Brief

Conversion Therapy and LGBT Youth

June 2019

Efforts to change someone’s sexual orientation or gender identity are associated with poor mental health for LGBT people. This study looks at the prevalence of conversion therapy among LGBT adults and estimates the number of LGBT youth who are likely to undergo the practice before they become adults.

Highlights
Conversion therapy, also known as sexual orientation or gender identity change efforts, is a practice grounded in the belief that being LGBT is abnormal.
As of June 2019, 18 states and the District of Columbia had passed statutes limiting the use of conversion therapy on LGBT youth.
Only 8% of respondents to a 2014 national poll said they thought conversion therapy could change a person’s sexual orientation.
Data Points
698,000
LGBT adults in the US have received conversion therapy
16,000
LGBT youth will receive conversion therapy before they reach the age of 18 in the 32 states that currently do not ban the practice
16,000
LGBT youth will receive conversion therapy before they reach the age of 18 in the 32 states that currently do not ban the practice
10,000
LGBT youth live in states that ban conversion therapy and have been protected from receiving conversion therapy before age 18
Brief

Executive Summary

Conversion therapy, also known as sexual orientation or gender identity change efforts, is a practice grounded in the belief that being LGBT is abnormal. It is intended to change the sexual orientation, gender identity, or gender expression of LGBT people.1 Conversion therapy is practiced by some licensed professionals in the context of providing health care and by some clergy or other spiritual advisors in the context of religious practice.2 Efforts to change someone’s sexual orientation or gender identity are associated with poor mental health3, including suicidality.4 As of June 2019, 18 states, the District of Columbia, and a number of localities have banned health care professionals from using conversion therapy on youth.

The Williams Institute estimates that:

  • 698,000 LGBT adults (ages 18-59)5 in the U.S. have received conversion therapy, including about 350,000 LGBT adults who were subjected to the practice as adolescents.6
  • 16,000 LGBT youth (ages 13-17) will receive conversion therapy from a licensed health care professional before they reach the age of 18 in the 32 states that currently do not ban the practice.7
  • 10,000 LGBT youth (ages 13-17) live in states that ban conversion therapy and have been protected from receiving conversion therapy from a licensed health care professional before age 18.8
  • An estimated 57,000 youth (ages 13-17) across all states will receive conversion therapy from religious or spiritual advisors before they reach the age of 18.9

This report updates conversion therapy estimates published by the Williams Institute in January 2018.10

History

Conversion therapy has been practiced in the U.S. for over a century. Academic literature has documented instances of conversion therapy being used as early as the 1890s and continuing through the present day.11 Throughout the history of conversion therapy, a range of techniques have been used by both health care professionals and religious figures seeking to change people’s sexual orientation or gender identity. Currently, talk therapy is the most commonly used therapy technique.12 Some practitioners have also used “aversion treatments, such as inducing nausea, vomiting, or paralysis; providing electric shocks; or having the individual snap an elastic band around the wrist when the individual became aroused to same-sex erotic images or thoughts.”13 Other practitioners have used non-aversive techniques such as attempting to “change thought patterns by reframing desires, redirecting thoughts, or using hypnosis.”14

An estimated 698,000 LGBT adults in the U.S have received conversion therapy either from a licensed professional or a religious advisor or from both at some point in their lives,15 including about 350,000 LGBT adults who received conversion therapy as adolescents.16

An estimated 698,000 LGBT adults in the U.S. have received conversion therapy at some point in their lives.

Current Perspectives

Professional Health Associations

A number of prominent national professional health associations—including the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics, among others—have issued public statements opposing the use of conversion therapy because it is harmful and ineffective.17 Several of these associations have called on Congress and state legislatures to pass laws that ban conversion therapy. For example, the CEO of the American Counseling Association (ACA) submitted testimony to the Illinois House and Senate in support of the state’s conversion therapy ban bill in 2015.18 In addition, ACA members sent 79 letters to the Governor and 84 letters to state legislators in support of the bill.19 Also, several professional health associations endorsed the Therapeutic Fraud Prevention Act, a federal bill that would have prohibited the practice of conversion therapy, including the National Association of School Psychologists, the American Psychoanalytic Association, the American Counseling Association, and the American Academy of Pediatrics.20

Public Opinion

Public opinion polls at the national level and in several states have found majority support for ending the use of conversion therapy on youth. A 2019 national poll conducted by Ipsos/Reuters found that 56% of US adults support making conversion therapy on youth by mental health practitioners illegal as compared to a minority (18%) who think that it should be legal.21 Majority support for making conversion therapy on youth illegal was observed across all age groups, regions of the US, and rural/urban residence.22

Data Source: Ipsos Poll Conducted for Reuters, Stonewall Anniversary Poll, June 6, 2019.

