The Supreme Court announced Monday it will hear a case regarding whether state bans on “conversion therapy” trying to change minors’ sexual orientation or gender identity are legal—a case that could carry billions of dollars in repercussions, as a 2022 study found conversion therapy carries an economic burden of approximately $9 billion annually for patients and their families.
Joseph Fons holds a Pride Flag in front of the U.S. Supreme Court building in Washington, DC, on ... [+]
The Supreme Court took up Chiles v. Salazar, a case challenging Colorado’s ban on LGBTQ “conversion therapy” for minors, which asks the justices to more broadly decide whether laws that “[censor] certain conversations between counselors and their clients based on the viewpoints expressed” are constitutional.
LGBTQ “conversion therapy,” as it’s commonly known, refers to any practices—including both emotional efforts, like talk therapy, or physical efforts, like electroconvulsive therapy—that aim to influence a patient’s sexual orientation or gender identity, which are typically framed as efforts to “cure” homosexuality or being transgender.
Repeated studies have shown such efforts are ineffective at changing people’s sexual orientation or gender identity and carry a variety of harmful effects—such as elevated risks for suicide, drug abuse and mental health issues—which has led to bans on conversion therapy for minors being enacted in more than 20 states.
Conversion therapy and its negative effects also have an economic impact, as a 2022 study published in JAMA Pediatrics found conversion therapy and its “associated harms” result in an economic burden of approximately $9.23 billion per year.
Conversion therapy alone costs approximately $650 million for participants annually in the U.S., with individuals who undergo it paying an extra $97,985 for treatment as compared with people who don’t undergo any counseling, according to the study, which was based on data from LGBTQ youth ages 13-24.
There are also significant costs associated with knock-on effects from conversion therapy and the study estimates each conversion therapy patient pays an extra $83,366 on average to treat the “downstream consequences” associated with the procedure, which combined raise the total economic burden of conversion therapy to $9.2 billion.
The Supreme Court will hear the case on conversion therapy at some point during its next term, which begins in October, so any ruling in the case is likely more than a year away.
The study, which was conducted by pro-LGBTQ rights organization The Trevor Project and research group Cytel, concluded there is a “high economic burden and high societal costs” that come along with conversion therapy, which the study refers to as sexual orientation and gender identity change efforts (SOGICE). Researchers analyzed the difference in costs between patients who underwent conversion therapy, LGBTQ youth who received no therapy and those who received therapy that affirmed their sexual orientation or gender identity. The study found conversion therapy carried the highest economic burden: In addition to the $650 million per year in total attributed to the therapy itself, there are also total annual costs of $190 million related to anxiety or “severe psychological distress” among those that underwent conversion therapy, $1.36 billion related to depression, $2.42 billion from suicide attempts, $1.17 billion from fatal suicides, $1.26 billion from alcohol use disorder and $2.18 billion from substance abuse. The likelihood of those negative outcomes was largely markedly higher among those who underwent conversion therapy as compared with other LGBTQ populations—except alcohol use disorder, where those without any therapy registered the highest number by one percentage point (42.26% among those with no intervention versus 41.26% among conversion therapy patients). As a result, the total costs incurred by conversion therapy patients were higher than the $4.85 billion in total annual costs among those who hadn’t received any treatment, and $3.04 billion among those who received affirmative therapy.
Researchers noted there were some limitations with the study’s methodology that may affect its results, such as being based on studies in which patients self-reported their experiences. That means it might not be fully representative of all LGBTQ patients, as many people may be unwilling to discuss their experiences. It also assumes the risks are the same across the LGBTQ population and for various types of conversion therapy, which may not be the case. Researchers argued they took a “conservative approach” with their findings, however, and noted the $9 billion figure is likely an underestimate of the total economic impact. The study only looked at adverse impacts from conversion therapy for three years after the treatment, for instance—though such effects could likely extend for much longer—and did not examine some other potential impacts, like post-traumatic stress disorder or medical consequences from various medications or electroconvulsive therapy.
13%. That’s the share of LGBTQ youth who have either been subjected to or threatened with conversion therapy, according to a 2024 survey conducted by The Trevor Project among more than 50,000 Americans ages 13-24. That includes 5% who have been subjected to the therapy and 8% who were threatened with it. The 5% share is down from 10% who said in 2020 they were subjected to the therapy, though that number could rise again should the Supreme Court outlaw state bans.
The Supreme Court case was brought by Kaley Chiles, a licensed counselor in Colorado who said in a court filing “she believes that people flourish when they live consistently with God’s design, including their biological sex.” Chiles objects to Colorado restricting her from counseling clients to change their sexual orientation or gender identity, claiming it violates her First Amendment rights and classifying state bans on conversion therapy as “silenc[ing] counselors’ ability to express views their clients seek on a topic of ‘fierce public debate.’” Chiles asked the Supreme Court to take up the case after a federal appeals court upheld Colorado’s policy restricting conversion therapy, ruling that it was regulating counselors’ professional conduct, rather than chilling First Amendment-protected speech. The case is the latest in a string of major cases related to LGBTQ rights the 6-3 conservative-leaning court has decided in recent years—such as cases over businesses being allowed to discriminate against same-sex couples or discriminate on the basis of sexual orientation and gender identity—and the court is deliberating on a case this term over gender-affirming care for minors.
Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States (JAMA Pediatrics)