In this op-ed, psychiatrist and conversion therapy survivor Dr. Matt R. Salmon addresses the Trump administration’s report on gender-affirming care and the idea of “exploratory therapy.”
Last week, the U.S. Department of Health and Human Services released a 409 page report called “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” Meant to be an evidence-based look at gender-affirming care for trans kids, the report reads less like a scientific review and more like a policy hit job against transgender youth.
There are many issues with the report, from cherry-picked data to advice that contradicts what nearly every major medical association has agreed constitutes best practices for treating trans youth. Among those many issues, all of which are alarming, is one that’s particularly egregious to me: The report repackages conversion therapy in a new outfit, calling it “exploratory therapy” and daring to suggest it be a new “intervention.”
Let me be clear: this isn’t evidence-based medicine. It’s state-sponsored gaslighting.
Conversion therapy is a debunked and discredited practice that aims to change the sexuality and/or gender identity of LGBTQ+ individuals. According to The Trevor Project, conversion therapy is based on the incorrect idea that LGBTQ+ identities are disordered and need to be fixed. Currently, 23 states and Washington D.C. ban the practice, and another four states and Puerto Rico specifically ban it for minors. The practice has been linked to increased depression, PTSD, and suicidality in LGBTQ+ people.
I’ve seen the impact of this practice myself. I know the harm this kind of “therapy” causes because I endured it. Mine was called “reparative therapy”—a clinical-sounding name for a process that sought to unmake me. I was told my queerness wasn’t inherent, but the result of emotional deficits — specifically, a lack of “healthy, non-sexual male bonding.” According to my professional counselor, I was trying to “consume” other men, a kind of “sexual cannibalism” meant to fill a missing masculine core. Week after week, I was dissected—my desires reframed as pathology, my identity treated as trauma. The damage wasn’t loud or immediate. It settled in slowly, teaching me to doubt intimacy, to fear tenderness, to see my own reflection as something to be fixed.
Now, I know that’s not the case, and I’ve spent my career working to undo that harm. As a divergent-affirming psychiatrist, I’ve sat across from transgender teens whose families rejected them, whose therapists tried to “neutralize” their identities, and whose medical access was dangled like a reward for compliance. I’ve seen firsthand what happens when we treat identity as a symptom to be cured instead of a truth to be honored. So, when I read that the HHS report is recommending “exploratory therapy” as a treatment for gender dysphoria, to encourage trans youth to “come to terms with their bodies,” it was an immediate red flag to me.
Conversion therapy has tried to rebrand before, but given the stated intent in the report— to repackage gender dysphoria as “common during puberty and adolescence” and to encourage “adolescents come to terms with their bodies” — this seems like yet another attempt. The report explicitly denies this, the authors seemingly aware that they’d come up against this criticism (the authors, by the way, have not been named).
