Amicus Curiae Brief — Kaley Chiles, Petitioner v. Patty Salazar, in Her Official Capacity as Executive Director of the Colorado Department of Regulatory Agencies, et al.

Supreme Court briefJun 12, 2025

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No. 24-539

In the Supreme Court of the United States

__________

KALEY CHILES,

Petitioner,

PATTY SALAZAR, IN HER OFFICIAL CAPACITY AS

EXECUTIVE DIRECTOR OF THE COLORADO DEPARTMENT

OF REGULATORY AGENCIES, ET AL.,

Respondents.

____________________

ON WRIT OF CERTIORARI TO THE UNITED STATES

COURT OF APPEALS FOR THE TENTH CIRCUIT

_______________

BRIEF FOR FAMILY RESEARCH COUNCIL

AND SAMARITAN’S PURSE AS AMICI CURIAE

IN SUPPORT OF PETITIONER

__________

CHRISTOPHER E. MILLS

Counsel of Record

Spero Law LLC

557 East Bay Street

#22251

Charleston, SC 29413

(843) 606-0640

cmills@spero.law

TABLE OF CONTENTS

Page

Table of Authorities ................................................... iii

Interest of Amici Curiae .............................................. 1

Summary of the Argument ......................................... 2

Argument ..................................................................... 4

APA, like Colorado’s other favored groups, is

driven by ideology—not science. ...................... 4

A. Ideology in APA’s history. ............................ 7

B. Ideology in APA’s guidelines. ..................... 10

C. Ideology in APA’s public policy positions. .. 13

D. Ideology in APA’s legal stances, including

here. ........................................................... 16

1. APA elides the distinction between

different therapies................................ 17

2. APA’s claim that talk therapy causes

harm is unsupported by its evidence

review. .................................................. 19

3. APA’s harm analysis lacks context and

contradicts its embrace of sterilizing

hormones and surgeries. ...................... 22

II. APA’s approach, mandated by Colorado, harms

children by preempting exploratory therapy

about issues like trauma. ............................... 28

A. Colorado’s law and APA’s ideological

enforcement lead to self-censorship. ......... 30

B. This censorship harms children. ................ 32

1. Colorado’s ban discourages therapists

from exploring trauma and other cooccurring mental health issues............ 33

2. Banning talk therapy will usher

children to dangerous medical

transitioning. ........................................ 35

Conclusion.................................................................. 38

iii

TABLE OF AUTHORITIES

Page(s)

CASES

Eknes-Tucker v. Governor of Alabama,

114 F.4th 1241 (CA11 2024) .................................. 37

NIFLA v. Becerra,

585 U.S. 755 (2018) .................................................. 2

Otto v. City of Boca Raton,

981 F.3d 854 (CA11 2020) ..................................... 26

Parents Involved in Cmty. Sch. v. Seattle Sch. Dist.

No. 1, 551 U.S. 701 (2007) ....................................... 9

Planned Parenthood of Se. Pennsylvania v. Casey,

505 U.S. 833 (1992) .................................................. 5

STATUTES

Colo. Rev. Stat. § 12-245-202(3.5) ............................. 29

OTHER AUTHORITIES

Am. Psychiatric Ass’n, Diagnostic and Statistical

Manual of Mental Disorders (5th ed. 2013) .......... 18

APA, American Psychological Foundation Establishes

Grant Honoring Christine Blasey Ford (2019),

https://perma.cc/57DK-DL9S ................................. 15

APA, APA Calls on President to Preserve “Dreamers”

Program (2017), https://perma.cc/EX6S-2E32 ...... 15

APA, Apology to People of Color for APA’s Role in

Promoting, Perpetuating, and Failing to Challenge

Racism, Racial Discrimination, and Human

Hierarchy in U.S. (Oct. 2021),

https://perma.cc/D5N8-3EPU ............................ 9, 10

APA, Gender Style and Grammar Guidelines (Oct.

2024), https://perma.cc/33EK-G3YN ..................... 12

APA, Government Shutdown Increasing Stress on

Federal Workers, Contractors, Families, APA Says

(2019), https://perma.cc/CB9X-VMN5 ................... 15

APA, Individual, Collective, and Intergenerational

Trauma Recovery (Aug. 2024),

https://perma.cc/P24C-DE94 ................................. 15

APA, Multicultural Guidelines: An Ecological

Approach to Context, Identity, and Intersectionality

(2017), https://perma.cc/QYM4-MRVQ ................. 11

APA, Report of the American Psychological

Association Task Force on Appropriate Therapeutic

Responses to Sexual Orientation (2009),

https://perma.cc/HX9S-6L57............ 3, 18, 19, 20, 24

APA, Resolution on Sexual Orientation Change

Efforts (Feb. 2021),

https://perma.cc/VQP5-BQQV ......................... 17, 20

APA, Role of Psychology and APA in Dismantling

Systemic Racism Against People of Color in U.S.

(Oct. 29, 2021), https://perma.cc/S8HA-925J .... 9, 10

APA, Statement Calling for an Immediate,

Permanent, and Comprehensive Ceasefire in the

Israel-Gaza Conflict (Aug. 2024),

https://perma.cc/DX75-N938 ................................. 15

APA, Statement of APA President Regarding the

Science Behind Why Women May Not Report

Sexual Assault (2018),

https://perma.cc/ST7A-NJY4 ................................. 15

APA, Style and Grammar Guidelines (Feb. 2024),

https://perma.cc/YDN5-Y868 ................................. 11

S. Ayad et al., A Clinical Guide for Therapists

Working with Gender-Questioning Youth, Gender

Exploratory Therapy Ass’n (2022),

https://perma.cc/7DGZ-RPAH ............................... 28

J. Block, Gender Medicine in the US: How the Cass

Review Failed to Land, BMJ (May 23, 2024),

https://perma.cc/R6XS-4JSB ........................... 27, 30

J. Blosnich et al., Sexual Orientation Change Efforts,

Adverse Childhood Experiences, and Suicide

Ideation and Attempt Among Sexual Minority

Adults, United States, 2016–2018, 110(7) Am. J.

Public Health 1024 (2020) ..................................... 20

W. Bockting, Transgender Identity Development, in 1

APA Handbook of Sexuality and Psychology (D.

Tolman & L. Diamond eds., 2014)......................... 36

Brief for APA as Amicus Curiae in Support of

Petitioners, Planned Parenthood of Se.

Pennsylvania v. Casey, Nos. 91-744, 91-902, 1992

WL 12006399 (U.S. Mar. 6, 1992) ......................... 16

Brief for APA as Amicus Curiae in Support of

Respondents, Metropolitical Edison Co. v. People

Against Nuclear Energy, No. 82-358, 1982 WL

1045125 (U.S. Sept. 30, 1982) ............................... 16

Brief for APA et al. as Amici Curiae Supporting

Respondent, Roper v. Simmons, No. 03-633, 2004

WL 1636447 (U.S. July 19, 2004) .......................... 25

Brief for APA et al. as Amicus Curiae in Support of

Respondents, Students for Fair Admissions, Inc. v.

President & Fellows of Harvard Coll., Nos. 20-

1199, 21-707, 2022 WL 3108813

(U.S. Aug. 1, 2022) ................................................. 16

Brief for Family Research Council as Amicus Curiae

in Support of State Respondents, United States v.

Skrmetti, No. 23-477, 2024 WL 4594889

(U.S. Oct. 15, 2024) ........................................ 5, 7, 24

Brief of Alabama as Amicus Curiae Supporting State

Respondents, United States v. Skrmetti, No. 23477, 2024 WL 4525181 (U.S. Oct. 15, 2024) ........... 7

Brief of Amicus Curiae APA in Support of Appellees,

Thornburgh v. Am. College of Obstetricians &

Gynecologists, No. 84-495, 1985 WL 669706

(U.S. Aug. 21, 1985) ............................................... 16

Brief of APA as Amicus Curiae in Support of

Defendants-Appellees and Affirmance, Chiles v.

Salazar, Nos. 22-1445, 23-1002, 2023 WL 3346804

(CA10 May 5, 2023)

........................ 2, 9, 18, 19, 20, 21, 23, 24, 25, 26, 27

Brief of APA et al. as Amici Curiae in Support of

Petitioner, United States v. Skrmetti, No. 23-477,

2024 WL 4101400 (U.S. Sept. 3, 2024)...... 23, 25, 26

S. Burga & R. Schneid, New HHS Report Urges

‘Exploratory Therapy’ for Transgender Youth,

TIME (May 1, 2025) ............................................... 29

H. Cass, Independent Review of Gender Identity

Services for Children and Young People (Apr.

