk is assessed actively. Practical meaning: change efforts are associated with roughly doubled suicidal thinking and attempts, so ask directly [source: Williams Institute summary of Blosnich et al. 2020].
  • Respect religion and culture without endorsing harm. Practical meaning: a client's faith is honoured as theirs; the change premise is not [source: UK MoU v2 signatories include a Christian counselling body; synthesis].
  • Safeguarding comes first for minors. Practical meaning: any child at risk of a change effort triggers local child-protection procedures [source: A/HRC/44/53, paras. 57, 74; synthesis].
  • Rights and redress are part of care. Practical meaning: help the client find pardons, disregards, legal advice and recognition if they want them [source: Stonewall 2017; Unlock 2017].
  • Boundaries in close communities. Practical meaning: where you share a faith or community with the client, consider multiple-relationship risks (APA Ethics Code Standard 3.05) [source: APA Ethics Code].
  • Laws change; check the date. Practical meaning: state legal positions with a date and check current official sources before relying on them [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 Historical literacy as preparation

  • Purpose / when: before working with older gay and bisexual men, their families, or anyone raising this history; it lets you hear the account without disbelief [synthesis].
  • Steps: (1) Learn the documented outline: Nazi-era castration tied to release from detention (USHMM); Dutch castration of detainees 1938-1968 (historians); Turing's 1952 conviction and hormone treatment, the 2009 apology and 2013 pardon; the 2017 posthumous pardons [source: USHMM; Public History Amsterdam 2015; Al Jazeera 2013; Stonewall 2017]. (2) Learn what the bodies now say (Section 1). (3) Keep the history at professional level; you do not need, and should not seek, procedural detail [synthesis].
  • Example language (illustrative): "I know some of the history of what was done to gay men in that period, so you don't have to explain it from scratch, but I'd like to hear what it was like for you."
  • Watch for: lecturing the client on history they lived; using the history to fill silences. Working: the client corrects or adds to your picture freely [synthesis].

4.2 Recognition: opening the door in assessment

  • Purpose / when: at intake with older LGBTQ+ clients, men with convictions for historical homosexual offences, or anyone describing past "treatment" for their sexuality [synthesis].
  • Steps: (1) Ask a broad question about past attempts by doctors, courts, institutions, family or religious leaders to change or suppress sexuality or gender. (2) If yes, ask permission before going further. (3) Record the fact, not the procedure. (4) Note that most people who report change efforts received them from religious leaders and a minority from health-care providers, so ask about both [source: Williams Institute summary of Blosnich et al. 2020; synthesis].
  • Example language (illustrative): "Has anyone, a doctor, a court, a church, your family, ever tried to change or stop your sexuality or how you saw your gender? You can say as much or as little as you want."
  • Watch for: sudden withdrawal, shame or dissociation; signs the question itself feels like an interrogation. Working: the client chooses the depth and returns to it later [synthesis].

4.3 Trauma-informed assessment with medical routing

  • Purpose / when: once a history of surgical or hormonal castration, or any medicalised change effort, is disclosed [synthesis].
  • Steps: (1) Assess trauma symptoms, depression, anxiety, shame and self-hatred, which the UN Independent Expert lists among reported harms [source: A/HRC/44/53, paras. 19, 56]. (2) Ask about current physical health concerns only in general terms. (3) Route any physical, hormonal or sexual-function concern to the GP, an endocrinologist or a sexual-health clinic; never advise on medicines or hormones. (4) Agree with the client what is shared with medical colleagues [synthesis].
  • Example language (illustrative): "Some of what you describe sounds like it might still affect your body. That's something a doctor should look at with you. Would it help if we thought together about how to raise it with your GP?"
  • Watch for: reluctance to see doctors because medicine was the source of harm; prepare the client for the appointment. Working: the client attends and reports feeling heard [synthesis].

