Author’s note: This article uses the phrase “conversion practices” instead of “conversion therapy” because these sexual orientation and gender identity change efforts are not therapeutic and lack the rigor and scientific guidance of actual therapeutic care.
Even though conversion practices have been discredited and are opposed by a majority of Americans, the far right remains determined to bring this harmful practice back into the mainstream. Conversion practitioners have brought legal challenges against state-level bans for more than a decade, and the Trump administration is now actively supporting their efforts.
In his joint speech to Congress on March 4, 2025, President Donald Trump promoted dangerous pro-conversion-practice dog whistles, such as describing social transition—when a transgender person begins using new pronouns or a new name—as “child abuse.” Trump ultimately stated his goal: “I want Congress to pass a bill permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body. This is a big lie. And our message to every child in America is that you are perfect exactly the way God made you.”
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The attempt to rebrand conversion practices as “therapy” is just another example of the Trump administration ignoring best-practice medicine when it doesn’t fit its agenda. The U.S. Supreme Court has previously denied writ of certiorari six times in cases against bans on conversion therapy. But this year, anti-LGBTQI+ group Alliance Defending Freedom has finally managed to get a case before the Supreme Court arguing for the protection of conversion practices on religious freedom and free speech grounds: Chiles v. Salazar. Oral argument for the case took place on October 7, 2025.
This article outlines the current legal landscape of conversion therapy bans across the states, the impacts of a potential Supreme Court ruling against these bans, and an analysis of what happened during oral argument in Chiles v. Salazar.
What is conversion “therapy”?
Conversion practices, also known as “change efforts,” are “any attempt to change a person’s sexual orientation or gender identity or expression, or any component of these.” Over the decades, conversion practices have undergone several rebrands, including “aversion therapy,” “reparative therapy,” “sexual orientation or gender identity change efforts,” and, most recently, “gender exploratory therapy.” The specific “treatment” strategies may vary, but the common feature of conversion practices is pressure on the LGBTQI+ individual to reject their identities and, in some cases, blame their families or social networks. Notably, conversion practices lead to higher rates of depression, anxiety, and suicidality, with mental health associations describing such efforts as harmful and ineffective. In 2023, 28 medical associations wrote a letter opposing conversion practices.
Proponents of conversion practices claim that they can change a person’s sexual orientation or gender identity. But decades of scientific research and testimonies of people who have been subjected to conversion therapy demonstrate that it does not work and even causes long-term harm. Conversion practices are rooted in the idea that sexual and gender minorities are wrong and identities can be changed. This is at odds with the widely accepted scientific understanding that gender diversity and sexual orientation are natural variations in humans. Conversion practitioners also believe that their “treatments” provide relief—which former conversion practitioners have admitted is untrue. In reality, the distress that LGBTQI+ people experience is caused by social stigma and discrimination, both of which are exacerbated by conversion practices.
The political landscape of conversion “therapy”
Along with being scientifically discredited, conversion practices are opposed by most Americans In particular, polling from 2025 shows that 56 percent of U.S. adults think conversion practices for LGBTQ minors should be banned. The far right’s push to protect conversion practices is out of step with the American public and both political parties. In all states that have passed protective laws banning conversion practices, the legislation had bipartisan support.
The first state law banning conversion practices was passed in California in 2012, quickly followed by a similar ban in New Jersey in 2013. These laws were challenged by conversion practitioners, but the 9th and 3rd circuits affirmed the laws in Pickup v. Brown (2013) and King v. Governor of New Jersey (2014), respectively. The California and New Jersey laws, like many others banning conversion practices, only named “sexual orientation change efforts” as prohibited conduct.
There is strong legal precedent supporting bans on conversion practices because the courts have affirmed that states hold the right to regulate medical practice, licensing, and professional conduct.
There is strong legal precedent supporting bans on conversion practices because the courts have affirmed that states hold the right to regulate medical practice, licensing, and professional conduct. Banning conversion practices helps parents support their kids and protect their ability to make informed choices in mental health care. The laws operate by banning conversion practices as a type of “unfair or deceptive act” using existing consumer protection laws.
Today, 23 states and Washington, D.C., ban conversion practices and fewer than 10 states restrict or prohibit restrictions on conversion practices. In 2015, the Obama administration called for a ban on conversion practices, and that same year, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a report condemning the practice.