2024),

https://perma.cc/74EA-L76V............ 6, 12, 26, 27, 36

Cass Review: Implications for Scotland, Current

Context (July 5, 2024),

https://perma.cc/9LYB-LV7N ................................ 27

vii

R. Cautin, The Founding of the Association for

Psychological Science: Part 1. Dialectical Tensions

Within Organized Psychology, 4(3) Persp. on Psych.

Sci. 211 (2009) ........................................................ 10

R. Cautin, The Founding of the Association for

Psychological Science: Part 2. The Tipping Point

and Early Years, 4(3) Persp. on Psych. Sci. 224

(2009) ........................................................................ 9

Corrected Expert Report of G. Nangia, M.D., Boe v.

Marshall, No. 22-184, Dkt. 557-11

(M.D. Ala. May 27, 2024) ................................. 34, 35

N. Cummings et al., Historical Chronology:

Examining Psychology’s Contributions to the Belief

in Racial Hierarchy and Perpetuation of Inequality

for People of Color in U.S., Ctr. for Hist. Psych.

(2021), https://perma.cc/VX6C-BUA5...................... 8

R. D’Angelo et al., One Size Does Not Fit All: In

Support of Psychotherapy for Gender Dysphoria,

50 Arch. Sexual Behavior 7

(2021) ........................................ 21, 22, 32, 33, 34, 35

T. DeAngelis & E. Andoh, Confronting Past Wrongs

and Building an Equitable Future, 53(2) Monitor

on Psych. (Mar. 2022),

https://perma.cc/VJD5-GLVR .................................. 8

C. Ferguson, “Everybody Knows Psychology is Not a

Real Science”: Public Perceptions of Psychology and

How We Can Improve Our Relationship with

Policymakers, the Scientific Community, and the

General Public, 70(6) Am. Psych. 527 (2015) ........ 13

J. Glassgold, Research on Sexual Orientation Change

Efforts: A Summary, in The Case Against

viii

Conversion “Therapy”: Evidence, Ethics, and

Alternatives (D. Haldeman ed., 2022) ............. 20, 25

N. Gorsuch & J. Nitze, Over Ruled: The Human Toll

of Too Much Law (2024) .......................................... 7

K. Hancock & D. Haldeman, APA’s Guidelines for

Psychological Practice With Lesbian, Gay, and

Bisexual Clients and Sexual Orientation Change

Efforts: A Brief History, in The Case Against

Conversion “Therapy”: Evidence, Ethics, and

Alternatives (D. Haldeman ed., 2022) ................... 22

S. James et al., The Report of the 2015 U.S.

Transgender Survey, National Center for

Transgender Equality (Dec. 2016),

https://perma.cc/FA4E-DHUQ............................... 21

C. Jones, The Façade of Medical Consensus: How

Medical Associations Prioritize Politics Over

Science, 2025 Harv. J. L. & Pub. Pol’y

Per Curiam 1 .......................................................... 25

H. Kazenoff, The American Psychological Association

Has Lost Its Mind, Capital Research Center

(March 8, 2019), https://perma.cc/2PSY-P246 .. 7, 10

M. Leslie, The Vexing Legacy of Lewis Terman,

Stanford Magazine (July 2000),

https://perma.cc/X2XV-2U69 ................................... 8

S. Levine, What is the Purpose of the Initial

Psychiatric Evaluation of Minors with Gender

Dysphoria, 50(6) J. Sex & Marital Therapy 773

(2024) ................................................................ 32, 36

M. Makary, Blind Spots: When Medicine Gets It

Wrong, and What It Means for Our Health

(2024) .................................................................. 4, 24

I. Meyer et al., LGBTQ People in the US: Select

Findings from the Generations and TransPop

Studies (June 2021),

https://perma.cc/B2TG-RPQC................................ 33

A. Miroshnychenko et al., Gender Affirming Hormone

Therapy for Individuals with Gender Dysphoria

Aged <26 Years: A Systematic Review and Metaanalysis, 110(6) Arch. Disease Childhood 437

(2025) ...................................................................... 26

New Restrictions on Puberty Blockers (May 29, 2024),

https://perma.cc/E3LR-XCEP ................................ 27

S. Pappas, APA Issues First-Ever Guidelines for

Practice with Men and Boys, 50(1) Monitor on

Psych. (2019) .......................................................... 11

D. Rivera & S. Pardo, Gender Identity Change

Efforts: A Summary, in The Case Against

Conversion “Therapy”: Evidence, Ethics, and

Alternatives (D. Haldeman ed., 2022) ................... 21

T. Salway et al., Prevalence of Exposure to Sexual

Orientation Change Efforts and Associated

Sociodemographic Characteristics and Psychosocial

Health Outcomes among Canadian Sexual

Minority Men, 65(7) Canadian J. Psychiatry 502

(2020) ...................................................................... 20

N. Silander & A. Tarescavage, Ideological Bias in

American Psychological Association

Communications: Another Threat to the Credibility

of Professional Psychology, in Ideological and

Political Bias in Psychology (C. Frisby et al. eds.,

2023) ................................................. 9, 11, 14, 15, 16

A. Tarescavage, Science Wars II: The Insidious

Influence of Postmodern Ideology on Clinical

Psychology, 27(2) Clinical Psych. Sci. Prac.

(2020) ...................................................................... 11

J. Turban et al., Association Between Recalled

Exposure to Gender Identity Conversion Efforts and

Psychological Distress and Suicide Attempts

Among Transgender Adults, 77(1) JAMA

Psychiatry 68 (2020) .............................................. 21

U.S. Dep’t of Health & Human Servs., Treatment for

Pediatric Gender Dysphoria: Review of Evidence

and Best Practices (May 1, 2025),

https://perma.cc/A322-8Z8L ......................................

5, 6, 12, 13, 24, 26, 27, 28, 29, 30, 31, 32, 33, 37, 38

INTEREST OF AMICI CURIAE

Family Research Council is a nonprofit research

and educational organization. It respects the dignity

of every human life, which entails protection of the

vulnerable. Two of its scholars, Dr. Jennifer Bauwens

and Walt Heyer, recently published a new book—

Embracing God’s Design: Addressing the Spiritual

and Psychological Crisis Behind Transgender

Identity—that addresses pertinent issues.

Samaritan’s Purse is a nondenominational,

evangelical Christian organization that provides

spiritual and physical aid worldwide. Samaritan’s

Purse’s concern arises when concepts of Biblical and

scientific reality are threatened by official action

compelling ideologies that diminish common grace

related to safety, privacy, speech, and religious

exercise.

Amici thus have a significant interest in this case.*

* No counsel for a party authored this brief in whole or in part,

and no person other than amici curiae, their members, or their

counsel monetarily contributed to it.

SUMMARY OF THE ARGUMENT

Colorado’s theory is that by imposing licensing and

content-based speech requirements, it can transform

speech into professional conduct and evade the First

Amendment. That theory is contrary to this Court’s

precedents, which recognize that speech is speech. See

NIFLA v. Becerra, 585 U.S. 755, 767 (2018). If

Colorado’s theory were right, States could just as

easily pair licensing with speech requirements on

journalists and thereby control what is printed in

newspapers, said on television, and posted on blogs.

But States do not have “unfettered power to reduce a

group’s First Amendment rights by simply imposing a

licensing requirement.” Id. at 773. Talk therapy is

pure speech, no matter if someone pays for it, so the

First Amendment protects it.

This brief makes two points supporting reversal.

First, Colorado and the courts below relied heavily

on a purported “consensus” of American medical

interest groups, led by the American Psychological

Association (APA). But there is no reason to trust APA

on this issue. APA’s history, guidelines, and public

policy positions show that it has long prioritized

ideology and political advocacy over science.

