The Supreme Court Just Made It Harder to Protect LGBTQ+ Youth from Conversion Therapy

On April 1, the U.S. Supreme Court ruled 8-1 in Chiles v. Salazar that Colorado’s ban on conversion therapy for minors violates the First Amendment. The decision didn’t just strike down one state’s law. It sent a signal to the more than 25 states with similar bans: your protections may not survive constitutional scrutiny either.

The ruling is the most significant legal setback for LGBTQ+ youth protections in years, and it arrived with an unlikely coalition — liberal and conservative justices alike agreeing that talk therapy, however harmful, is speech the government cannot easily restrict.

What the Court Actually Said

Justice Neil Gorsuch, writing for the majority, framed the case narrowly but with sweeping implications. Kaley Chiles, a licensed Christian counselor in Colorado, had challenged the state’s ban on conversion therapy — treatment aimed at changing a minor’s sexual orientation or gender identity. Chiles argued she only engaged in talk therapy, not the aversive physical interventions that conversion therapy is perhaps most associated with, and that the law prevented her from expressing her views during counseling sessions.

Gorsuch agreed. The law, he wrote, “may address conduct — such as aversive physical interventions,” but as applied to Chiles, “the law regulates what she may say” and “what views she may and may not express.” That, the majority found, amounts to viewpoint discrimination — a category of speech restriction that triggers the most demanding level of judicial review, known as strict scrutiny.

Under strict scrutiny, the government must prove that a restriction on speech serves a compelling interest and is narrowly tailored to achieve that interest. It’s a standard that laws rarely survive. Gorsuch wrote that “any law that suppresses speech based on viewpoint represents an ‘egregious’ assault” on First Amendment protections, and sent the case back to the lower courts to apply that heightened standard.

The Court did not outright declare Colorado’s law unconstitutional. But by requiring strict scrutiny, it effectively raised the bar so high that conversion therapy bans — at least as they apply to talk therapy — will be extraordinarily difficult to defend in court.

The Surprising Vote

Perhaps the most jarring aspect of the decision is the vote count. This wasn’t a 5-4 split along the usual ideological lines. Justices Elena Kagan and Sonia Sotomayor — two of the Court’s liberal members — joined the majority. Kagan even filed a concurrence calling the case a “textbook” example of viewpoint discrimination.

That leaves Justice Ketanji Brown Jackson as the sole dissenter. Jackson warned that the ruling “could be ushering in an era of unprofessional and unsafe medical care.” Her dissent argued that the ban regulates medical conduct, not speech as such, and that states have a legitimate and long-established interest in setting standards of care for healthcare professionals.

“This decision might make speech-only therapies and other medical treatments involving practitioner speech effectively unregulatable,” Jackson wrote. The long-term effects, she cautioned, could be “catastrophic” if states cannot step in to protect patients from harmful therapeutic practices.

Why This Matters Beyond Colorado

More than 25 states and the District of Columbia have enacted laws restricting or banning conversion therapy for minors. These laws were built on a growing consensus in medicine and psychology: every major medical and mental health organization in the United States — including the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics — has condemned conversion therapy as ineffective and harmful. Research consistently links it to depression, anxiety, and suicidality in LGBTQ+ youth.

None of that medical consensus was disputed by the Court. The majority opinion simply held that when the treatment takes the form of speech — a conversation between therapist and patient — the First Amendment demands that the government meet a higher burden before it can intervene.

That distinction between speech and conduct is where the practical fallout begins. States will now need to determine whether their existing bans can survive strict scrutiny, or whether they need to be rewritten to focus exclusively on physical practices while leaving talk therapy unregulated. Some may not bother to try.

Maryland lawmakers were already scrambling as of April 1, weighing late-session amendments to shore up their own protections. Other states are expected to follow.

What This Means for LGBTQ+ Youth

For queer and trans young people, the ruling arrives in an already hostile landscape. The 988 Suicide and Crisis Lifeline recently shuttered its specialized LGBTQ+ youth line, and anti-trans legislation continues to advance in statehouses across the country. Puerto Rico’s governor just signed a law banning hormone therapy and gender-affirming surgeries for people under 21.

Conversion therapy bans were one of the few areas where LGBTQ+ protections had been gaining ground steadily over the past decade. This ruling doesn’t eliminate those bans overnight, but it provides a legal roadmap for challengers in every state that has one.

The Court was careful to say it wasn’t deciding whether conversion therapy bans are inherently unconstitutional. But in practice, by subjecting them to the most demanding standard of judicial review, it has made them vastly harder to maintain. And for the LGBTQ+ youth these laws were designed to protect, the practical difference between “technically possible to defend” and “effectively unenforceable” may be no difference at all.