4.4 Clarifying the context without assumptions

  • Purpose / when: when the client's account involves hormonal or surgical treatment and its context is unclear [synthesis].
  • Steps: (1) Ask what the treatment was for, who ordered or offered it, and whether the client felt free to refuse. (2) Distinguish, in your own formulation, a conversion effort aimed at sexuality from forensic anti-androgen treatment for sexual offending and from gender-affirming care the client chose. (3) Do not relabel the client's experience for them. (4) If forensic issues arise, work within the relevant forensic and legal framework [synthesis; UK MoU v2 on gender-affirming care].
  • Example language (illustrative): "Can you tell me how it came about, whose idea it was, and whether saying no felt possible?"
  • Watch for: your own assumptions (for example, that all such treatment was forced, or that any conviction means an offence against another person). The Dutch history shows that both offences against minors and laws criminalising consensual same-sex contact were involved [source: Public History Amsterdam 2015]. Working: a formulation the client recognises [synthesis].

4.5 Psychoeducation: what the bodies now say

  • Purpose / when: when a client still half-believes their orientation was an illness, or asks whether the treatment "could have worked" [synthesis].
  • Steps: (1) Ask what they were told at the time. (2) Share, briefly and in plain words, the current positions: the APA 2021 resolution finds no evidence of change; the UN Independent Expert and the World Psychiatric Association say orientation cannot be changed by these means; the UK Memorandum says orientation and gender identity are not disorders [source: APA press release 2021; A/HRC/44/53, para. 20; UK MoU v2]. (3) Invite the client's response.
  • Example language (illustrative): "What you were told then is not what medicine and psychology say now. The professional bodies are clear that being gay was never an illness, and that these treatments didn't change anyone's orientation."
  • Watch for: relief turning into anger or grief (expected); the client feeling patronised. Working: the client can hold "it was wrong" without "I was wrong" [synthesis].

4.6 An affirming, agenda-free stance

  • Purpose / when: throughout the work [source: UK MoU v2].
  • Steps: (1) Use the client's own words for their identity and relationships. (2) Show, without overstatement, that you see their orientation as a normal variation; the APA describes trans and nonbinary identities as "normal variations in human expression of gender" [source: APA press release 2021]. (3) Check your own reactions in supervision [synthesis].
  • Example language (illustrative): "I'd like to use the words that fit for you. How do you describe yourself, and the people who matter to you?"
  • Watch for: over-enthusiastic affirmation that leaves no room for ambivalence; ambivalence is explored, not corrected. Working: the client brings mixed feelings without fearing judgement [synthesis].

4.7 A client who asks for help to change or suppress orientation or gender identity

  • Purpose / when: a client asks for therapy, medication, hormones or surgery to remove or suppress same-sex desire or a gender identity [source: UK MoU v2; APA 2021].
  • Steps: (1) Thank them for telling you. (2) Explore what drives the request: family, faith, community, fear of violence, internalised stigma, a current crisis. (3) Say clearly that you will not attempt change and why, citing the bodies' positions. (4) Offer what the UK Memorandum describes: help to reduce distress, live more comfortably and move towards self-acceptance [source: UK MoU v2]. (5) If the client asks about a medical route to suppression, do not refer for it; acknowledge the request, explain that it is not a recognised treatment for orientation, and assess risk [synthesis; A/HRC/44/53, para. 21].
  • Example language (illustrative): "I won't try to change who you're attracted to, because the evidence is that it doesn't work and it harms people. What I can do is help with the pain that's making you want it gone."
  • Watch for: the client leaving to seek a change provider elsewhere; keep the door open and assess suicide risk. Working: the request softens into exploration of the distress beneath it [synthesis].