APA’s brief to the Tenth Circuit confirms this

orientation. Invoking its own evidentiary review, APA

told the court below that talk therapies that could lead

a child to their original identity “do cause harm” and

“do not offer the possibility of conversion.”1 Those

1 Brief of APA 2, 4, Chiles v. Salazar, Nos. 22-1445, 23-1002, 2023

WL 3346804 (CA10 May 5, 2023) (“Br.”).

claims are not evidence-based. How do we know? Most

obviously, APA’s own review said that “[t]here are no

scientifically rigorous studies . . . that would enable us

to make a definitive statement about whether [these

therapies are] safe or harmful”—or “effective.”2 No

sound evidence supports APA’s claim of a causal

connection between talk therapy for minors and harm.

Beyond misrepresenting its own systematic review,

APA relies on a handful of slipshod studies that did

not focus on talk therapy or control for relevant

variables. APA cites this deficient evidence to claim

that children cannot provide informed consent to

simply talking in therapy. Yet it told this Court in

United States v. Skrmetti that children could consent

to vastly more dangerous and unproven hormones and

surgeries that involve a certainty of permanent

sterilization. APA and its tagalong interest groups

should not be credited on this issue.

Second, banning talk therapy—as Colorado has

done and APA supports—will harm children. Even in

States that have not banned talk therapy for children

suffering from gender dysphoria, APA’s heavy-handed

ideological enforcement has deterred therapists from

offering thorough counseling for these vulnerable

youth. Instead, APA and Colorado demand immediate

affirmation. Not only does that approach deprive

children of the opportunity to air and address the

causes and effects of co-occurring mental health

2 APA, Report of the American Psychological Association Task

Force on Appropriate Therapeutic Responses to Sexual

Orientation 43, 83 (2009), https://perma.cc/HX9S-6L57 (J.A.131)

(“Report”).

issues—most notably, childhood trauma—but it also

ushers children onto a conveyor belt ending in

sterilizing hormones and surgeries. Thus, the

approach demanded by APA and codified by Colorado

will cause lifetime devastation to some number of

hurting children. The Court should reverse.

ARGUMENT

The question here “is whether to recognize an

exception to freedom of speech when the leaders of

national professional organizations declare certain

speech to be dangerous and demand deference to their

views.” Pet.86a (Hartz, J., dissenting). Once again,

this Court is told that it must subordinate

constitutional principles to “the prevailing medical

consensus” of “[e]very mainstream medical and

mental health organization.” Pet.66a, 68a n.44. But on

contested issues of personal identity, these American

interest groups—led here by APA—are motivated by

ideology rather than science. And their demanded

approach, codified by Colorado—denying children

beneficial talk therapy that could address underlying

causes of mental health issues like childhood trauma

without the need for sterilizing hormones and

surgeries—will harm children.

I. APA, like Colorado’s other favored groups, is

driven by ideology—not science.

Medical interest groups are often wrong, blinded

by ideology, self-interest, ignorance, or “consensus.”

Hence eugenics, lobotomies, opioids, thalidomide,

smoking, and peanut allergies. See generally Makary,

Blind Spots (2024).

As one amicus has recently shown, the dangers of

relying on purported medical consensus are especially

severe in debates involving sexuality and gender

identity. On those issues, American medical consensus

reflects nothing more than underlying ideological

commitments, as medical interest groups release

evidence-free statements and guidelines that fit their

desired narrative. See generally Brief for Family

Research Council as Amicus Curiae 6–28, United

States v. Skrmetti, No. 23-477, 2024 WL 4594889 (U.S.

Oct. 15, 2024) (“FRC Skrmetti Br.”).

Yet once again, this Court is told that it must defer

to “the mainstream sense” of medical interest groups.

Pet.67a. Even while the Tenth Circuit below

recognized that these groups are often wrong, it

offered a “Nietzschean vision” that we are “tested by

following”3 them: though “expert medical organizations have changed their view[s],” “we still trust

doctors, and the professional organizations representing them.” Pet.69a n.45 (cleaned up).

But as the United States Department of Health

and Human Services explains in a comprehensive

report about childhood gender dysphoria, that vision

“overlook[s] the fact that fundamentally, these

organizations operate as trade associations.”4 Even if

individual clinicians may be “motivated by altruism,”

3 Planned Parenthood of Se. Pennsylvania v. Casey, 505 U.S. 833,

996 (1992) (Scalia, J., concurring in judgment in part and dissenting in part).

4 Treatment for Pediatric Gender Dysphoria: Review of Evidence

and Best Practices 205 (May 1, 2025), https://perma.cc/A3228Z8L (“HHS Review”).

“it should not be assumed that the collective actions of

an organization” subject to “institutional biases,

reliance on external guidance from advocacy-oriented

groups, and internal political dynamics” are.5 These

organizations “may impede or even oppose evidencebased medicine” because of ideology or financial

interests, and they “foster[] environments in which

clinicians feel compelled to self-censor.”6 Worse, these

organizations will often “target[] individuals and

groups that question or critically examine prevailing

practices.”7

As the HHS review emphasizes, these problems

are especially severe for the issues implicated here,

which are often “framed as” “civil rights issue[s] or a

struggle against discrimination.”8 The United

Kingdom’s Cass Report—the other seminal review of

evidence about childhood gender transition—likewise

found that “[t]here are few other areas of healthcare

where professionals are so afraid to openly discuss

their views, where people are vilified on social media,

and where name-calling echoes the worst bullying

behaviour.”9 The result? “[M]ajor medical associations

issued advocacy-driven recommendations prematurely, without adequate scientific support.”10

5 Id. at 205, 211.

6 Id. at 205–06.

7 Id. at 209.

8 Id. at 210.

9 Cass, Independent Review of Gender Identity Services for Chil-

dren and Young People 13 (Apr. 2024), https://perma.cc/74EAL76V (“Cass Report”).

10 HHS Review 211.

Amicus has already documented this phenomenon

at several medical groups that Colorado has invoked,

including the World Professional Association for

Transgender Health (WPATH) and the American

Academy of Pediatrics (AAP). FRC Skrmetti Br. 8–23;

see also Brief of Alabama as Amicus Curiae, Skrmetti,

2024 WL 4525181 (U.S. Oct. 15, 2024).

The major player in this case, however, is the

American Psychological Association (APA), whose

reports and amicus briefs were repeatedly relied on by

the courts below. Pet.42a, 44a, 51a, 61a, 65a, 66a, 67a,

68a, 71a. That reliance was misplaced. APA’s opposition to talk therapy is not based on the best available

evidence. Rather, APA’s statements are rooted in its

ideological commitments. APA should not be trusted

to provide evidence-based analysis on issues of

sexuality and gender identity.

A. Ideology in APA’s history.

When APA was founded in 1892, psychology “was

still an extremely new field,”11 and the group did not

position itself as a public policy organization. Yet from

the start, it pushed its own ideological agenda

divorced from reliable evidence. For instance, the

eugenics “idea of sterilizing people deemed ‘unfit’ to

procreate gained wide acceptance in intellectual

circles” in the early twentieth century thanks in large

part to APA. Gorsuch & Nitze, Over Ruled: The

Human Toll of Too Much Law 54–55 (2024). Between

Kazenoff, The American Psychological Association Has Lost Its

Mind, Capital Research Center (March 8, 2019), https://perma.

cc/2PSY-P246.

1892 and 1947, a whopping 31 of APA’s presidents—

more than half—led eugenics organizations.12 Many

other “APA leaders actively supported eugenics for

decades, calling for sterilization initiatives for ‘unfit

and inferior races.’”13

APA has a heinous record on race issues

generally.14 In 1923, APA elected Lewis Terman—a

leading eugenics proponent15—as its president.

Terman infamously created “a revised version of the

Stanford-Binet scale to justify a segregated system of

education to train certain children, such as Blacks,

Mexicans, and Native Americans.”16 APA later

admitted that due to Terman’s work, “[o]ther

intelligence tests based on scientific racism

followed.”17 There was never anything “scientific”

about Terman’s and APA’s racism. Rather, it was

ideology masquerading as science.

Likely due to APA’s persistent inclination toward

ideology rather than science, throughout the 1970s,

“scientists perceived that the APA was beginning to

12 Cummings,

Historical Chronology 5, Ctr. for Hist. Psych.

(2021), https://perma.cc/VX6C-BUA5.

13 DeAngelis & Andoh, Confronting Past Wrongs and Building an

Equitable Future, 53(2) Monitor on Psych., at 24 (Mar. 2022),

https://perma.cc/VJD5-GLVR.