There have been attempts to implement a federal ban on conversion practices as well: The Therapeutic Fraud Prevention Act was first introduced in 2015 and has been reintroduced by Rep. Ted Lieu (D-CA), Sen. Patty Murray (D-WA), and Sen. Cory Booker (D-NJ) every year since. The latest versions, H.R. 3243 and S. 1663, have 103 co-sponsors in the House and 38 in the Senate, respectively.
How did Chiles v. Salazar make it to the Supreme Court?
Between 2013 and 2025, five cases on conversion practice bans were heard by appellate courts and two were heard by state supreme courts. (see Table 1) Judges upheld the bans in six of these seven cases. Only one appellate court, the 11th Circuit, ruled against a ban on conversion practices in Otto v. Boca Raton. Despite losing in court for years, the far right has not stopped fighting these bans, and Chiles v. Salazar is the result of this obsessive litigation.
Two circuit courts evaluated these bans as regulations of free speech, which is the question the Supreme Court must now address in Chiles v. Salazar. In King, the 3rd Circuit reviewed New Jersey’s ban on conversion practices through both standards: professional conduct and free speech. However, the 3rd Circuit still upheld the ban on conversion practices, stating: “Because Plaintiffs are speaking as state-licensed professionals within the confines of a professional relationship, however, this level of protection is diminished.” In King, the interest of the state of New Jersey to protect minors from harm was determined to be sufficient reason for the government to curtail the speech of state-licensed professionals during therapy sessions.
Yet the 11th Circuit’s decision in Otto v. Boca Raton contradicted the 3rd Circuit’s ruling. The 11th Circuit ruled that two 2017 local ordinances—in Boca Raton and Palm Beach, Florida—were government restrictions on free speech, rejecting the claim that the local government’s interest in protecting minors from harmful “therapy” was sufficient justification to regulate speech. Now, Alliance Defending Freedom is using that decision to claim that there is a “circuit split” over how judges review these bans—as regulating professional conduct or limiting personal speech.
Chiles v. Salazar is about the 2019 Colorado ban on conversion practices—known as the Minor Conversion Therapy Law, or H.B. 19-1129. Kaley Chiles, a licensed mental health care professional, challenged the law, claiming that it violated her first amendment right to free speech. Yet the district court denied her request for an injunction in 2022 and later upheld Colorado’s law. Upon appeal by Chiles, the 10th Circuit Court reviewed the case and ruled against her in 2024. Following this loss, Chiles and her lawyers petitioned the Supreme Court to take the case. In March 2025, the court granted their petition. The U.S. solicitor general was granted permission to participate in oral argument in support of Chiles.
What is at stake in Chiles v. Salazar?
The question now before the Supreme Court is whether state laws prohibiting conversion practices are regulating professional conduct or personal speech. If the court decides that this ban violates the First Amendment rights of Kaley Chiles, then it puts all state and local bans on conversion practices at risk of being challenged and ultimately overturned on constitutional grounds.
There is also a risk that such a decision could embolden challenges to similar laws that regulate health care, which could endanger access to transgender health care, reproductive health care, and more. The groundwork for this has already been laid: Alliance Defending Freedom won a major case in 2017, National Institute of Family and Life Advocates v. Becerra, that opened the door for all medical disclosures to be reviewed by judges as free speech rather than professional conduct. This distinction is important since the government must meet a very high threshold to justify limiting an individual’s speech.
Alongside these risks, a decision in favor of Kaley Chiles would be shocking for two reasons. First, there is strong precedent to uphold bans on conversion practices. Second, ruling that conversion practices are protected as personal speech would upend legal precedent by weakening regulations on professional conduct. If the Supreme Court were to decide in favor of Chiles, it would be another example of the justices’ willingness to bend to far-right ideology rather than perform their constitutional obligations.
See also
The battle over conversion practices reveals that the far right’s attacks on transgender people are just the tip of the iceberg in a broader effort to force gender and sex conformity on everyone.
The battle over conversion practices reveals that the far right’s attacks on transgender people are just the tip of the iceberg in a broader effort to force gender and sex conformity on everyone. If these efforts are successful, all LGBTQI+ people will be at risk and health care misinformation may become even more widespread.