The medical consensus
on gender-transition treatments for minors is shifting. PTL! But
many state laws are not — and families are paying the price.
Imagine your 14-year-old daughter has been struggling — withdrawn, anxious, overwhelmed by social media. She comes home one day and tells you she thinks she’s actually a boy. You love her dearly and want her to get help. So, you find a licensed therapist who shares your family’s faith, someone your daughter trusts, someone who will listen carefully and take her pain seriously. In most areas of medicine, that choice — your child, your doctor, your values — belongs to you. But in states like Colorado (CO), it belongs to the state.
Therapists in CO have only one legally safe response: affirm the transition. Any other approach — including simply helping your daughter explore her feelings, understand her identity through the lens of her faith, or grow more comfortable with her biological sex — risks a $5,000 fine and the loss of the therapist’s license. The conversation between the therapist and patient is no longer private. The state has inserted itself into the room.
This is the reality of bans on “conversion therapy” — found in CO as well as 22 states and the District of Columbia. This spring, the U.S. Supreme Court (SCOTUS) will decide whether such laws can stand.
Across the U.S. and Europe, medical authorities are urging greater caution. A growing number of hospitals and health systems are restricting or have discontinued gender-transition procedures for minors, citing legal risks and scientific uncertainty. Britain’s 2024 Cass Review — the most comprehensive examination of pediatric gender medicine to date — found the evidence supporting medical interventions in minors to be weak and inconclusive, prompting sweeping policy changes. The American Society of Plastic Surgeons has recommended against gender surgeries on minors, and the American Medical Association has endorsed deferring such interventions to adulthood.
Yet under CO law, licensed therapists may not help minors explore alternatives to gender transition without risking their careers — even as the rest of the medical world pumps the brakes.
The therapist challenging CO, Kaley Chiles of Colorado Springs, is a Christian whose clients often seek her out because of that shared faith. Many are young people struggling to reconcile feelings of gender confusion with their religious beliefs and family relationships. These young people and their parents are not asking for a predetermined outcome. They want help untangling a confusing situation — not a state-mandated conclusion handed down before the first session ends. “The law basically restricts the speech between me and my client,” Chiles has said. “If your daughter were to say, I think I am a boy, we can only affirm and validate that and assist with gender transition.”
That isn’t therapy. That’s ideology with a license.
Supporters of these laws rely heavily on the emotionally charged term “conversion therapy.” The phrase conjures images of electroshock treatments and coercive programs once used on same-sex-attracted kids. But as Chiles’s attorneys argued before the SCOTUS, the studies CO cites lump together violent aversive treatments and ordinary talk therapy as if they were the same thing. They are not, and there is no credible evidence that compassionate, conversational counseling damages children.
Earlier this year, a Westchester County jury awarded $2 million in a malpractice case to Fox Varian, a 22-year-old who underwent a double mastectomy at 16, finding that her psychologist and surgeon had deviated from reasonable standards of care. Her mother testified at trial that the doctors assured the surgery would improve her daughter’s well-being and suggested that failing to do so would likely drive the child to commit suicide.
Meanwhile, evidence continues to emerge that medical transition does not deliver the psychological benefits often claimed. A recent report from the Department of Health and Human Services found no reliable evidence that such interventions reduce suicide risk or improve long-term mental health in minors, while documenting serious risks including infertility, cardiovascular complications, and regret. Other research suggests that up to 90% of children who experience gender dysphoria before puberty naturally reconcile with their biological sex if allowed to mature without intervention.
SCOTUS Justice Samuel Alito pressed the point during oral argument, drawing comparisons to other once-dominant medical consensus positions — on forced sterilization or institutionalizing children with Down syndrome — that history has since judged harshly. CO’s attorney had no good answer.
The constitutional problem is straightforward. The First Amendment does not permit the government to compel citizens to express ideas they do not believe, and that protection applies with particular force inside the confidential relationship between therapist and patient. CO is not regulating medical procedures. It is regulating conversations.
Families facing these challenges want access to counselors who share their values and will speak honestly, without fear of government punishment. That includes the right of parents to seek care from treating professionals that doesn’t begin with a foregone conclusion. The Constitution guarantees such freedom. We will soon learn if the SCOTUS vindicate it.
Chaplain (Colonel-Ret), U.S. Army
Pastor, Ft. Snelling Memorial Chapel
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