14 Cummings, supra note 12, at 5.

15 Leslie, The Vexing Legacy of Lewis Terman, Stanford Magazine

(July 2000), https://perma.cc/X2XV-2U69.

16 DeAngelis & Andoh, supra note 13, at 25.

17 Ibid.

undervalue science and scientific standards, thus

threatening ‘the integrity of the discipline.’”18

In 2021, APA issued an apology for (some of) its

past wrongs,19 and now is purportedly “dedicated to

increasing and disseminating psychological knowledge.” Br. 1. But to use the words of APA’s apology,

“history can repeat itself.”20 “Indeed, if our history has

taught us anything, it has taught us to beware of elites

bearing” “faddish social theories.” Parents Involved in

Cmty. Sch. v. Seattle Sch. Dist. No. 1, 551 U.S. 701,

780–81 (2007) (Thomas, J., concurring). And APA’s

recent statements and positions provide no reason to

believe that its ideological orientation is “a relic of the

past [and] that future theories will be nothing but

beneficent.” Id. at 781–82.

Even as APA apologized for its past racism, it

pledged future racism in service of “becom[ing] an

actively antiracist discipline.”21 It seeks to impose

racial discrimination in hiring, publication, and

leadership.22 APA pledges “to develop[] future policy”

18 Silander & Tarescavage, Ideological Bias in American Psycho-

logical Association Communications, in Ideological and Political

Bias in Psychology 315, 318 (Frisby et al. eds., 2023) (citing

Cautin, The Founding of the Association for Psychological

Science: Part 2, 4(3) Persp. on Psych. Sci. 224, 225 (2009)).

19 APA, Apology to People of Color for APA’s Role in Promoting,

Perpetuating, and Failing to Challenge Racism (Oct. 2021),

https://perma.cc/D5N8-3EPU.

20 Ibid.

21 Ibid.

22 APA, Role of Psychology and APA in Dismantling Systemic

Racism (Oct. 29, 2021), https://perma.cc/S8HA-925J.

in a way that “decenters Whiteness.”23 For instance,

APA dismisses as a “[s]tructural bias[]” “a lack of

appreciation for qualitative and mixed-methods

research”—i.e., non-rigorous research reflecting

feelings and “lived experiences.”24 APA disdains

statistically sound research methods as “epistemologies most closely aligned with Whiteness.”25 APA has

announced that “no one methodological approach is

‘better,’” and it wants to elevate “constructivist,

critical-ideological, and other critical paradigms.”26

Unsurprisingly,

APA

continues

make

pronouncements dictated by ideology, not sound

science. This can be seen in APA’s guidelines, its

public policy positions, and its arguments here.

B. Ideology in APA’s guidelines.

From APA’s founding, the organization developed

an ideological “far-left streak.”27 Though psychologists

have traditionally skewed left, APA’s shift toward an

ideological approach became most evident during the

early 1970s when “leaders in the practice community

began organizing politically.”28 Enthusiasm quickly

grew “within the APA for taking a more active role in

issues of public policy.”29

23 Apology, supra note 19.

24 Role of Psychology, supra note 22; Apology, supra note 19.

25 Role of Psychology, supra note 22.

26 Ibid.

27 Kazenoff, supra note 11.

28 Cautin,

The Founding of the Association for Psychological

Science: Part 1, 4(3) Persp. on Psych. Sci. 211, 217 (2009).

29 Ibid.

In its guidelines, APA regularly relies on far-left

ideological concepts that lack empirical examination.30

For instance, the concepts of intersectionality, racial

privilege, oppression, and the social construction of

gender and sexuality have become major pillars of

recent guidelines, including its “Multicultural

Guidelines.”31 Likewise, APA’s recent recommendations on male patients instruct practitioners to treat

masculinity as “on the whole, harmful” and socially

constructed.32 APA’s “overemphasis” on ideological

concepts has resulted in “underdeveloped and off-themark responses” to psychological issues.33

APA’s ideology also influences “the reporting and

execution of psychological research in a top-down

manner.”34 APA’s recent “Style Guidelines,” which set

forth rules for “scholarly communication,” include a

section on bias-free language relying on ideologicallydriven postmodern concepts.35 APA admonishes that

“birth sex” and “natal sex” (and “males” and “females”)

are improper because they “imply that sex is an

immutable characteristic without sociocultural

30 Tarescavage, Science Wars II, 27(2) Clinical Psych. Sci. Prac.,

at 2 (2020).

31 APA, Multicultural Guidelines (2017), https://perma.cc/QYM4MRVQ.

32 Pappas, APA Issues First-Ever Guidelines for Practice with

Men and Boys, 50(1) Monitor on Psych., at 34, 35 (2019).

33 Silander & Tarescavage, supra note 18, at 321.

34 Tarescavage, supra note 30, at 2.

35 APA,

Style and Grammar Guidelines (Feb. 2024),

https://perma.cc/YDN5-Y868; see Tarescavage, supra note 30, at

influence.”36 Thus, APA requires the use of “assigned

sex,” which APA says refers to “determination of

chromosomes and anatomical structures of the body at

birth, which necessarily is interpreted within a

sociocultural context.”37 APA does not explain how

chromosomes differ across “sociocultural contexts.”

As HHS recently noted, “‘Sex assigned at birth’ is

not a euphemism for ‘biological sex’ but a critique of

the very concept.”38 Nor is “assigned sex” “a harmless

euphemism,” for it “suggests an arbitrary decision . . . rather than the observation of a characteristic

present long before birth.”39 And “[t]he terminology of

‘sex,’ ‘male,’ and ‘female’ is indispensable if the

medical and ethical issues are to be discussed

responsibly.”40 But not only does APA believe there is

no objective way to define “sex” in research contexts,

it eventually throws up its hands and decrees it more

“important to use the terms people use to describe

themselves.”41 That would make a hash of any

research effort involving sex.

APA’s response to research that deviates from its

ideology is censorship. After the Cass Report was

published in April 2024, several APA state affiliates

“prohibited its very discussion on their professional

36 APA,

Gender Style and Grammar Guidelines (Oct. 2024),

https://perma.cc/33EK-G3YN.

37 Ibid. (emphasis added).

38 HHS Review 32.

39 Ibid.

40 Id. at 31.

41 Gender Style, supra note 36.

listservs.”42 The Pennsylvania affiliate banished

discussion because “LGBTQIA+” members and their

“allies” may feel “targeted.”43

In short, APA’s “mandates” are “dominated by

ideology rather than evidence.” Pet.86a (Hartz, J.,

dissenting).

C. Ideology in APA’s public policy positions.

American medical groups have largely moved

beyond trying to report objective scientific facts,

taking on a primary role of advocating for certain

public policies. APA is no different. But APA’s

pronouncements reveal an especially lopsided shift

toward advocacy.

APA’s advocacy goals and resulting statements are

typically a “product of self-selected political” inclinations rather than a representation of the perspectives

of the psychological community.44 In many ways, APA

has become an “echo chamber[] where dissent is

suppressed, confirmation biases go unchecked, and

professional deference is exploited.”45 As one academic

noted, APA has “consistently failed to distinguish”

“between scientific ‘truths’ (which are few and far

between) and policy positions” that are dictated by

ideology rather than empirical data.46

42 HHS Review 206.

43 Id. at 207.

44 Ferguson, “Everybody Knows Psychology is Not a Real Science”:

Public Perceptions of Psychology, 70(6) Am. Psych. 527, 533

(2015).

45 HHS Review 204.

46 Ferguson, supra note 44, at 535.

A recent study analyzed 1,437 APA press releases

issued from 2000 to April 2020.47 From 2000 through

2002, APA issued 144 press releases, compared to 297

between 2017 and 2019—a 106% increase.48 Only 6 of

the 144 press releases (4.1%) between 2000 and 2002

directly commented on political issues, whereas 77 out

of the 297 press releases between 2017 through 2019

were political—a 532% increase.49 From 2017 to 2019,

61 of 77 political press releases (79.2%) slanted left,

and 3 purportedly slanted right (about veterans).50

Political Press Releases (Blue: Left; Red: Right)51

47 Silander & Tarescavage, supra note 18, at 323, 325.

48 Id. at 325.

49 Id. at 326.

50 Ibid.

51 Ibid.

Notwithstanding APA’s status as a purportedly

scientific group, “only 40% of [APA’s] political press

releases reference psychological research,” and “only

14% provided citations for the research reviewed.”52

These numbers only tell part of the story. Many of

the political issues that APA feels compelled to weigh

in on have little to no relation to the profession of

psychology: opposing a partial government shutdown,53 supporting the Deferred Action for Childhood

Arrivals program,54 demanding a ceasefire in the

conflict in Israel,55 and calling for reparations.56

That these public statements stem from ideological

biases is reinforced by the group’s lack of comment on

other issues. For instance, APA swiftly commented on

allegations against a Supreme Court nominee—

denouncing “statements questioning the integrity of

Dr. Ford and the veracity of her allegation due to her

prior lack of reporting”—and developed a grant in the

name despite the evidence against her allegations.57

52 Id. at 332.

53 APA,

Government Shutdown Increasing Stress (2019),

https://perma.cc/CB9X-VMN5.

