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Supreme Court ruling makes vulnerable children therapists safer in Colorado

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by Amy E. Hamilton, opinion contributor - 04/09/26 8:00 AM ET

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by Amy E. Hamilton, opinion contributor - 04/09/26 8:00 AM ET

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The Supreme Court’s recent 8-1 ruling in Chiles v. Salazar affects how states can regulate therapy for minors. It also raises a deeper question about who controls the conversation — the state, or clients and clinicians?

I submitted an amicus brief in support of Kaley Chiles, and I welcome the decision with great relief. The statute’s intent was purportedly to protect vulnerable minors from harm. In practice, its effect would be the opposite.

The statute narrowed the scope of therapy for minors struggling with their sexual and gender identity, policing therapeutic conversation and forbidding exploration of potential fluidity and change. These restrictions, enforced by threat of legal censure, actively reduce the pool of therapists willing to work with these struggling youth.

That Colorado engaged in viewpoint discrimination was evident in that the statute did not prohibit all therapeutic discussion exploring sexual or gender identity change. Rather, the state explicitly carved out an exception for the one identity change path with the most risk and known harms: gender transition.

I have every compassion for struggling youth and their parents. Had I been a teen in this era, I could easily have been trans-identified. As a gender non-conforming youth in the 1980s, I wore a tuxedo to my high school dance. My appearance was androgynous enough for me to often be mistaken for a boy. I used this style as a shield to guard me from the vulnerability of being female, which had, in my reasoning, exposed me to abuse. It is a familiar story: My teen self was confused and deeply depressed.

The Dutch gender clinicians where this practice began originally urged caution due to the “high levels of psychopathology found” in adolescents with “gender identity disorder.” Twenty-five years later, abundant data and evidence show that similar patterns persist. Many young people today who present as trans-identifying also experience mental health co-morbidities or have had adverse childhood experiences.

By forbidding all change-exploring talk therapy — except for that which affirms a change away from one’s biological sex — Colorado’s statute effectively prohibited clinicians from doing their job. They banned them from considering patients’ past, preventing exploration of both what is absent (e.g., the absence of prior childhood gender dysphoria) and what is often present, including trauma, family dysfunction, mental health issues, autism or history of sexual assault — factors that in any other circumstance would warrant deeper evaluation.

Under Colorado’s ban, clinicians were forbidden from discussing future considerations that might override the gender identity presentation of the moment. They could not mention the long-term health harms, nor the loss of fertility, nor the evidence of shortened lifespans and increased suicidality in the long run — all of which are objective and well-documented outcomes.

According to psychiatrist and gender clinician Dr. Stephen Levine, responsible therapy takes a “wider lifecycle view.” He rightfully urges that when working with youth, “the overriding consideration is the creation of a happy, highly functional, mentally healthy person for the next 50 to 70 years of life — not merely during a transient stage of childhood or adolescent development.”

Imagine a state legislatively restricting therapists from exploring a minor’s past, present and future if it conflicts with the client’s current identity declarations and perceptions. That is effectively what Colorado’s statute required. In so doing, the state narrowed young persons’ options and failed to guard their right to an “open future.”

Several years ago, during testimony on a bill that sought to ban “gender-affirming” medicine for minors, a father stepped up to the microphone with his young son who now identified as a girl and described how his child had found “true happiness” in the a identity. But stories like this one become more complex when considered through a wider lifecycle view.

At the time, I had been reading articles about emerging innovations using Tilapia fish skin grafts in sex-reassignment surgery for boys whose puberty had been blocked so early that there was not enough material to work with. I had been hearing clinicians discuss the long-term health implications, such as sexual dysfunction and infertility, that are part and parcel of this path.

I also thought of