4.8 Suicide-risk assessment and safety planning

  • Purpose / when: at intake and whenever distress rises; LGB adults exposed to change efforts were nearly twice as likely to think about and attempt suicide [source: Williams Institute summary of Blosnich et al. 2020]; the UN report lists suicidal ideation and attempts among harms [source: A/HRC/44/53, para. 56].
  • Steps: (1) Ask directly about suicidal thoughts, plans and past attempts. (2) Assess protective factors and current stressors (anniversaries, records checks, illness, bereavement). (3) Build a written safety plan with the client, including people to contact and safer-environment steps (removal or secure storage of means, without discussing methods). (4) Give crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland). (5) Follow your service's escalation route if risk is high [synthesis].
  • Example language (illustrative): "People who went through what you did often have times of wanting to die. Have you had thoughts like that, now or in the past?"
  • Watch for: risk rising when old records or media coverage resurface; isolation in older age. Working: the client uses the plan and tells you when risk rises [synthesis].

4.9 Working with shame and internalised stigma

  • Purpose / when: when the client blames himself, believes he deserved the treatment, or still regards his desire as dirty [source: A/HRC/44/53, para. 19 lists shame and self-hatred; steps synthesis].
  • Steps: (1) Name shame gently as an understandable result of what was done. (2) Trace where each self-judgement came from (court, doctor, family, faith). (3) Separate the voices of those who harmed from the client's own. (4) Use the client's preferred approach (compassion-focused, narrative or other evidence-informed work you are trained in) [synthesis].
  • Example language (illustrative): "When you say you were 'disgusting', whose word was that first?"
  • Watch for: shame spikes after disclosure; pace slowly and check in after sessions. Working: the client starts to speak of the people who harmed him as responsible [synthesis].

4.10 Grief for loss of years, relationships and bodily integrity

  • Purpose / when: when the client mourns a life, partner, family or body changed by the treatment or conviction [synthesis].
  • Steps: (1) Invite the client to name the losses in their own order. (2) Allow anger, sadness and numbness without rushing to meaning. (3) Where losses are permanent, help the client find ways of living with them rather than resolving them. (4) Consider rituals of acknowledgement the client chooses [synthesis].
  • Example language (illustrative): "It makes sense to grieve what was taken. We don't have to make it tidy."
  • Watch for: complicated grief, depression or rising suicide risk (return to 4.8). Working: the client can speak of the losses with less overwhelm [synthesis].

4.11 Body image, intimacy and sexual wellbeing

  • Purpose / when: when the client describes lasting effects on body image, sexual function or intimacy [synthesis].
  • Steps: (1) Ask permission before discussing sexuality and the body. (2) Explore meanings (loss of masculinity, fear of intimacy, distrust of touch) rather than physical detail. (3) Refer physical and sexual-function concerns to medical or sexual-health services, and to a qualified sexual and relationship therapist if wanted; never advise on medicines or hormones. (4) Any touch-based or body-focused work elsewhere requires consent before and during and a right to stop [synthesis].
  • Example language (illustrative): "Would it be all right to talk about how this has affected how you feel in your body and in closeness with others? We can stop whenever you want."
  • Watch for: shame or dissociation; a sense of being examined again. Working: the client sets the pace and reports more ease with closeness [synthesis].

4.12 Records, pardons and disregards (UK)

  • Purpose / when: a living client in England and Wales with a conviction for consensual same-sex conduct, or a family member of a man who has died [source: Stonewall 2017; Unlock 2017].
  • Steps: (1) Ask whether the client knows about redress. (2) Explain in outline: since January 2017 men who have died are automatically pardoned for convictions for conduct now legal; living men must apply to the Home Office disregard scheme, which removes the offence from their record and also brings a pardon; Scotland has its own 2018 Act with automatic pardons and disregards [source: Stonewall 2017; Unlock 2017]. (3) The scheme does not cover non-consensual acts or acts with people under the age of consent [source: Unlock 2017]. (4) Point the client to Unlock's self-help guide or legal advice for applications; check current scope, which Stonewall reports was being widened [source: Stonewall 2017; current scope uncertain: not verified]. (5) Process feelings the application stirs up [synthesis].
  • Example language (illustrative): "There is now a way to have that conviction removed from your record. Would you like to look at what it involves, and how it might feel to do it?"
  • Watch for: retraumatisation from revisiting records; anger that a pardon implies forgiveness for something that was not a wrong. Working: the client decides freely whether to apply [synthesis].