54 APA, APA Calls on President to Preserve “Dreamers” Program

(2017), https://perma.cc/EX6S-2E32.

55 APA, Statement Calling for an Immediate, Permanent, and

Comprehensive Ceasefire (Aug. 2024), https://perma.cc/DX75N938.

56 APA, Individual, Collective, and Intergenerational Trauma

Recovery (Aug. 2024), https://perma.cc/P24C-DE94.

57 APA, Statement of APA President Regarding the Science

Behind Why Women May Not Report Sexual Assault (2018),

https://perma.cc/ST7A-NJY4; APA, American Psychological

Foundation Establishes Grant Honoring Christine Blasey Ford

(2019), https://perma.cc/57DK-DL9S.

Yet APA stayed silent when then-candidate Joe Biden

faced similar accusations soon after.58 Ideology

decides when APA speaks—and what it says.

D. Ideology in APA’s legal stances, including

here.

APA’s ideological bent infects its legal work too, as

APA churns out amicus briefs that are outside its

supposed expertise or misrepresent science. From

repeatedly advocating for abortion on demand,59 to

protesting the nuclear reactor at Three Mile Island,60

to advocating for race-based preferences,61 APA’s

eagerness to insert its ideological preferences is farreaching. Even when a case involves some potentially

relevant regulation—as when States have enacted

modest pre-abortion informed consent requirements—

APA has loudly opposed state “intru[sion]”: “[e]ffective

counseling,” APA insisted, “requires the exercise of

professional discretion regarding . . . what to say.”62

But APA sings a different tune here. As APA has

done in similar cases, it filed an amicus brief below

58 Silander & Tarescavage, supra note 18, at 332.

59 E.g., Brief for APA as Amicus Curiae, Planned Parenthood of

Se. Pennsylvania v. Casey, Nos. 91-744, 91-902, 1992 WL

12006399 (U.S. Mar. 6, 1992).

60 Brief for APA as Amicus Curiae, Metropolitical Edison Co. v.

People Against Nuclear Energy, No. 82-358, 1982 WL 1045125

(U.S. Sept. 30, 1982).

61 Brief for APA as Amicus Curiae, Students for Fair Admissions,

Inc. v. President & Fellows of Harvard Coll., Nos. 20-1199, 21707, 2022 WL 3108813 (U.S. Aug. 1, 2022).

62 Brief of Amicus Curiae APA 8, Thornburgh v. Am. College of

Obstetricians & Gynecologists, No. 84-495, 1985 WL 669706 (U.S.

Aug. 21, 1985) (emphasis omitted).

supporting Colorado’s law. And the Tenth Circuit

repeatedly relied on both that brief and APA’s other

publications. Pet.42a, 44a, 51a, 61a, 65a, 66a, 67a,

68a, 71a. That reliance was misplaced.

APA’s brief claims “to provide the Court with

context regarding the state of scientific knowledge

about the safety and effects of . . . sexual orientation

and gender identity change efforts.” Br. 1. APA then

says such efforts are “dangerous, discredited

practices.” Id. at 4. APA leans on its own 2009 report

purporting to provide a systematic review of sexual

orientation change therapy, along with 2021

resolutions that voice APA’s disapproval of sexual

orientation and gender identity change therapies. Id.

at 11–13. Though APA claims it is describing “the best

available evidence,” id. at 6, that is incorrect. APA in

fact misrepresents its own evidence and fails to engage

with evidence it dislikes. APA’s argument is suspect in

at least three major ways.

1. APA elides the distinction

different therapies.

between

First, APA’s brief elides the distinction between

the type of talk therapy that Petitioner and other

licensed therapists provide and “aversive techniques”

involving physical stimuli. APA refuses to even use

the term “therapy,” on the basis that this term

“impli[es] that there is some disorder to be treated.”63

But gender dysphoria is listed in the Diagnostic and

63 APA, Resolution on Sexual Orientation Change Efforts 1 (Feb.

2021), https://perma.cc/VQP5-BQQV.

Statistical Manual of Mental Disorders, which APA’s

brief otherwise relies on.64

At any rate, APA’s brief lumps everything together

as “change efforts,” conflating aversive techniques

with talk therapy and pretending that the same

conclusions apply to both. But its own systematic

review “found that nonaversive and recent approaches

to [change efforts] have not been rigorously

evaluated.” Report 43. And “[g]iven the limited

amount of methodologically sound research, we cannot

draw a conclusion regarding whether recent forms of

[these efforts] are or are not effective.” Ibid.

Even the Tenth Circuit majority had to agree that

APA has identified no “studies confined only to talkbased conversion therapy administered only to

minors.” Pet.71a n.47. APA has not even identified a

study “limited to talk therapy,” much less talk therapy

“by licensed professionals.” Pet.119a, 123a n.26

(Hartz, J., dissenting).

Common sense suggests that a different costbenefit analysis could apply to talk therapy and

aversive techniques like “induc[ing] nausea, vomiting,

or paralysis” or “providing electric shocks.” Pet.14a

n.7. Yet APA’s brief unreservedly proclaims that all

these therapies “are dangerous” and “do not offer the

possibility of conversion.” Br. 4. Those extravagant

claims are not grounded in the evidence about talk

therapy.

64 Am. Psychiatric Ass’n, Diagnostic and Statistical Manual of

Mental Disorders 451 (5th ed. 2013); see Br. 9.

2. APA’s claim that talk therapy causes harm

is unsupported by its evidence review.

APA claims that its 2009 systematic review

“concluded” that sexual orientation change efforts are

“adverse” and “do cause harm.” Br. 2. Here’s what

APA’s 2009 report actually concluded: “Early and

recent research studies provide no clear indication of

the prevalence of harmful outcomes among people who

have undergone efforts to change their sexual

orientation or the frequency of occurrence of harm

because no study to date of adequate scientific rigor

has been explicitly designed to do so.” Report 42. While

APA says that its report noted a potential “loss of

sexual feeling, depression, suicidality, and anxiety,”

Br. 15, APA omits the critical conclusion just after this

list of hypothetical “side effects”: “There are no

scientifically rigorous studies of recent [sexual

orientation change efforts] that would enable us to

make a definitive statement about whether recent

[therapies] [are] safe or harmful and for whom.”

Report 83. APA made the point repeatedly: “We

conclude[] that research on” these therapies “has not

answered basic questions of whether [they are] safe or

effective and for whom.” Id. at 90.

APA does not disclose any of these “ultimate[]

conclu[sions]” (Br. 15) in its brief. (Neither does

Colorado, even though its lead witness authored APA’s

report. See BIO 6; J.A.19.) APA’s brief highlights

several studies without noting its report’s conclusion

that those exact studies “do not provide valid causal

evidence of the efficacy of [change therapy] or its

harm” and “do not provide the kind of information

needed for definitive answers to questions [about]

safety and efficacy.” Report 42, 83; see Br. 16 & n.7.

Only by disregarding its own systematic review can

APA assert that these therapies “do cause harm” and

“do not offer the possibility of conversion.” Br. 2, 4.

APA’s brief tries to backfill with studies after its

report, but those have the same underlying

deficiencies. See Br. 16–17. Indeed, a book published

by APA (in a chapter written by Colorado’s witness)

found that no “methodologically sound studies”

between 2008 and 2020 enabled any sound conclusion

about the safety or efficacy of these therapies.65

APA’s brief cites a study about Canadian sexual

minorities, but that study said that “[w]e are unable

to know whether [sexual orientation change efforts]

preceded the psychosocial health outcomes identified,”

and “establishing causal inference was not the

objective of this study.”66 APA’s other study also could

not identify “causal relationships.”67

The disconnect between APA’s legal representations to the courts and its underlying research is

disqualifying. According to APA, psychologists “do not

misrepresent research” and “strive to prevent bias

from their own beliefs.”68 APA’s brief defies those

descriptions.

