High Court Conversion Therapy Decision Underscores Trump Efforts

The US Supreme Court’s ruling against Colorado’s ban on conversion therapy sparked concern among legal analysts that a door is opening for further state and federal limits on transgender rights through litigation and enforcement.

Nearly 30 states restrict LGBTQ conversion therapy for minors, according to nonprofit Movement Advancement Project. In voting 8-1 that Colorado’s ban likely violates a talk therapist’s free speech, the court last week cast doubt on those and other laws.

Colorado’s law bars therapy treatment that aims to change an individual’s sexual orientation or gender identity and related behaviors. In the majority opinion, Justice Neil M. Gorsuch claimed the law censored “speech based on viewpoint,” though the court stopped short of striking it down, kicking the case back to the lower court for a second look.

While the decision is narrow and focused on Colorado, it “may provide additional sort of atmospheric leeway” for the Trump administration in scaling back LGBTQ+ protections, said Shannon Minter, legal director at the National Center for LGBTQ Rights, who was involved in drafting state statutes. “They’re likely to exploit this decision to claim that it somehow supports those efforts.”

‘Test Case’

The ruling complicate states’ abilities to project LBTGQ+ youth “from harmful practices outside the standards of care for the medical profession,” said Kara N. Ingelhart, director of the LGBTQI+ Rights Clinic at Northwestern, in a statement.

In an interview, she said states having to defend themselves from similar challenges will need to put a lot of defensive work into litigation, placing administrative burden on resources. Whenever a legal strategy “finds purchase” for the Supreme Court, it suggests a “potential path” for other challenges.

“This does seem like it was a test case,” Ingelhart said.

Other cases are percolating throughout the states.

At the US Court of Appeals for the Eighth Circuit, two counselors are fighting against Kansas City and Jackson County ordinances. Another case looms over a Wisconsin city ordinance. In January, a court blocked Michigan from enforcing against plaintiffs a ban on conversion therapy for minors.

The Supreme Court decision also raised concerns states may seek restrictions on transgender people.

It’s “another decision where the court has sided with First Amendment assertions of civil rights over the civil rights of LGBTQ plus populations,” said Nicole Huberfeld, law professor at Boston University.

Last month, Texas Attorney General Ken Paxton issued an opinion that states’ ban on gender-affirming care also extends to talk therapy for transgender youth.

In November, policy group KFF reported 27 states had policies or laws that limited gender-affirming care access for youth.

“In this moment, it probably also matters that the Trump administration has taken actions that disfavor the civil rights of LGBTQ+ populations,” Huberfeld said.

Religious Rights

The Trump administration has implemented protections for faith-based organizations and their viewpoints, and the decision could embolden further action or investigations, according to the top lawyer for a major medical group granted anonymity to speak candidly.

The Department of Health and Human Services Office for Civil Rights said it would prioritize enforcement of religious protections, in line with rulemaking in President Donald Trump’s first term.

Trump also issued an executive order calling for action to prohibit gender-affirming care. Steps to scale back access include rulemaking to cut off federal funds to hospitals offering care to minors and a 400-plus page report that critics say seems to endorse conversion therapy.

The Administration for Children and Families proposed rolling back requirements that foster youth are placed with families that affirm their sexual orientation or gender identity. And the Office for Civil Rights investigated a state health department over alleged discrimination against behavioral health providers that didn’t want to help facilitate the care.

The Trump administration “went out on a limb” with its transgender actions, “and now the Supreme Court’s also sort of given its blessing,” said Josh Blackman, professor at South Texas College of Law Houston.

That follows other decisions against transgender-related causes, he said.

In 2025’s United States v. Skrmetti, the justices upheld a Tennessee law outlawing certain medical treatments for transgender children. In Mahmoud v. Taylor, the majority ruled Maryland likely violated the Constitution in using LGBTQ+-friendly books without notice to parents.

Those who support the decision see it as a win for religious rights.

Jim Campbell, chief legal counsel for the Christian legal group challenging the Colorado law, Alliance Defending Freedom, said the decision “will help protect counselors from this law and similar ones in more than 20 other states and over 100 localities across the country.”

“From professional groups to medical malpractice verdicts, the tide is turning on the issue of gender ideology, and the truth is coming to light,” Campbell said.

Luke Goodrich, senior counsel for the Becket Fund for Religious Liberty, said in a thread on X that the Colorado law “is part of a nationwide ‘transgender conveyor belt'—a web of laws that channel kids down the path of harmful gender transitions.”

“Every step of the conveyor belt is being challenged in court. The conveyor belt is not inevitable. It is legally fragile because it contradicts basic principles of religious freedom, free speech, parental rights, and medical science,” Goodrich said.

Medical Malpractice Claims

States retain the ability to regulate provider licensing and their ethics board, but other cases could test the limits of how much control state licensing boards have on medical speech in areas like vaccines.

Last week’s ruling, however, doesn’t prevent individual people who’ve undergone conversion therapy from filing medical malpractice claims as recourse.

Some advocacy groups hope to increase the statute of limitations for malpractice claims following the decision.

“I think there are both avenues that states could pursue on the front end as well as the back end for survivors to bring civil lawsuits or malpractice claims after the fact and potential for other variations of the laws to survive,” said Shayna Medley, senior litigation staff attorney at Advocates for Trans Equality.