4.13 Testimony, narrative and commemoration

  • Purpose / when: when the client wants their experience recorded, recognised or used to help others [synthesis].
  • Steps: (1) Explore what recognition would mean. (2) Discuss options (private written account, LGBTQ+ archives or oral-history projects, memorial events) and their privacy implications. (3) Help the client control how they are named. (4) Prepare for media or public reactions [synthesis].
  • Example language (illustrative): "Some people want what happened to them on record; others want it to stay private. Neither is wrong. What would feel right for you?"
  • Watch for: pressure from campaigns or family to go public; exposure the client later regrets. Working: the client feels ownership of the story [synthesis].

4.14 Families and descendants

  • Purpose / when: a client whose father, grandfather, uncle or partner was treated, convicted or detained; or a family discovering the history in records [synthesis].
  • Steps: (1) Explore what the family knew and what was kept secret. (2) Offer accurate historical context (4.1, 4.5). (3) Work with mixed feelings: pride, shame, anger at institutions, guilt about past family attitudes. (4) For a deceased relative in England and Wales, explain the automatic posthumous pardon [source: Stonewall 2017]. (5) Consider family sessions if all members want them [synthesis].
  • Example language (illustrative): "Finding this in your grandfather's papers can turn a family story upside down. What has it changed for you?"
  • Watch for: relatives speaking for the person harmed; intergenerational secrecy repeating. Working: the family can talk about it openly [synthesis].

4.15 Religious clients and families

  • Purpose / when: when faith is part of the distress, the change pressure or the client's support [synthesis].
  • Steps: (1) Ask what the client's faith means to them and how their community responds to sexuality. (2) Separate the client's faith from the change premise; do not attack either the faith or the client's wish to keep it. (3) Where helpful, note that the UK Memorandum is signed by a Christian counselling body as well as secular ones [source: UK MoU v2]. (4) Where a spiritual or religious difficulty is the focus, "Religious or Spiritual Problem" (Z65.8) may be recorded [source: ICD-10-CM Z65.8 (Unbound Medicine)]; the DSM-5-TR Cultural Formulation Interview, with its supplementary module on spirituality, religion and moral traditions, can structure the conversation. (5) Mind multiple-relationship risks if you share the community (APA Ethics Code Standard 3.05) [source: APA Ethics Code].
  • Example language (illustrative): "Your faith matters to you, and so does being able to live as yourself. Let's look at how those can sit together, rather than which has to go."
  • Watch for: pressure from religious leaders toward change efforts (most reported change efforts came from religious leaders) [source: Williams Institute summary of Blosnich et al. 2020]. Working: reduced conflict and a less isolated faith life [synthesis].

4.16 Safeguarding minors

  • Purpose / when: a child or young person is at risk of any change effort, including medicalised or hormonal suppression, or being sent abroad for one; the UN report urges urgent protection of children [source: A/HRC/44/53, paras. 57, 74].
  • Steps: (1) Follow your service's safeguarding policy and local child-protection procedures; consult your safeguarding lead. (2) Make mandatory or statutory reports where required in your jurisdiction. (3) Seek the young person's views and assent, keeping them informed as far as safe. (4) Record facts, not speculation. (5) Assess suicide risk (4.8) [synthesis].
  • Example language (illustrative): "What you've told me means I need to talk to people whose job is to keep young people safe. I'll tell you what I'm doing and why."
  • Watch for: the young person withdrawing or being removed from therapy; school dropout and substance use [source: A/HRC/44/53, para. 57]. Working: the young person remains safe and engaged [synthesis].