Recent polls in six states have also found strong support for laws that ban licensed health care professionals from using conversion therapy on youth.

*23 24 25 26 27 28 29

Polling also indicates that many people do not think conversion therapy is effective; only 8% of respondents to a 2014 national poll said they thought conversion therapy could change a person’s sexual orientation from gay to straight.30

Current Laws

Conversion Therapy by Licensed Health Care Professionals

As of June 2019, 18 states and the District of Columbia had passed statutes limiting the use of conversion therapy: California, Colorado, Connecticut, Delaware, D.C., Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.31 The laws protect youth under age 18 from receiving conversion therapy from licensed mental health care providers.32 California was the first state to pass a conversion therapy ban in 2012.33 Four states—Colorado, Maine, Massachusetts, and New York—passed bans in 2019.34 In addition, a number of cities and counties in states without statewide bans have passed bans at the local level.35

All of the state statutory bans allow licensing entities to discipline health care providers who use conversion therapy on youth under age 18.36 Under Connecticut, Illinois, and New Hampshire laws, the use of conversion therapy on youth is also considered an unfair business practice, and the laws allow for enforcement and penalties consistent with other state laws against such practices.37 In addition, in 2015, a New Jersey court held that providing conversion therapy in exchange for payment constitutes a fraudulent business practice, regardless of whether it is used on youth or adults.38

16,000 LGBT youth (ages 13-17) will receive conversion therapy from a licensed health care professional before they reach the age of 18 in the 32 states that currently do not ban the practice, unless additional states pass conversion therapy bans.39 Approximately 10,000 LGBT youth (ages 13-17) who live in states with bans have been protected from receiving conversion therapy from a licensed health care professional before age 18 because their states have banned the practice.40

In addition to state bans, members of Congress have introduced federal legislation aimed at limiting conversion therapy. The Therapeutic Fraud Prevention Act, introduced in both the House and Senate in 201741 and 201542, would have classified conversion therapy provided in exchange for payment as a form of consumer fraud.43 The law would have allowed state attorneys general and the Federal Trade Commission to bring enforcement actions against individuals who are providing conversion therapy for payment or advertising such services.44 Additionally, the Prohibition of Medicaid Funding for Conversion Therapy Act and the Every Child Deserves a Family Act would limit the practice of conversion therapy by prohibiting payments under the Medicaid and Social Security programs for conversion therapy.45 Both of these bills have been introduced in Congress in 2019.46

Conversion Therapy by Religious and Spiritual Advisors

The state statutory conversion therapy bans apply to licensed mental health care professionals and sometimes more broadly to others who seek to provide conversion therapy in exchange for payment.47 The laws generally do not apply to religious or spiritual advisors who engage in sexual orientation or gender identity change efforts within their pastoral or religious capacities.

These exclusions for therapy provided by religious or spiritual advisors leave many youth vulnerable to conversion therapy even in states with bans. An estimated 57,000 youth (ages 13-17) across all states will receive conversion therapy from religious or spiritual advisors before they reach the age of 18.48 This includes approximately 38,000 youth (ages 13-17) who will receive conversion therapy from religious or spiritual advisors, but not a licensed health care professional before they reach the age of 18.49 Some youth will receive conversion therapy from both a licensed health care provider and a religious or spiritual advisor before they reach age 18.

Conclusion

Conversion therapy continues to be used in the U.S. despite support for ending the practice among prominent medical and mental health associations and the public. An estimated 698,000 LGBT adults in the U.S. have received treatment to change their sexual orientation or gender identity at some point in their lives, including about 350,000 who received treatment as adolescents. As of June 2019, 18 states, the District of Columbia, and a number of localities had enacted laws banning licensed professionals from using conversion therapy on youth. An estimated 16,000 LGBT youth will receive conversion therapy from a licensed professional before they reach the age of 18 in the 32 states that currently do not ban the practice. In addition, an estimated 57,000 LGBT youth across all states will receive conversion therapy from religious or spiritual advisors. Because of the large number of youth who may be vulnerable to conversion therapy, individuals who have contact with minors should be aware that the American Psychological Association has issued a resolution “advising parents, guardians, young people, and their families to avoid sexual orientation change efforts that portray homosexuality as a mental illness or developmental disorder and to seek psychotherapy, social support and educational services that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth[.]”50

Conversion Therapy and LGBT Youth

Judith M. Glassgold et al., Am. Psych. Assoc., Report of the Am. Psych. Assoc. Task Force on Appropriate Therapeutic Responses to Sexual Orientation 22 (2009).

