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Two decades into the 21st century, male and female genitals mark the new frontier of human organ transplantation. But testicle transplants remain off limits, except in extremely rare cases, for bioethical reasons.

A century ago, however, rejuvenation-minded surgeons embraced the idea with gusto. If a pair of testicles makes a guy masculine, why not three? The more, they thought, the manlier.

There was a hitch, however. Viable human testicles were in short supply, even at the mortuary. So someone, perhaps an aging tycoon with a flagging libido, apparently hired hoods to kidnap men off the street, knock them out, and hustle them into involuntary castration operations.

At least three Chicago men fell victim to "gland larceny" in the early 1920s, including one who accused two of the most notorious murderers in American history of mutilating him.

The rash of testicle thefts, which may be the world's earliest cases of human organ trafficking, has roots in the late 19th century. That's when the new field of endocrinology began to suggest that male sex glands produced a chemical that boosted manliness. Around the same time, medicine began to turn organ transplants into reality. Meanwhile, as always, men desperately sought to be more virile. Voila! Scrotum-based synergy.

"There was this notion that glands play an important role in many human activities and, especially, in rejuvenation," said University of Wisconsin-Madison medical historian Susan E. Lederer, PhD, in an interview. "When it comes to enhancement or restoration of function or appearance, people are willing to do extraordinary things," said Lederer, who wrote , a 2008 book about the history of organ transplantation and blood transfusions.

One Doctor's Self-Experimentation

A Chicago urologist named Frank Lydston, for example, sewed a cadaver's testicle into his own scrotum in 1914. (A colleague assisted and presumably gained anecdotes to last a lifetime.) Lydston wrote that the self-surgery quickly produced "a marked exhilaration and buoyancy of spirits," possibly because of hormone secretion.

His sexual function didn't improve outside of "reflex erections" in response to touch, and his "rather constipated habit" didn't get better either. But he kept experimenting by performing testicle experiments on himself, regularly showing off the results to his Windy City colleagues. One fellow surgeon was startled to see Lydston take off his shirt and reveal a series of lumps on his chest. They were bits of testicular tissue, Lydston confided. Chesticles, if you will.

Lydston was an eccentric with a tendency toward racism, eugenics, and a firm belief that transplanted testicles could cure homosexuality. But he wasn't quite as crazy as he may sound today. "Before the isolation of testosterone as a hormone in the 1930s, the idea that you would take glands or pieces of glands and implant them seemed like a legitimate, scientific way of restoring men's vitality," Lederer said.

By 1922, rejuvenation-by-testicle-transplantation was such a sensation that the Journal of the American Medical Association felt the need to publish noting that "now in the limelight is the transplantation into the old man of testicular substance removed from young men, monkeys, goats or whatever the market affords."

A year later, Arthur Conan Doyle published a Sherlock Holmes that hinged on the sleuth's deduction (spoiler alert!) about a rejuvenation potion – a "wondrous strength-giving serum" -- derived from monkeys.

Chicago's Gland Pirates

Around the same time, men started getting kidnapped in Chicago and waking up with empty scrota. The first reported victim, in October 1922, was a World War I veteran named Joseph Wozniak. According to the Washington (D.C.) Herald, four "gland pirates" liquored him up, knocked him out with chloroform, "and took him to some unknown hospital where a surgeon deprived him of one of his glands." Wozniak's wife, however, wondered if he'd actually made up the story after selling his testicle, the newspaper reported.

Whatever the real story, the case may have been a landmark in medical history. "When it comes to trafficking in organs," medical historian Lederer said, "the earliest I can find is 1922, and the organ is not the skin or nerves or kidneys. It's the testicle."

Then at least two more victims came forward. One, an electrical worker named Harry Johnson, blacked out when he tried to drunkenly find his way home. "In the morning, he was found in a hallway, his masculinity gone," the Chicago Tribune reported.

Police and physicians took these cases seriously, a sign that they weren't hoaxes. "The slave markets were nothing compared to the gland market," a police captain hyperbolized to the Tribune. "Civilization cannot permit it to go on!"

A wire service report quoted a detective as saying an "aged millionaire" had been offering $100,000 for a "gland transplantation operation" as he anticipated marriage to a 25-year-old woman. Never mind that the president of the Chicago Medical Society sternly declared that "no reputable physician would accept an old gland brought into his office for sale."