4.17 When a colleague or institution offers a change effort

  • Purpose / when: you learn that a practitioner, clinic or organisation offers or refers for conversion practices, including medicalised forms [synthesis].
  • Steps: (1) Do not provide, supervise or refer. (2) Document what you know. (3) Raise it through your professional body's complaints route; the UK Memorandum's signatories (including BACP, BPS, BABCP, NHS England and NHS Scotland) treat conversion therapy as unethical [source: UK MoU v2]. (4) Where a minor is involved, follow 4.16. (5) Where a criminal offence may be involved, the UN report says claims should be investigated and, where relevant, prosecuted [source: A/HRC/44/53, para. 65]. (6) Take it to supervision [synthesis].
  • Example language (illustrative, to a colleague): "I'm not able to be involved in this. The professional bodies regard it as harmful, and I'll need to raise it formally."
  • Watch for: being drawn into informal arrangements; retaliation against you or the client. Working: the concern is formally recorded and acted on [synthesis].

4.18 Advocacy and legal routes

  • Purpose / when: a client harmed by a change effort wants accountability or compensation [synthesis].
  • Steps: (1) Explain that you are not a legal adviser. (2) Note that courts in some countries have ordered compensation and apologies [source: A/HRC/44/53, para. 79], and that in the US, after Chiles v. Salazar, people harmed may still pursue consumer-fraud or malpractice claims as the Trevor Project describes [source: Trevor Project 2026]. (3) Help the client find legal advice and survivor organisations as they publish themselves. (4) Support the client through the process [synthesis].
  • Example language (illustrative): "I can't advise on the law, but I can help you find someone who can, and be alongside you while you decide."
  • Watch for: litigation stress; the client's goals shifting. Working: the client acts from choice rather than pressure [synthesis].

4.19 Your own reflection and supervision

  • Purpose / when: throughout; the history implicates the helping professions [synthesis].
  • Steps: (1) Notice reactions (horror, guilt on the profession's behalf, voyeuristic curiosity, discomfort with the client's anger at clinicians). (2) Take them to supervision. (3) Keep learning LGBTQ+ history and the current positions of professional bodies [synthesis; UK MoU v2 on cultural competence].
  • Example language (illustrative, to yourself or a supervisor): "I notice I want to apologise for my profession. Is that for the client, or for me?"
  • Watch for: defensiveness when the client criticises therapists. Working: you can hear the criticism and stay steady [synthesis].

5. Handling problems

  • The client cannot or will not talk about it. Respect silence; work on present-day difficulties; let the history surface when the client chooses. Do not press for detail [synthesis].
  • Overwhelm or dissociation during disclosure. Slow down, ground in the present, shorten the focus, and end sessions with time to settle. Return to safety planning if distress persists [synthesis].
  • Rising suicide risk (anniversaries, records checks, illness, bereavement, media coverage). Reassess (4.8), update the safety plan, give 988 (US) or Samaritans 116 123 (UK and Ireland), and escalate as your service requires [synthesis; risk association: Williams Institute summary of Blosnich et al. 2020].
  • Anger at clinicians, including you. Treat it as legitimate: the helping professions took part in these practices [source: A/HRC/44/53, para. 46]. Acknowledge without defending; repair the rupture by naming it [synthesis].
  • Distrust of medicine blocks needed medical care. Explore the fear, prepare questions together, offer to coordinate with consent; never substitute advice about medicines or hormones [synthesis].
  • The client still asks for change. Return to 4.7: explore, decline to attempt change, keep the relationship, assess risk. If the client leaves to seek a change provider, say the door remains open [source: UK MoU v2; synthesis].
  • Family or faith community pressure. Help the client map allies and risks; if a minor is involved, safeguard (4.16) [synthesis].
  • Non-attendance or stop-start engagement. Common when old shame is stirred; keep contact low-pressure and agree in advance how you will follow up [synthesis].
  • Conflating different histories. If the client or family treat forensic anti-androgen treatment, gender-affirming care and conversion castration as the same thing, gently clarify contexts (4.4) without dismissing the client's own experience [synthesis].
  • Contested evidence raised by the client. Some clients have read reanalyses disputing a causal link between change efforts and suicide risk; a published exchange between Sullins (2022) and Blosnich and colleagues exists [uncertain: not verified]. Present the professional bodies' positions as they state them, acknowledge that research debates exist, and keep the clinical focus on the client's own risk [synthesis].
  • Your own distress or vicarious trauma. Use supervision and personal support; limit exposure to graphic material [synthesis].
  • Legal position uncertain. Laws on conversion practices differ and change. 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]. The ruling did not itself declare the practice safe [source: Dorsey 2026; Trevor Project 2026]. Check current official sources before advising anyone on law [synthesis].