Susan L. Morrow and A. Lee Beckstead, Conversion Therapies for Same-Sex Attracted Clients in Religious Conflict: Context, Predisposing Factors, Experiences, and Implications for Therapy, 32 Counseling Psychologist 641, 642 (2004).

E.g., Annesa Flentje, Nicholas C. Heck and Bryan N. Cochran, Sexual Reorientation Therapy Interventions: Perspectives of Ex-Ex-Gay Individuals, 17 J. Gay and Lesbian Mental Health 256 (2013); Elizabeth M. Weiss et al., A Qualitative Study of Ex-Gay and Ex-Ex-Gay Experiences, 14 J. Gay and Lesbian Mental Health 291 (2010); Ariel Shidlo and Michael Schroeder, Changing Sexual Orientation: A Consumer’s Report, 33 Prof. Psych.: Research and Practice 249 (2002).

Sandy E. James et al., Nat’l Ctr. for Transgender Equality, The Report of the 2015 U.S. Transgender Survey (2016); Caitlin Ryan et al., Parent-Initiated Sexual Orientation Change Efforts with LGBT Adolescents: Implications for Young Adult Mental Health and Adjustment, J. Homosexuality (Nov. 7, 2018) (online).

698,000 US LGBT adults ages 18 to 59 are estimated to have received treatment to change their sexual orientation or gender identity [range 572,000 to 857,000]. This figure was calculated by adding estimates for LGB and transgender adults and rounding them to the nearest 1,000. In order to determine an estimate for the number of LGB adults who have received conversion therapy, we started with the proportion of LGB adults ages 18 to 59 who report having received treatment to change their sexual orientation (6.7%) from the Generations Study*, a national probability study of LGB individuals supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD078526 (Ilan H. Meyer, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The proportion who received conversion therapy across three age cohorts (18-25, 34-41, and 52-59) did not statistically significantly differ across cohorts and is assumed to be consistent for those ages 18 through 59 years (Williams Institute unpublished analyses). That proportion was then multiplied by the proportion of adults ages 18 to 59 who identify as LGBT (5.3%) in the 2015-2017 Gallup Daily Tracking Survey (Williams Institute unpublished analyses) and the proportion of LGBT individuals ages 18 to 59 who are cisgender (87.7%) among LGBT-identified respondents to the 2014-2015 BRFSS (Williams Institute unpublished analyses), and then applied to the number of adults ages 18 to 59 in the U.S. (180,757,997), according to 2016 population estimates from the 2010 U.S. Census. For total 18-59 population estimates: search American FactFinder, (last visited Dec. 15, 2017) (select advanced search, enter “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” under topic or table name, and select “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” 2016 Population Estimates). The same steps were followed with 95% confidence intervals to calculate a range for each estimate.

In order to determine an estimate for the number of transgender adults who have received conversion therapy, we started with the proportion of transgender adults who report that one or more professionals tried to make them identify only with their sex assigned at birth or try to stop them from being transgender (13.0%), as observed in the U.S. Transgender Survey—the largest purposive sample study of transgender adults to date and reported in James et al., supra note 4. The proportion who received conversion therapy was multiplied by the proportion of adults ages 18 and older who are estimated to be transgender (0.6%) and then applied to the number of adults ages 18 to 59 in the U.S. (180,757,997). This estimate is likely to be somewhat conservative given that slightly larger proportions of the population identify as transgender among younger age cohorts. For transgender population estimates see Andrew R. Flores et al., The Williams Institute, How Many Adults Identify as Transgender in the United States? (2016).

*About the Generations Study. Generations participants were recruited by Gallup, Inc., a survey research consulting company (http://www.gallup.com/) using the Gallup Daily Tracking Survey as initial contact. Generations baseline participants were screened and enrolled in the study between March 28, 2016 – March 30, 2017. The Daily Tracking Survey is a telephone interview of a national probability sample of 1,000 adults ages 18 and older that is conducted daily (350 days a year) to inquire about topics including the respondents’ politics, economics and general well-being. Respondents include English and Spanish-speaking individuals from all 50 U.S. states and the District of Columbia. Gallup uses a dual-frame sampling procedure, which includes random-digit dialing (RDD) to reach both landline and cellphone users, as well as an additional random selection method for choosing respondents with landlines. Gallup stratifies the RDD list to ensure that the unweighted samples are proportionate by U.S. Census region and time zone. Gallup weights the data daily to compensate for disproportionalities in non-response and selection probabilities.