65 Glassgold, Research on Sexual Orientation Change Efforts, in

Case Against Conversion “Therapy” 33 (Haldeman ed., 2022).

66 Salway, Prevalence of Exposure to Sexual Orientation Change

Efforts, 65(7) Canadian J. Psychiatry 502, 507 (2020).

67 Blosnich, Sexual Orientation Change Efforts, 110(7) Am. J.

Public Health 1024, 1029 (2020).

68 Resolution, supra note 63, at 4, 7.

As for gender identity-related therapy, APA never

claims to have conducted a systematic review of the

literature. See Br. 6 n.5. Instead, its ideological task

force appears to have considered cherry-picked

evidence and passed a resolution. But APA does not

and cannot contend that any higher-quality, relevant

evidence exists here. Nonetheless, its brief announces

without qualification that gender identity therapy

“lead[s] to adverse outcomes like emotional distress,

loss of relationships, and low self-worth.” Br. 18. Yet

again, APA’s own 2022 book said that there was no

“empirical base supporting” a conclusion of “harm”

from gender identity change therapies.69

APA’s cited studies confirm why APA’s book

rejected what its brief now claims. APA’s (and

Colorado’s, BIO 6) lead study expressly disclaimed any

“determination of causation,” relied on self-reported

responses to poorly-worded questions, ignored any

differences in therapies, and failed to control for

relevant variables, including baseline mental health.70

APA’s only other “study,” the 2015 U.S. Transgender

Survey, was a non-randomized, anonymous online

survey with no statistical analysis—much less proof of

causation.71 Tellingly, more rigorous studies with in-

Rivera & Pardo, Gender Identity Change Efforts, in Case

Against Conversion “Therapy,” supra note 65, at 62.

70 Turban, Association Between Recalled Exposure to Gender

Identity Conversion Efforts and Psychological Distress, 77(1)

JAMA Psychiatry 68, 75 (2020); see generally D’Angelo, One Size

Does Not Fit All, 50 Arch. Sexual Behavior 7 (2021).

71 James, Report of the 2015 U.S. Transgender Survey 26, 35,

Nat’l Ctr. for Transgender Equality (Dec. 2016), https://perma.cc/

FA4E-DHUQ.

person interviews that supported change therapy have

been retracted as not “credible.” Pet.116a n.20 (Hartz,

J., dissenting). Presenting “highly confounded association[s] as causation is a serious error, given its

potential to dangerously misinform and mislead

clinicians, policymakers, and the public.”72

In sum, around 2000, “[c]onsensus among

mainstream psychologists seemed to be that because

the APA is [purportedly] a professional organization

and not an advocacy organization, it was unlikely to

prohibit conversion therapy in the absence of

controlled studies indicating harm.”73 Those studies

still do not exist, especially about talk therapy. Yet

APA eagerly endorses Colorado’s ban. That’s because

APA is now—and has long been—an advocacy

organization in which science plays second fiddle.

3. APA’s harm analysis lacks context and

contradicts its embrace of sterilizing

hormones and surgeries.

APA’s brief also fails to define harm or explain its

role in clinical decisionmaking. And the analysis it

provides cannot be squared with its argument

favoring medical gender transition of children, where

APA relegates certain harms to mere “side effects”

that could be disregarded by “informed consent” from

a child. If a child can consent to genital surgeries or

72 D’Angelo, supra note 70, at 11.

73 Hancock

& Haldeman, APA’s Guidelines for Psychological

Practice With Lesbian, Gay, and Bisexual Clients and Sexual

Orientation Change Efforts, in Case Against Conversion

“Therapy,” supra note 65, at 134.

their chemical equivalent—as APA fervently

believes—how could the principle of “do no harm” (Br.

21) preclude consent to talk therapy without any

physical risks? APA has no answer.

Of course, practically no psychological—or

medical—treatment is immune to some potential risk.

Take it from APA, which told this Court in Skrmetti

that “standards of care require that evidence certainty

and quality are appropriately weighted against the

balance of benefits and harms.”74

To decide this balance, an appropriate

understanding of harms and their likelihood is

necessary. But APA does not even define what “harm”

means here. APA’s report found “no good measures of

effectiveness or harm,” so it “had no occasion to weigh

them against one another and determine whether

[talk] therapy should be prohibited.” Pet.119a (Hartz,

J., dissenting).

Trying to justify its evidence-free concern with

hypothetical harms from talk therapy, APA’s brief

suggests that “the lack of recent scientifically-valid

efficacy studies on the broad range of [therapies] used

in recent decades is due in part to the ethical barriers

to such research.” Br. 8. According to APA, these

therapies should not ever be “studied” “because they

may cause harm to patients.” Id. at 24 (emphasis

omitted).

74 Brief of APA et al. as Amici Curiae 31, Skrmetti, 2024 WL

4101400 (U.S. Sept. 3, 2024) (“APA Skrmetti Br.”); see id. at 26

(“all medications may have side effects”).

But APA’s brief again contradicts its 2009 report,

which said that “many of the problems” with existing

literature “were avoidable,” like “(a) inappropriate use

of statistical tests, (b) poor measurement, and (c)

designs that did not permit valid causal conclusions to

be drawn.” Report 90. APA’s report also refutes

assuming harm to justify the absence of research,

explaining that assessing harms first “is a high

priority.” Id. at 91. And it makes no difference why

there is a lack of valid research; the point is that a lack

of valid research would preclude any organization

interested in scientific evidence from making the

sweeping claims APA’s brief does. Last, “witness the[]

new circular, ‘intellectually lazy,’ and ‘dishonest’

method” of medical interest groups: “design evidencefree ideological guidelines, then use those guidelines

as a shield against trying to obtain evidence.” FRC

Skrmetti Br. 27 (emphasis omitted) (quoting Blind

Spots, supra, at 220). “[T]he logic of this argument is

something Lewis Carroll would love.” Pet.122a n.26

(Hartz, J., dissenting).

APA’s supposed concern with harm is also hard to

credit given its advocacy of medically transitioning

children. APA has no problem forging ahead with sex

hormones and surgeries to transition children, despite

“the absence of scientifically valid studies of efficacy

showing safety” “and in the presence of retrospective

reports of harm.” Br. 19.75 In Skrmetti, APA waved

75 See, e.g., HHS Review 96 (explaining that medical transition

interventions “produce certain physical and physiological

effects[,] and there is considerable uncertainty regarding their

psychological and long-term health outcomes”).

away proven risks of harm to children—including

permanent sterilization and sexual dysfunction—on

the ground that providers can “weigh the risks and

benefits for each patient, and obtain informed consent,

as with any other medical treatment.”76 APA hung its

hat on informed consent—“including informed parental consent for patients under 18”—reasoning that

adolescents can “ha[ve] the emotional and cognitive

maturity

required

provide

informed

consent/assent.” (Pay no heed that APA told this

Court in advocating against the death penalty that

adolescents have “[d]evelopmentally immature

decision-making, paralleled by immature neurological

development.”78) Here—for talk therapies that will not

involve permanent sterilization or any other nearcertain physical harms—APA never mentions

informed consent. Rather, APA says that “client

autonomy or self-determination” can never justify talk

therapy, as that would “abdicate[] the responsibility of

[providers].”79

Similarly, in Skrmetti, APA said that withholding

cross-sex hormones and surgeries on minors would

violate ethical principles by “requir[ing]” providers to

“ignore or disregard clients’ desires.”80 Though the

76 APA Skrmetti Br. 23.

77 Id. at 15, 24.

78 Brief for APA et al. as Amici Curiae 2, Roper v. Simmons, No.

03-633, 2004 WL 1636447 (U.S. July 19, 2004); see also Jones,

The Façade of Medical Consensus, 2025 Harv. J. L. & Pub. Pol’y

Per Curiam 1, 6–8.

79 Br. 28; see Glassgold, supra note 65, at 44 (asserting “inability”

of “children and youth” “to provide informed consent”).