Harm account

What was actually done

  • Nazi Germany. In summer 1940 Heinrich Himmler ordered that men convicted of homosexual offences "who have seduced more than one partner" be sent to concentration camps after prison; this "preventive detention" could be shortened if the man underwent castration, presented as voluntary; from 1942 camp commandants could order castration [source: USHMM, Persecution of Homosexuals, chapter 8]. Hormone experiments on homosexual prisoners are covered in row 057.
  • Netherlands, 1938-1968. Under a 1938 Ministry of Justice procedure, about 400 men detained "at the government's discretion" (TBR) in psychiatric institutions were surgically castrated; most had been convicted of sexual offences against children under 16 or of exhibitionism, but homosexual men made up about 40% of those castrated, and some had been convicted under a law criminalising same-sex contact with 16- to 21-year-olds. The procedure required the detainee's written request to the Minister, but historians doubt it was voluntary given detention, social vulnerability and pressure, and some men were poorly informed [source: Public History Amsterdam 2015, summarising Vijselaar et al. 2015 (ZonMw) and Van der Meer 2008; both originals uncertain: not verified].
  • Britain, 1950s. After his 1952 conviction for "gross indecency" over a relationship with another man, Alan Turing lost his security clearance, was monitored, and was required to take oestrogen to suppress his sex drive, which some call chemical castration [source: Al Jazeera 2013]. Prime Minister Gordon Brown apologised in 2009 and Queen Elizabeth II granted a posthumous pardon in December 2013 [source: Al Jazeera 2013]. The extent of similar treatment of other men is [uncertain: not verified].
  • Other countries. Castration of homosexual men in other European countries in the 20th century is reported in secondary literature [uncertain: not verified]. The UN Independent Expert records that past medical approaches to changing orientation included removal of sexual organs, that present medicalised forms rely on medication and hormone or steroid therapy, and that in Iran people who fail to change their orientation are often pressured toward surgery [source: A/HRC/44/53, paras. 46, 49].

What it looked like to the men. In each of these settings the "treatment" reached men through the criminal or detention system, not as care they had sought. In Nazi Germany castration was presented as a voluntary way out of indefinite camp detention and, from 1942, could simply be ordered by a camp commandant [source: USHMM, chapter 8]. In the Netherlands, men already detained in psychiatric institutions had to sign a written request to the Minister of Justice, which historians judge was not a free choice given their detention, vulnerability and the pressure on them; some were poorly informed about what the operation meant [source: Public History Amsterdam 2015]. In Britain, the Prime Minister's apology of September 2009 described the "miserable choice" Alan Turing faced after his conviction, between prison and chemical castration by female hormones, and called his treatment "horrifying" [source: Gordon Brown's statement, as published by the University of Manchester, 2009]; the hormones were given to suppress his sex drive, he lost his security clearance and was monitored, and he died two years after the sentence [source: Al Jazeera 2013; University of Manchester 2009]. The physical effects of the treatment on him, as his biographers describe them, are [uncertain: not verified]. The UK study commissioned by the Government Equalities Office lists hormone treatment among the historical methods of conversion therapy [source: GEO 2021], and the UN Independent Expert records that medicalised conversion practices today rely on medication and hormone or steroid treatment (para. 46) [source: A/HRC/44/53].