The Generations study used a 2-step recruitment procedure. In the first step, utilizing a question asked of all Gallup respondents, all LGBT
individuals were identified. The Gallup question to assess sexual orientation and gender identity asked by the phone interviewer is “I have one final question we are asking only for statistical purposes. Do you, personally, identify as lesbian, gay, bisexual, or transgender?” In
the second step, Gallup respondents who were identified as LGBT were assessed for eligibility for participation in the Generations study
and those eligible were invited to participate in Generations. Respondents were eligible if they identified as LGB (and not transgender)
in response to a Generations question that asked if they were lesbian, gay, bisexual, queer, or same-gender loving, if they were in the age and
race/ethnicity groups targeted for the 3 cohorts under investigation in Generations: ages 18-25, 34–41, or 52–59; Black, Latino, or White;
completed 6th grade at least, and if they spoke English well enough to conduct the phone interview in English. Transgender respondents
were recruited into a contemporary TransPop study.

Respondents who were eligible for participation in Generations were invited to participate in the study. If they agreed, they were emailed
or mailed a survey questionnaire to complete by self- administration (via a web link or printed questionnaire, respectively). Respondents
were sent $25 gift certificate with their invitation to participate in the study, which they could redeem at any time. Prior to completing
the survey, respondents reviewed an information sheet about the study and their rights and responsibilities as research participants.
Respondents who agreed to participate then submitted the web survey online or returned the printed questionnaires for data entry using
a provided addressed envelope.

In total, 366,644 participants were screened by Gallup for inclusion in the Generations study. Of them, 3.5% were identified as LGBT and
27.5% of them were eligible for Generations based on the eligibility criteria. Of these, 80% agreed to participate in the survey and of
those, 48% completed the survey. The final Generations baseline sample size was 1,345. Generations is funded by a grant from the Eunice
Kennedy Shriver National Institute of Child Health and Human Development (NICHD grant 1R01HD078526) and through supplemental
grants from the National Institutes of Health, Office of Behavioral and Social Sciences Research and the Office of Research on Women’s
Health.

Generations Survey Items about Conversion Therapy

133 Did you ever receive treatment from someone who tried to change your sexual orientation (such as try to make you straight/heterosexual)?          If yes, please mark all that apply.

  • No-Skip to the text before Question 135
  • Yes, from a healthcare professional (such as a psychologist or counselor who was not religious-focused)
  • Yes, from a religious leader (such as a pastor, religious counselor, priest)

134 About how old were you the last time you received treatment to change your sexual orientation? Your best estimate is fine.

Continue

Among adults who have received conversion therapy, approximately 49.9% of LGB adults in the Generations Study and 51.0% of transgender adults in the U.S. Trans Survey are estimated to have received treatment at or before the age of 18. These proportions are applied to the number of LGB and transgender adults ages 18 to 59 who are estimated to have received conversion therapy, as described above. Thus, we estimate that 350,000 LGBT adults [range 287,000 to 429,000] received treatment as adolescents. We believe that our estimate of conversion therapy among cisgender LGB adolescents is, if anything, an underestimate because the Generations Study survey asked about age at which last conversion therapy was received versus the age at which conversion therapy first began. It is possible that some youth received conversion therapy that did not end until age 18 or later and that these individuals are missing in our estimates of the percentage of LGB youth who received conversion therapy. This would lead to an underestimate of the number of current LGB youth currently at risk of conversion therapy.

16,000 LGBT youth ages 13 to 17 [range 10,000 to 26,000] are estimated to live in states without state-wide conversion therapy bans and will receive conversion therapy from a professional before the age of 18. This figure was calculated by adding estimates for LGB and transgender youth. In order to determine an estimate for the number of LGB youth who will receive conversion therapy before age 18, we multiplied the proportion of LGB adults ages 18 to 59 who report having received treatment from a health care professional to change their sexual orientation that began and ended before the age of 18 (1.2%) from the Generations Study (Williams Institute unpublished analyses) by the proportion of youth in grades 9 through 12 who identify as LGB (8.0%) in the 2015 YRBS and by the proportion of LGB young adults ages 18 to 24 who are cisgender (95.7%) among LGB-identified respondents to the 2014-2015 BRFSS (Williams Institute unpublished analyses), and then applied this proportion to the number of youth ages 13 to 17 in the U.S. (20,870,650), according to 2016 population estimates from the 2010 U.S. Census. For total 13-17 population estimates: search American FactFinder, (last visited Dec. 15, 2017) (select advanced search, enter “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” under topic or table name, and select “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” 2016 Population Estimates). For estimates of the proportion of youth who identify as lesbian, gay, or bisexual see Laura Kann et al., Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors among Students in Grades 9-12 – United States and Selected Sites, 2015 (2016). Note: The proportion who received conversion therapy from a health care professional to change their sexual orientation that began and ended before the age of 18, was not significantly different across the three age cohorts (18-25, 34-41, and 52-59) where receipt of conversion therapy is assumed to be consistent for those ages 26 to 33 and 42 to 51 (Williams Institute unpublished analyses).