Meanwhile, yet another victim came forward – a 21-year-old cab driver named Charles Ream. He said he was kidnapped after leaving a street car, chloroformed, and operated upon. In a bizarre twist of history, the victim accused infamous convicted thrill killers Richard Loeb and Nathan Leopold of castrating him. He took them to civil court but a hung jury scuttled his bid for a $100,000 settlement.

Testicle transplants were risky in the 1920s for both donor (if he was still alive at the time) and recipient. A surgeon told The New York Times that Ream would have died if it wasn't for careful bandaging. "The operation was evidently performed by someone who knew what he was about," the surgeon said, a sign that Leopold and Loeb were innocent.

In some cases, donated testicles had to be removed due to infection. Eight days after his operation in 1914, urologist Lydston's self-transplant was painful and had become "what apparently was a somewhat dangerous foreign body" with protruding "seminiferous tubules." He tried to remove the spare gland. However, he only managed to take about half, leaving a remainder the size of a "small almond" (as of June 1) and a "hazel nut" (as of an Aug. 1 update).

Wanting to Believe the Hype

Even if transplanted testicle tissue managed to settle itself harmlessly in its new home, it's not clear that it directly contributed to any positive sexual impact like Lydston's improved "reflex erections." From a modern perspective, it seems likely that positive thinking played a major role in making men feel revitalized.

But many surgeons chose to believe the transplants made a difference, said McGill University medical historian Thomas Schlich, MD, author of about the history of organ transplantation, in an interview.

"At the time, some really believed that the testicles survived and kept secreting hormones. Some felt that the hormone that was in the testicles already was absorbed by the body -- a complicated way of administering hormones. Still others believed it would stimulate the recipient's own testicles to restart the production of hormones. All these explanations were common at the time."

What really happened? "It's hard to tell," he said. "We know that transplanted thyroid tissue is absorbed by the body, including the hormone, and has an effect like a drug. I don't know if that's possible for testicular hormones."

In 1920s-era Illinois, the purloined testicles set off a panic as a state legislator of making involuntary castration a death-penalty offense. The effort didn't go anywhere. And the transplant craze ensnared one of Chicago's most storied names when a delighted press reported that ultra-rich industrialist Harold McCormick had – apparently via a male monkey -- in order to energetically entertain his new, much-younger lover.

"I tried to find the operative report. But the medical librarian who has access to the old hospital files says somehow those years are missing. I'll bet," said retired Illinois urologist John Nanninga, MD, in an interview. He wrote , a 2017 book about the early years of male rejuvenation.

Monkeys did indeed provide testicles for wealthy men in search of a pick-me-up, but another animal stood in the wings – the horny farm goat. In the 1930s, a Kansas super-quack named John Brinkley became the American Medical Association's Public Enemy Number One by creating a based on transplanting goat testicles into willing men. "There's nothing that makes men crazier than threats to virility. Nothing," said Indiana journalist Pope Brock, author of , a 2008 book about Brinkley, in an interview.

But testicle transplants – human, monkey or goat -- dwindled as testosterone became a common, easy-to-administer medication. "Otherwise, you'd still have men having testicles attached to themselves today," said author Randi Epstein, MD, MPH, in an interview. She wrote the 2018 book about the history of hormones.

In recent years, surgeons have transplanted penises and a scrotum into men who lost their genitals to injury or cancer. And, as 乌鸦传媒 first reported, the first-ever penis transplant in a person born a biological female is in the planning stages. But transplanted testicles mostly remain off limits because of concerns that they will produce their original owner's sperm, which could then produce the original owner's offspring – a prospect that raises a host of . An exemption came a year ago when a man born without testicles in a surgery performed in Serbia.

"Doing a testicle transplant was not a big deal," a surgeon who performed a similar twin-to-twin procedure in the late 1970s in 2019. He had performed thousands of kidney transplants in rodents, he said, "and it was like just another kidney transplant in a rat."

He noted that the donor was gay, and the recipient was straight, but the procedure didn't change anyone's sexual orientation. So much for 1914-era theories about supposed testicular powers. , meanwhile, didn't mention any rejuvenation in the recipient, who'd been getting testosterone injections but reported fluctuations in his mood and sex drive. However, he did go on to father five children.

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