How it caused harm

  • It did not change orientation. Professional and international bodies state that conversion practices do not change sexual orientation or gender identity [source: APA press release 2021; A/HRC/44/53, paras. 20, 70].
  • Bodily harm and loss of bodily integrity. Surgical castration is irreversible; hormonal suppression was imposed under legal compulsion [source: Al Jazeera 2013; Public History Amsterdam 2015; qualitative description synthesis].
  • Psychological harm. Reported consequences of conversion practices include depression, anxiety, shame, self-hatred, PTSD symptoms, suicidal ideation and attempts, and physical pain; the harm is often long-lasting [source: A/HRC/44/53, paras. 19, 56, 61]. LGB adults who underwent change efforts were nearly twice as likely to think about and attempt suicide [source: Williams Institute summary of Blosnich et al. 2020].
  • Coercion and degradation. The UN Independent Expert describes conversion practices as "by their very nature degrading, inhuman and cruel", cites the Independent Forensic Expert Group (IRCT) that they may amount to torture depending on the circumstances, and states that forced practices can be cruel, inhuman or degrading treatment [source: A/HRC/44/53, paras. 62, 83]. Castration offered in exchange for release removed any real choice [source: USHMM; Public History Amsterdam 2015].
  • Social harm. Criminal records, loss of employment and security clearance, surveillance, and family and community exclusion [source: Al Jazeera 2013; Stonewall 2017].

Recognising it today

  • Older clients with convictions for consensual same-sex conduct, or who describe medical, court or institutional "treatment" for their sexuality [synthesis].
  • Families discovering these histories in records or after a relative's death [synthesis].
  • Current medicalised change efforts: offers of medication, hormones or surgery to remove or suppress same-sex desire or a gender identity, whether by a clinician, a religious adviser or an online provider [source: A/HRC/44/53, paras. 46, 49]. Covert framing ("reparative", "help with unwanted attraction") is common [source: UK MoU v2 on covert practice].
  • Pressure toward surgery as a way to make a person's sexuality acceptable, as the UN report describes for Iran [source: A/HRC/44/53, para. 49].
  • Distinguish forensic anti-androgen treatment for sexual offending and chosen gender-affirming care, which are not conversion practices [source: UK MoU v2 on gender-affirming care; otherwise synthesis].

What to do instead and how to help those harmed

  • Supported care. Affirming therapy free from any agenda about orientation or gender identity, helping clients reduce distress, live more comfortably and reach self-acceptance [source: UK MoU v2]; the APA's Guidelines for Psychological Practice with Sexual Minority Persons accompany the 2021 resolutions [source: APA press release 2021].
  • Survivors. Trauma-informed assessment, suicide-risk assessment and safety planning, medical routing for physical concerns, shame and grief work (Section 4). Crisis lines: 988 (US); Samaritans 116 123 (UK and Ireland).
  • Redress. In England and Wales, automatic posthumous pardons since 2017 and the Home Office disregard scheme for living men; in Scotland, the 2018 Act [source: Stonewall 2017; Unlock 2017] [uncertain: scheme scope may have changed since]. Stonewall reports a government apology accompanied the 2017 pardons [source: Stonewall 2017]. Courts in some countries have ordered compensation and apologies [source: A/HRC/44/53, para. 79].
  • Families. Accurate history, space for mixed feelings, and help with posthumous recognition [synthesis].
  • Reporting and legal routes. Report practitioners to their professional body; follow child-protection procedures for minors; refer to legal advice for claims; the UN Independent Expert recommends that States ban these practices and investigate claims [source: A/HRC/44/53, paras. 65, 87; UK MoU v2].
  • Survivor and rights organisations as they publish themselves, such as Stonewall and Unlock in the UK for records and pardons [source: Stonewall 2017; Unlock 2017].

Sources

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