In order to determine an estimate for the number of transgender youth who have received conversion therapy we multiplied the proportion of transgender adults who report that a professional (nonreligious or spiritual) tried to make them identify only with their sex assigned at birth or stop them from being transgender (9.0%) by the proportion for whom this had happened at or before age 18 (51%), as observed in the U.S. Transgender Survey and reported in James et al., supra note 4. This proportion (4.6%), those who received conversion therapy at or before age 18, was multiplied by the proportion of youth ages 13 to 17 who are estimated to be transgender (0.73%) and then applied to the number of youth ages 13 to 17 in the U.S. (20,870,650). For transgender population proportion estimates see Jody L. Herman et al., The Williams Institute, Age of Individuals Who Identify as Transgender in the United States (2017).

For a list of the states that have banned conversion therapy state-wide see note 33, infra. Although some cities and counties have enacted local bans on conversion therapy, the population of these localities is not large and would not have an appreciable impact on state estimates.

Following the same approach described above, we estimate that approximately 10,000 LGBT youth [range 6,000 to 16,000] live in states that have banned conversion therapy state-wide by licensed professionals.

57,000 LGBT youth ages 13-17 [range 37,000 to 94,000] are estimated to be at risk of receiving treatment to change their sexual orientation or gender identity from a religious leader, advisor or counselor at or before age 18. This figure was calculated by adding estimates for LGB and transgender youth. In order to determine an estimate for the number of LGB youth who will receive conversion therapy, we multiplied the proportion of LGB adults ages 18 to 25 who report having received treatment from a religious leader (pastor, religious counselor, priest) to change their sexual orientation that began and ended before the age of 18 (3.4%) from the Generations Study (Williams Institute unpublished analyses) by the proportion of youth in grades 9 through 12 who identify as LGB (8.0%) in the 2015 YRBS and by the proportion of LGB young adults ages 18 to 24 who are cisgender (95.7%) in the 2014-2015 BRFSS (Williams Institute unpublished analyses), and then applied this proportion to the number of youth ages 13 to 17 in the U.S. (20,870,650), according to 2016 population estimates from the 2010 U.S. Census. For total 13-17 population estimates: search American FactFinder, (last visited Dec. 15, 2017) (select advanced search, enter “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” under topic or table name, and select “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” 2016 Population Estimates). For estimates of the proportion of youth who identify as lesbian, gay, or bisexual see Kann et al., supra note 7.

In order to determine an estimate for the number of transgender youth who received conversion therapy from a religious or spiritual counselor/advisor, we multiplied the proportion of transgender adults who report that such a person tried to make them identify only with their sex assigned at birth or stop them from being transgender (4.0%) by the proportion for whom this had happened at or before age 18 (51%), as observed in the U.S. Transgender Survey and reported James et al., supra note 4. This proportion (2.0%), those who received conversion therapy at or before age 18, was then multiplied by the proportion of youth ages 13 to 17 who are estimated to be transgender (0.73%) and then applied to the number of youth ages 13 to 17 in the U.S. (20,870,650). For transgender population proportion estimates see Herman et al., supra note 7.

In our prior report, the Williams Institute estimated that approximately 20,000 LGBT youth (ages 13-17) would receive conversion therapy from a licensed health care professional before they reached the age of 18 in the 41 states that had not banned the practice as of January 2018. The report further estimated that approximately 6,000 LGBT youth (ages 13-17) who lived in states that had bans in place in January 2018 would have received conversion therapy from a licensed health care professional before they reached the age of 18 had their states not banned the practice. This report considers the impact on those numbers of the nine state-level conversion therapy bans that were enacted between January 2018 and June 2019.

See, e.g., Prince Morton, Sexual Perversion or Vice? A Pathological and Therapeutic Inquiry, 25 J. Nervous and Mental Diseases 237
(1898); William Stekel, Is Homosexuality Curable? 7 Psychoanalytic Review 443 (1930); Frank S. Caprio, Female Homosexuality: A
Psychodynamics Study of Lesbianism 299 (1954); Irving Bieber et al., Homosexuality: A Psychoanalytic Study (1962); Jolande Jacobi, Case
of Homosexuality, 154 J. Analytical Psychology 48 (1969); Lee Birk, The Myth of Classic Homosexuality: Views of a Behavioral Psychotherapist
in Homosexual Behavior 376 (J. Marmor, ed., 1980); Robert L. Sptizer, Can Gay Men and Lesbians Change Their Sexual Orientation? 200
Participants Reporting a Change from Homosexual to Heterosexual Orientation, 32 Archives of Sexual Behavior 403 (2003).

