Between 1912 and the mid 1920s Mühsam was involved in several pioneering surgeries that he wrote up for the Therapie der Gegenwart journal in 1926. None of the patients are given names.
In 1912 he did a double mastectomy and a hysterectomy on a painter aged 25, born female, who had always considered himself to be a "man in disguise".
In 1920, at the request of Magnus Hirschfeld, Mühsam castrated a 23-year-old who had been dismissed from military school for not being brave enough, although he did serve in the Great War as an officer, which tested his manhood. By 1920 he could no longer function. "He gave up his medical studies ... spent the day in bed and slept most of the day". He normally wore a corset and stockings when he went out. He masturbated 3-8 times a day imagining himself as female. He implored Mühsam, who considered him to be a severe sexual neurotic, that he be castrated. This was done on 21 June 1920, and two days later he had stopped masturbating and resumed his studies. Mühsam wrote (seven times in three pages) that the purpose of the castration was to enable the patient to work. However now felt an enhanced desire to become a woman, and started living fulltime as female. He requested to have an ovary implanted to generate female hormones, and this was done in March 1921 by another doctor. The patient also requested genital surgery. A month later, Mühsam, who was reluctant, cut a "vagina-like structure" and hid the penis within. Mühsam had created the first constructed vagina for a male-born person. However by August the patient returned. He had fallen in love with a woman, dressed and behaved in a manly fashion and now demanded a reversal. This Mühsam was able to do. Reportedly, the man qualified as a doctor, emigrated and became a pathologist.
Also in 1921, Mühsam removed the ovaries from his 1912 patient. Unfortunately the painter died in 1924 of tuberculosis. Mühsam did a similar service for another trans man, but he later committed suicide. Mühsam decided that "female" transvestites could not be treated surgically as the removal of the ovaries does not affect their sex drive.
In addition Mühsam performed four testicle implants on three gay men and one bisexual – the Steinach procedure. This was supposed to induce heterosexual tendencies. However Mühsam reported that it worked only for the bisexual, and he discontinued the practice.
Richard Mühsam died at age 66 as Europe prepared for war. His widow emigrated to the US, and died in Colorado in 1969 at age 94.
- Richard Mühsam,. Über den Fundort des Bacillus pyocyaneus und seine Farbproduction bei der Symbose mit anderen Mikroorganismen. Thesis (doctoral)--Friedrich-Wilhelms-Universität Berlin, 1893.
- Richard Mühsam. Compendium der Operations- und Verbandstechnik von Eduard Sonnenburg und Richard Mühsam. 2 volumes. Berlin: Aug. Hirschwald, 1903.
- Richard Muhsam. "Chirurgische Eingriffe bei Anomalien des Sexuallebens," Therapie der Gegenwart 28, 1926: 451-55
- Richard Mühsam,. Was kann und wann muss der praktische Arzt operieren? Leipzig: G. Thieme, 1928.
- Hans Hirschfeld & Richard Mühsam. Chirurgie der Milz. Stuttgart: Enke, 1930.
- Sander L. Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton University Press, 1999: 272-5.
- Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002: 18.
- Volker Weiß. "Transsexualität im Geschlechtsdispositiv", Part III of „Eine Weibliche Seele Im Männlichen Körper“ – Archäologie Einer Metapher Als Kritik Der Medizinischen Konstruktion Der Transsexualität. PhD Thesis, Freien Universität Berlin, 2007. PHD.
- Robert Beachy. Gay Berlin: Birthplace of a Modern Identity. Knopf, 2014: 176-7.
Mühsam (like Harold Gillies 20 years later) did only one male-to-female operation. It is a shame that a better candidate was not chosen.
The co-author of Mühsam’s last book was one Hans Hirschfeld. A German doctor called Hirschfeld in 1930 raises the suggestion that he was a relative of Magnus Hirschfeld, but I could not confirm this in any of the books about Magnus.