80 APA Skrmetti Br. 30–31.

state law here would require therapists to disregard

their clients’ wishes, APA takes the opposite view:

“[t]he concept of self-autonomy with respect to

minors,” APA declares, “is simply wrong.” Br. 28.

Of course, APA’s arguments in this case and

Skrmetti share a common theme: distorting the

scientific literature. In both cases, APA pretends that

individual, flawed studies foreclose scientific debate,

misrepresenting the body of evidence. While APA said

below and in Skrmetti that “[a] myriad of studies

demonstrate that gender-affirming care leads to

positive outcomes,” Br. 27; see APA Skrmetti Br. 23

(“[m]ultiple studies”), the “overarching theme” of all

the systematic reviews on medical interventions “is

the lack of high-quality evidence” supporting them.81

According to the United States, “Every public health

authority that has conducted a systematic review of

the evidence has concluded that the benefit/risk

profile of [pediatric medical transition] is either

unknown or unfavorable.”82

But APA ignored those systematic reviews in

Skrmetti, just as it ignores that its own systematic

review here found that the “‘complete lack’ of ‘rigorous

recent prospective research’” foreclosed conclusions

about potential harm. Otto v. City of Boca Raton, 981

F.3d 854, 868–69 (CA11 2020).

On the Cass Report, one therapist reprimanded for

posting about that report said “that the American

81 Miroshnychenko, Gender Affirming Hormone Therapy, 110(6)

Arch. Disease Childhood 437, 443 (2025).

82 HHS Review 77; see generally id. Chapter 5.

Psychological Association should ‘gather its integrity

and put out a statement that says we’re taking the

Cass [R]eport seriously.’”83 But APA dismisses that

report on the ground that “gendered systems and

healthcare in European countries are vastly different”

(Br. 28)—as if that has anything to do with the Cass

Report’s six systematic reviews showing that the

worldwide evidence refutes APA’s position.

Remarkably, APA also claims that the Cass Report

has led the United Kingdom “to expand and strengthen

gender-affirming care for youth.” Ibid. But the UK

“strengthened” care for gender dysphoria by

prohibiting the “affirming” interventions that APA

demands. The UK prohibited puberty blockers in new

patients, Scotland prohibited both puberty blockers

and cross-sex hormones, and the talk therapy that

APA dislikes “is now the recommended first-line

treatment” across Europe.84

APA echoes Colorado and the decision below in

demanding the outsourcing of medical regulation—

and constitutional law—to the “consensus” of major

(American) medical organizations. Br. 24; see also BIO

29; Pet.67a–68a. On APA’s view, if that “consensus”

wants dangerous interventions—like sterilizing

hormones and genital surgeries in Skrmetti—the

Block, Gender Medicine in the US 1, BMJ (May 23, 2024),

https://perma.cc/R6XS-4JSB.

84 New Restrictions on Puberty Blockers (May 29, 2024),

https://perma.cc/E3LR-XCEP; Cass Review: Implications for

Scotland (July 5, 2024), https://perma.cc/9LYB-LV7N; HHS

Review 249.

Constitution must be read to force States to allow

them. If that “consensus” opposes certain

interventions—like

talk

therapies

here—the

Constitution must be read so States can outlaw them.

Neither the histories of science and medicine nor

APA’s suspect statements justify such extraordinary

deference. APA’s positions in this area are based on

ideology, not science. “[A]nyone who has had faith in

the pronouncements of the American Psychological

Association” “and its partners on the subject

should . . . view those pronouncements with skepticism.” Pet.124a n.27 (Hartz, J., dissenting).

II.

APA’s approach, mandated by Colorado,

harms children by preempting exploratory

therapy about issues like trauma.

Exploratory therapy—also known as talk

therapy—“is the least invasive intervention for

addressing psychological distress, regardless of its

etiology, and it has been recognized as the

international standard of care for a wide range of

mental health diagnoses.”85 This type of therapy “is a

patient-centered process which aims to explore,

understand and address the multiple, intersecting

factors generating distress in the young person’s

life.”86 Though high quality evidence is rare here,

studies suggest that exploratory therapy for gender

dysphoria “may effectively resolve the condition

noninvasively.”87 And systematic reviews have found

85 HHS Review 250.

86 Ayad, A Clinical Guide for Therapists 3, Gender Exploratory

Therapy Ass’n (2022), https://perma.cc/7DGZ-RPAH.

87 HHS Review 254.

that “there is no reliable evidence to suggest that” this

therapy “is harmful.”88

But laws like Colorado’s—aided by APA’s

ideological enforcement—force therapists to stop

offering this beneficial therapy. Colorado has

suggested that its ban’s vague exception—for therapy

that provides “acceptance, support, and understanding for the facilitation of an individual’s coping, social

support, and identity exploration and development”89—could permit some talk therapy. But the

exemption does not apply if “the counseling” could

seek “to change behaviors or gender expressions.”90 So

the ban at minimum applies when a person seeks talk

therapy potentially to “meet voluntary, self-selected

goals” of aligning gender expression or identity with

sex. Pet.23a. And Colorado’s allies routinely equate

exploratory therapy with conversion therapy.91 Any

therapist in Colorado who offers talk therapy without

immediate “acceptance” and affirmation puts their

career at risk.

Denying children access to talk therapy will harm

them by foreclosing consideration of underlying

issues—often childhood trauma—that can give rise to

both gender dysphoria and other mental health issues.

88 Id. at 255.

89 Colo. Rev. Stat. § 12-245-202(3.5).

90 Ibid.

91 HHS Review 255 & n.80; see id. at 35–36; see also Burga &

Schneid, New HHS Report Urges ‘Exploratory Therapy,’ TIME

(May 1, 2025) (Trevor Project spokesperson: “exploratory

therapy” is “conversion therapy” “under a new, rebranded

name”).

And it will result in children being prematurely

ushered into medical transitions that lack any proven

benefit and carry the certainty of lifelong harms.

A. Colorado’s law and APA’s ideological

enforcement lead to self-censorship.

By throwing its weight behind laws like Colorado’s,

APA will deprive children of beneficial exploratory

therapy. As HHS recently explained, “[a]ctivist

organizations” like APA and others have increasingly

“target[ed] individuals and groups that question or

critically examine prevailing practices in gender

medicine.”92 Like others noted above, “[a] clinical

psychologist who describes herself as ‘a liberal

feminist’ and who has ‘marched in Pride marches’”

said “she was ‘reprimanded’ by the Illinois

Psychological Association after posting about the Cass

Review on a therapist listserv.”93 “[T]he political

activist group Southern Poverty Law Center” has

encouraged “efforts to ‘hunt’ therapists who practice

exploratory therapy, with the goal of leveling

complaints leading to licensure revocations.”94

Similarly, APA’s (and Colorado’s) description of

exploratory therapy as “conversion therapy” is “a

problematic and potentially harmful rhetorical device”

to shame therapists by connecting talk therapy with

physically coercive interventions to change sexual

orientation.95 But talk therapy “resides outside the

92 HHS Review 209.

93 Id. at 204 (quoting Block, supra note 83, at 2).

94 Id. at 209 n.29.

95 Id. at 256.

affirmation-conversion binary and aims to address the

distress of gender-dysphoric youth” rather than “force

change or impose any predetermined notion.”96 It may

“help children and adolescents come to terms with

their bodies.”97 If anything, the affirming approach to

gender dysphoria better “deserves th[e] label” of

“conversion therapy,” as that approach requires

“altering a person’s body in response to distress rooted

in internalized social disapproval.”98 But Colorado and

APA misuse this label for its in terrorem effect, putting

therapists’ “careers and reputations” in “jeopard[y].”99

Unsurprisingly, given all this pressure by both

states and professional organizations like APA, “there

is growing evidence of self-censorship among

clinicians and researchers, driven by concerns about

professional repercussions and reputational risks.”100

As HHS explained, “Medical professionals’ years of

training and social status leave them acutely aware of

and sensitive to reputational risks.”101 “Fear of online

attacks and social disapproval within professional

medical societies may have contributed to widespread

self-censorship among clinicians.”102 This effect is

magnified by framing “affirmation” “as a civil rights

issue” and skeptics as “‘anti-trans’ or intolerant.”103

96 Id. at 256 n.83.

97 Id. at 256.

98 Ibid.

99 Id. at 257 & n.88.

100 Id. at 210.

101 Ibid.

102 Ibid.

103 Ibid.

The result? “[P]arents everywhere report that

open-minded,

developmentally

oriented,

not

immediately affirmative therapists are hard to

locate”—which deprives many children of beneficial

therapy.104

B. This censorship harms children.

As researchers and HHS have explained,

“[s]tigmatizing non-‘affirmative’ psychotherapy” for

gender dysphoria and similar issues “as ‘conversion’