Nat’l Ctr. for Lesbian Rights, #BornPerfect: The Facts About Conversion Therapy, http://www.nclrights.org/bornperfect-the-facts-aboutconversion-therapy/ (last visited Jan. 2, 2018).

Glassgold et al., supra note 1 at 22.

Id. at 33.

For methodology, see note 5, supra.

For methodology, see note 6, supra.

American professional organizations that have issued statements opposing the use of conversion therapy on youth include: American
Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Association for Marriage and Family
Therapy, American College of Physicians, American Counseling Association, American Medical Association, American School Health
Association, American Psychoanalytic Association, American Psychiatric Association, American Psychological Association, American
School Counselor Association, and National Association of Social Workers Stewart L. Adelson, Practice Parameter on Gay, Lesbian, or
Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents, 51 J. Am. Acad. Child & Adolescent Psychiatry 957 (2012); Am. Acad. of Pediatrics, Homosexuality and Adolescence, 92 Pediatrics 631 (1993); Am. Assoc. for Marriage and Family Therapy, Positions on Couples and Families: Reparative/Conversion Therapy (Mar. 25, 2009), http://www.aamft.org/iMIS15/
AAMFT/Content/about_aamft/position_on_couples.aspx; Hilary Daniel & Renee Butkis, Lesbian, Gay, Bisexual, and Transgender Health
Disparities: Executive Summary of a Policy Position Paper from the American College of Physicians, 163 Annals of Internal Medicine 135
(2015); Am. Counseling Assoc., Ethical Issues Related to Conversion or Reparative Therapy (Jan. 16, 2013), https://www.counseling.
org/news/updates/2013/01/16/ethical-issues-related-to-conversion-or-reparative-therapy; Am. Med. Assoc., Policies on Lesbian, Gay,
Bisexual, Transgender & Queer (LGBTQ) Issues, H-160.991 Health Care Needs of the Homosexual Population, https://www.ama-assn.
org/delivering-care/policies-lesbian-gay-bisexual-transgender-queer-lgbtq-issues (last visited Dec. 1, 2017); Am. Psychoanalytic Assoc.,
Position Statement on Attempts to Change Sexual Orientation, Gender Identity, or Gender Expression (June 2012), available at http://
www.apsa.org/content/2012-position-statement-attempts-change-sexual-orientation-gender-identity-or-gender; Am. Psychiatric Assoc.;
Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) (2000); Barry
S. Anton, Proceedings of the Am. Psychological Assoc. for the Legislative Year 2009: Minutes of the Annual Meeting of the Council of Representatives and Minutes of the Meetings of the Board of Directors, 65 Am. Psychologist 385 (2010); Am. Psychological Assoc., Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts (2009); Am. School Counselor Assoc., The Professional School Counselor and LGBTQ Youth (revised 2016), available at https://www.schoolcounselor.org/asca/media/asca/PositionStatements/PS_LGBTQ.pdf; Nat’l Assoc. of Social Workers, Nat’l Comm. on Lesbian, Gay, Bisexual, and Transgender Issues, Position Statement: Sexual Orientation Change Efforts (SOCE) and Conversion Therapy with Lesbians, Gay Men, Bisexuals, and Transgender Persons (2015), https://www.socialworkers.org/LinkClick.aspxfileticket=yH3UsGQQmYI%3d&portalid=0;

Press Release, Am. Counseling Assoc., ACA Advocacy Efforts Assist in Prohibiting ‘Conversion Therapy’ for Minors in Illinois (Aug. 21,
2015), available at https://www.counseling.org/news/news-release-archives/by-year/2015/2015/08/21/aca-advocacy-efforts-assist-inprohibiting-conversion-therapy-for-minors-in-illinois.

Id.

Press Release, U.S. Rep. Ted Lieu, Rep. Lieu Introduces the Therapeutic Fraud Prevention Act of 2017, https://lieu.house.gov/mediacenter/
press-releases/rep-lieu-introduces-therapeutic-fraud-prevention-act-2017.

Reuters/Ipsos Poll Data, Ipsos Poll Conducted for Reuters: Stonewall Anniversary Poll 06.06.2019, https://www.ipsos.com/sites/default/
files/ct/news/documents/2019-06/2019_reuters_tracking_-_stonewall_anniversary_poll_06_07_2019.pdf (last visited June 11, 2019).

