The Supreme Court heard arguments on October 7, 2025 to lift Colorado’s ban on “conversion therapy,” a discredited practice which targets LGBTQ+ youth to change their sexual orientation or gender identity. In Chiles v. Salazar, Kaley Chiles, a Colorado-licensed professional counselor, challenged a Colorado state regulation which prohibits providers from engaging in “conversion therapy” with anyone under 18. The practice can include anything from talk therapy to electric shock or pharmaceutical interventions. The Court heard arguments about what therapists may say to their patients—specifically, whether talk counseling is “conduct” or “speech,” and whether it is protected under the First Amendment and the Free Exercise Clause.
There is overwhelming evidence and medical consensus that the efforts to change a child’s sexual orientation or gender identity are unsafe and ineffective. In August 2025, the American Psychological Association, joined by the American Psychiatric Association and 12 other mental health and medical professional organizations, filed an amicus brief in support of the Colorado law. Research consistently demonstrates that “conversion therapy” has long-lasting consequences, including depression, anxiety, suicidality, substance misuse, damaged familial relationships, loss of connection to community, self-blame, guilt, and shame. Twenty-three states have prohibited healthcare providers from subjecting minors to “conversion therapy.” A recent UCLA study shows 698,000 LGBTQ+ adults have undergone “conversion therapy,” with half of them (350,000) receiving the treatment as adolescents.
The central question for the judges in Chiles is whether Colorado’s law interferes with free speech protected by the First Amendment, or whether it is a necessary legal regulation of professional conduct. Chiles argues that “conversion therapy” is speech, not conduct, and thus states “do not have a freer hand to regulate speech simply because the speaker is ‘licensed’ or giving ‘specialized advice.’” Conservative judges shared concerns about the law’s apparent threat to Christianity-informed free speech. Justice Alito called the statute “blatant viewpoint discrimination,” posing two hypotheticals—one in which a boy asks a therapist to help end his attraction to men, and one in which he asks for support to feel comfortable being gay—and stating that the statute requires opposite results depending on the viewpoint expressed. Justice Gorsuch and Justice Barrett also raised concerns regarding how laws justify medical regulations.
Justice Jackson, conversely, noted that states have a long history of regulating medical treatment, and doctors would clearly be liable if they used medication that the state deemed substandard care. Citing the Supreme Court 2024 decision in Skrmetti, which upheld the Tennessee law banning gender-affirming care for minors, Jackson questioned why the Colorado regulation “isn’t just the functional equivalent,” since both prohibit a medical treatment for minors that major medical associations say can lead to an increased risk of depression and suicidal thoughts. Justice Sotomayor was fundamentally concerned with whether Chiles even had standing to challenge the law, noting that “merely having a law on the books is not enough.” She pressed Chiles’ attorney to explain how she was personally harmed by the law, observing she does not face a “credible threat of prosecution.”
There is no clear consensus among circuit courts on First Amendment protections regarding professional speech. For example, the Ninth Circuit has held that there is a continuum, where on one end “public dialogue” gets robust protection, and on the other end, conduct such as individual treatment or professional counseling is not protected. Other courts insist that speech protections apply fully to counseling conversations even in professional settings, while many reaffirm that health professionals must provide treatment consistent with the government-regulated standard of care. In Chiles, the court seemed skeptical of Colorado’s claim that conversion therapy is conduct and not speech, but it remains uncertain if it will be sent back to the lower courts.
Chiles comes amidst a nationwide surge of anti-LGBTQ+ legislation and decisions, including laws that ban or punish gender-affirming care, restrict trans athletes from participating in sports, and create religious exemptions for LGBTQ+ nondiscrimination protections. In two Colorado cases, in 2017 and 2023, the Supreme Court sided with Christian business owners who opposed marriage equality and rebuked LGBTQ+ nondiscrimination laws in the process. Chiles could not only redefine the boundary between speech and conduct and set precedent for medical regulations, but also have wide-ranging consequences on legal safeguards meant to protect LGBTQ+ youth from discrimination and harm.