will reduce access to treatment alternatives for

patients.”105 Given “the highly charged accusation of

‘conversion therapy,’” many therapists are “under

significant pressure to assume—often without critical

evaluation—that mental health issues co-occurring

with [gender dysphoria] are primarily the result of

minority stress.”106 Thus, they may “overlook the

significant possibility” that gender dysphoria “has

arisen from trauma, ‘primary’ mental health concerns,

or neurodevelopmental conditions.”107

“If these possibilities are ignored, medical and

surgical interventions may be recommended as the

obvious treatment”108—even as the therapy necessary

for “meaningful informed consent” is denied.109 All

this will have “a chilling effect on the ethical

104 Levine,

What is the Purpose of the Initial Psychiatric

Evaluation of Minors with Gender Dysphoria, 50(6) J. Sex &

Marital Therapy 773, 781 (2024).

105 D’Angelo, supra note 70, at 7.

106 HHS Review 258.

107 Ibid.

108 Ibid.

109 D’Angelo, supra note 70, at 13.

psychotherapists’ willingness to take on complex

[gender dysphoria] patients, which will make it much

harder for [these] individuals to access quality mental

health care.”110

1. Colorado’s ban discourages therapists

from exploring trauma and other cooccurring mental health issues.

Gender dysphoric youth “often present[] with

complex psychosocial histories and multiple mental

health concerns,” which is why proper therapy for this

population “takes a holistic approach—addressing the

full range of issues rather than focusing exclusively

on” gender dysphoria—or immediately “affirming” a

new identity.111 Exploratory therapy “for adolescents

with [gender dysphoria] is a well-suited intervention,

as it is intended to help patients develop selfunderstanding, engage with emotional vulnerability,

and build practical strategies for managing

distress.”112

This holistic approach is especially important

because many of those who identify as transgender

report past trauma, like childhood sexual abuse.113

“Trauma affects how children and adolescents process

the world around them, how they interact and engage

in relationships,” and how they “perceive their own

110 HHS Review 259 (quoting D’Angelo, supra note 70, at 13).

111 Id. at 260.

112 Ibid.

113 See,

e.g., Meyer, LGBTQ People in the US 3 (June 2021),

https://perma.cc/B2TG-RPQC.

bodies.”114 Trauma symptoms can manifest as

thoughts, emotions, or actions that may appear

unrelated to a traumatic event. Many of these

symptoms can be similar to those experienced by

individuals who identify as transgender. These

symptoms include mental health conditions like

depression, aggression, low self-esteem, suicidal

ideation, and identity confusion.

This overlap makes it especially important to

explore potential trauma and any other co-occurring

mental health issues that may be contributing to—or

being masked by—gender dysphoria. “Children do not

generally disclose trauma on initial assessment”; they

“must experience safety within the therapeutic

relationship, which takes time and patience to

establish.”115 But Colorado’s law bans a holistic

therapeutical approach in favor of one that prioritizes

immediate affirmation.

Several researchers and clinicians have illustrated

the problem with “[t]he self-evident crudeness of the

[change therapy] versus ‘affirmation’ binary” pushed

by APA and codified by Colorado.116 “Consider a

female victim of sexual assault, who subsequently

develops an intense discomfort with her female

anatomy and expresses a desire to undergo biomedical

interventions to change her body.”117 “It would be

114 Corrected Expert Report of G. Nangia ¶ 136, Boe v. Marshall,

No. 22-184, Dkt. 557-11 (M.D. Ala. May 27, 2024) (“Nangia

Rep.”).

115 Id. ¶ 141.

116 D’Angelo, supra note 70, at 11.

117 Ibid.

unethical for the clinician to overlook the contribution

of sexual victimization to this nascent [gender

dysphoria].”118 “A therapist enthusiastically supporting this patient’s new male identity would be failing to

provide appropriate treatment for what amounts to a

post-traumatic condition, instead providing an

inappropriate treatment with the potential to harm”—

as discussed next.119

“Similarly, a boy who has been traumatized by

relentless bullying due to his gender ‘nonconformity’

(e.g., interest in classical music or fashion and

avoidance of sports) may conclude that if he were a girl

then he would ‘fit in’ and the humiliation would

stop.”120 “In this case too, gender-affirming

interventions miss the mark when what this traumatized young person requires is psychotherapy”—the

holistic therapy that Colorado law bans.121 By banning

this therapy, Colorado will deprive vulnerable

children of the chance to have underlying traumas

aired and addressed.

2. Banning talk therapy will usher children

to dangerous medical transitioning.

According to APA itself, “[i]n no more than about

one in four children does gender dysphoria persist

from childhood to adolescence or adulthood”—absent

118 Id. at 11–12.

119 Id. at 12.

120 Ibid.

121 Ibid.; see also Nangia Rep. ¶ 147.

medical interventions.122 Banning talk therapy and

requiring affirmation, however, presents a real danger

of locking children into an identity that they would

have otherwise considered and then moved away from.

As the Cass Report found, clinicians “are unable to

determine with any certainty which children and

young people will go on to have an enduring trans

identity.”123 Harm will result from early “affirmation”

of individuals who would otherwise have returned to

their original identity. Thus, affirmation is not a

neutral or necessarily positive intervention, but can

detrimentally change the child’s natural developmental trajectory. Colorado is imposing its own vision of

how a child should develop.

“Affirmative” therapy “focus[es] on the patient’s

readiness for gender transition”—unlike the

exploratory therapy that Colorado bans, which focuses

“on identifying the predisposing, precipitating, and

maintaining forces on the patient’s identity.”124 Thus,

the goal of the “affirmative” model is “to qualify the

patient for the sequence of social transition,

hormones, and surgery.”125 “[O]ften by the second

visit” to an “affirming” therapist, “a prescription for

hormones is given or surgery is scheduled.”126

122 Bockting, Transgender Identity Development, in 1 APA Hand-

book of Sexuality and Psychology 744 (Tolman & Diamond eds.,

2014).

123 Cass Report 22.

124 Levine, supra note 104, at 774–75.

125 Id. at 773.

126 Id. at 776.

Indeed, in current practice, this sequence from

social transition to drugs to surgeries has no brakes.

As HHS recently explained, several studies “suggest[]

the majority of children who socially transition before

puberty progress to medical interventions.”127 These

interventions often start with puberty blockers. While

puberty blockers have been defended as a “pause”

button, the United States now expresses “considerable

concern that pubertal suppression may alter the

course of gender identity development, essentially

‘locking in’ a gender identity that may have reconciled

with biological sex during the natural course of

puberty.”128 “Several studies have suggested continuation rates from [puberty blockers] to [cross-sex

hormones] exceed 90%,” making blockers “more like a

‘gas pedal’ that accelerates medical transition.”129

Affirmation is thus likely to usher children to

irreversible, unproven, and sterilizing sex hormones—

and eventually surgeries. Children who take puberty

blockers then cross-sex hormones—the near-universal

transitioning pathway—are expected to become sterile

and suffer many other negative repercussions. See

generally Eknes-Tucker v. Governor of Alabama, 114

F.4th 1241, 1260–61, 1268–70 (CA11 2024) (Lagoa, J.,

concurring).

Thus, some children will be permanently harmed

by unblinking affirmation, as they will suffer

“irreversible hormonal and/or surgical interventions

[and] ultimately [will] not continue to identify as

127 HHS Review 71.

128 Id. at 70–71 (internal quotation marks omitted).

129 Id. at 71.

transgender.”130 The approach advocated by APA and

codified by Colorado leads to that outcome—

destroying the lives of vulnerable youth.

CONCLUSION

The Court should reverse.

Respectfully submitted,

CHRISTOPHER E. MILLS

Counsel of Record

Spero Law LLC

557 East Bay Street

#22251

Charleston, SC 29413

(843) 606-0640

cmills@spero.law

Counsel for Amici Curiae

JUNE 12, 2025

130 HHS Review 71–72.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.