Williams Institute analysis of Reuters/Ispos poll data collected May 29-30, 2019 and June 5-6, 2019. Reuters/Ipsos Poll Data,
Ipsos Poll Conducted for Reuters: Stonewall Anniversary Poll 06.06.2019, https://www.ipsos.com/sites/default/files/ct/news/
documents/2019-06/2019_reuters_tracking_-_stonewall_anniversary_poll_06_07_2019.pdf (last visited June 11, 2019).

Respondents were asked if they supported a range of protections for LGBTQ people in the state, including a ban on conversion therapy
on youth; non-discrimination protections in employment, housing, and public accommodations; and non-discrimination protections
for prospective parents and kids in the child welfare system. Fifty-four percent of respondents supported all protections. It is not
possible to determine the level of support for each individual type of protection from available data. Hart Research Assoc., Key Findings
from the Arizona Survey on LGBT Equality (Dec. 8, 2017), https://assets2.hrc.org/files/documents/Hart-Polling-Memo-_Arizona.pdf?_
ga=2.2178288.1323628615.1559927537-706045989.1558542516.

Doug Kaplan, Political Climate Forecast for Florida in 2018 Looks Positive for John Morgan, Negative for Gay Conversion Therapy,
and Uncertain on the Future of American Involvement in Syria, Orlando Political Observer, Apr. 3, 2017, http://orlando-politics.com/2017/04/13/political-climate-forecast-for-florida-in-2018-looks-positive-for-john-morgan-negative-for-gay-conversion-therapy-and-uncertain-on-the-future-of-american-involvement-in-syria/

Ctr. for Civil Policy, 2017 Landscape Poll (Jan. 15, 2017), https://civicpolicy.com/2017-landscape-poll/.

In response to the poll, 80% of respondents immediately said that they think conversion therapy should be illegal on children under 18.
Half of the remaining 20% of respondents (those who initially agreed or had no opinion) agreed that the practice should be banned when
they had a better understanding of what the practice entails. Born Perfect N.C., Protecting LGBT Youth in North Carolina from Conversion
Therapy, https://southernequality.org/wp-content/uploads/2019/04/BornPerfectNCPolling.pdf (last visited June 8, 2019).

Respondents were asked if they supported a range of protections for LGBTQ people in the state, including a ban on conversion therapy
on youth; non-discrimination protections in employment, housing, and public accommodations; and non-discrimination protections for
prospective parents and kids in the child welfare system. Fifty-four percent of respondents supported all protections. It is not possible
to determine the level of support for each individual type of protection from available data. Hart Research Assoc., Key Findings from
Pennsylvania Survey on LGBTQ Equality (Dec. 14, 2017), https://assets2.hrc.org/files/documents/Hart-Polling-Memo-Pennsylvania.pdf?_
ga=2.204736336.1323628615.1559927537-706045989.1558542516.

Gravis Marketing, Pennsylvania Polling (Jan. 6, 2018), https://www.realclearpolitics.com/docs/Gravis_PA_18_Special_Election_
January_6_2018.pdf.

Gravis Marketing, Virginia Election Poll (May 26, 2017), http://www.gravismarketing.com/polling-and-market-research/virginiaelection-
poll052016/.

Peter Moore, Only 8% of Americans Think Gay Conversion Therapy Works, YouGov.com, June 12, 2014, https://today.yougov.com/
news/2014/06/12/gay-conversion-therapy/.

Cal. Bus. & Prof. Code § 865 (2017); 2017 Conn. Pub. Acts 5 (Reg. Sess.); H.B. 19-1129, 72nd Gen. Assemb., Reg. Sess. (Colo. 2019)
(enacted); S.B. 65, 149th Gen. Assemb., Reg. Sess. (Del. 2018) (enacted); D.C. Code § 7-1231.14 (2017); S.B. 270, 29th Leg., Reg. Sess. (Haw.
2018) (enacted); 405 Ill. Comp. Stat. 48/1 (2017); H.P. 755, 129th Leg., Reg. Sess. (Me. 2019); H.B. 140, 191st Gen. Court, Reg. Sess. (Mass.
2019) (enacted); S.B. 1028, 2018 Gen. Assemb., Reg. Sess. (Md. 2018) (enacted); S.B. 201, 79th Leg., Reg. Sess. (Nev. 2017); H.B. 587, 2018
Gen. Ct., Reg. Sess. (N.H. 2018) (enacted); N.J. Rev. Stat. § 45:1-54 (2016); S.B. 121, 2017 Leg., Reg. Sess. (N.M. 2017); S.B. S1026, 2019-
2020 Gen. Assemb., Reg. Sess. (N.Y. 2019) (enacted); Or. Rev. Stat. §§ 675.070; 675.300; 675.336; 675.540; 675.745 (2016); H. 5277, 2017
Gen. Assem., Reg. Sess. (R.I. 2017); Vt. Stat. Ann. tit. 18, § 8351; Vt. Stat. Ann. tit. 26, §§ 1354(a), 1842(b), 3016, 3210(a), 3271(a), 4042(a),
4062(a), 4132(a); S.B. 5722, 65th Leg., Reg. Sess. (Wash. 2018) (enacted).

Some laws apply to other types of health professionals as well. For example, New Mexico’s conversion therapy ban applies to nurses and
doctors of osteopathic medicine. S.B. 121, 2017 Leg., Reg. Sess. (N.M. 2017)

Cal. Bus. & Prof. Code § 865.

S.B. 65, 149th Gen. Assemb., Reg. Sess. (Del. 2018) (enacted); S.B. 270, 29th Leg., Reg. Sess. (Haw. 2018) (enacted); S.B. 1028, 2018 Gen. Assemb., Reg. Sess. (Md. 2018) (enacted); H.B. 587, 2018 Gen. Ct., Reg. Sess. (N.H. 2018) (enacted); S.B. 5722, 65th Leg., Reg. Sess. (Wash.
2018) (enacted).

Trevor Project, Progress Map, https://www.thetrevorproject.org/get-involved/trevor-advocacy/50-bills-50-states/progressmap/?location=fl-br (last visited June 8, 2019).

See note, supra.

2017 Conn. Pub. Acts 5 (Reg. Sess.); 405 Ill. Comp. Stat. 48/1 (2017); H.B. 587, 2018 Gen. Ct., Reg. Sess. (N.H. 2018) (enacted).

Ferguson v. JONAH, No. L-5473-12 (N.J. Sup. Ct. Dec. 18, 2015).

For methodology, see note 7, supra.

For methodology, see note 8, supra.

H.R. 2119, 115th Cong. (2017); S. 928, 115th Cong. (2017).

H.R. 2450, 114th Cong. (2015); S. 2880, 114th Cong. (2015).

Id.

Id.

H.R. 1981, 116th Cong. (2019); H.R. __, 116th Cong. (2019).

Id.

See note 33, supra.

For methodology, see note 9, supra.

38,000 LGBT youth ages 13-17 [range 24,000 to 61,000] are estimated to be at risk of receiving treatment to change their sexual
orientation or gender identity from a religious leader, advisor or counselor only at or before age 18. This figure was calculated by adding
estimates for LGB and transgender youth and rounding them to the nearest 1,000. In order to determine an estimate for the number of
LGB youth who will receive conversion therapy, we multiplied the proportion of LGB adults ages 18 to 59 who report having received
treatment from a religious leader (pastor, religious counselor, priest) to change their sexual orientation that began and ended before the
age of 18 (2.2%), and who did not also receive conversation therapy from a health care professional, from the Generations Study (Williams
Institute unpublished analyses) by the proportion of youth in grades 9 through 12 who identify as LGB (8.0%) in the 2015 YRBS and by
the proportion of LGB young adults ages 18 to 24 who are cisgender (95.7%) in the 2014-2015 BRFSS (Williams Institute unpublished
analyses), and then applied this proportion to the number of youth ages 13 to 17 in the U.S. (20,870,650), according to 2016 population
estimates from the 2010 U.S. Census. For total 13-17 population estimates: search American FactFinder, (last visited Dec. 15, 2017)
(select advanced search, enter “Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States,
and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016” under topic or table name, and select “Annual Estimates of the Resident
Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2016”
2016 Population Estimates). For estimates of the proportion of youth who identify as lesbian, gay, or bisexual see Kann et al., supra note
7. The proportion who received conversion therapy from a religious leader only did not statistically significantly differ across age cohorts
(18-25, 34-41, and 52-59) (Williams Institute unpublished analyses).

In order to determine an estimate for the number of transgender youth who received conversion therapy from a religious or spiritual
counselor/advisor, we multiplied the proportion of transgender adults who report that such a person tried to make them identify only with
their sex assigned at birth or stop them from being transgender (4.0%) by the proportion for whom this had happened at or before age 18
(51.0%), as observed in the U.S. Transgender Survey and reported James et al., supra note 4. This proportion (2.0%), those who received
conversion therapy at or before age 18, was then multiplied by the proportion of youth ages 13 to 17 who are estimated to be transgender
(0.73%) and then applied to the number of youth ages 13 to 17 in the U.S. (20,870,650). For transgender population proportion estimates
see Herman et al., supra note 7.

Am. Psych. Assoc., Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts, http://www.apa.
org/about/policy/sexual-orientation.aspx (last visited Dec. 18, 2017).