09-05-2025
Trump's 'Exploratory Therapy' Is Still Just Conversion Therapy — and It's Dangerous
Marjan_Apostolovic
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).
'Critics of exploratory psychotherapy for [gender dysphoria] claim that therapists are trying to 'promote gender identities that are aligned with the person's sex assigned at birth,'' the report says. 'A less theoretically-laden description would be that some therapists are trying to help children and adolescents come to terms with their bodies.'
Again, let's be clear: Any therapy meant to convince you to be someone you know you're not isn't a 'treatment,' it's a dangerous effort at control and conformity. Critics of gender-affirming care for trans youth often say they're simply urging 'caution,' wanting to sway kids away from treatments that they might later regret (though statistics show they overwhelmingly do not regret this care). This isn't about caution, it's about control. It's about forcing trans kids to sit in rooms with adults who believe their existence is a pathology. It's about framing trauma as a treatment plan. It's about replacing affirming care with coercive, ideologically driven delay tactics—until it's too late.
The HHS report isn't just ethically bankrupt—it's medically indefensible. It ignores decades of research and consensus from major medical organizations like the American Academy of Pediatrics, the American Psychiatric Association, and the World Professional Association for Transgender Health, all of which support gender-affirming care as the appropriate standard. Instead, the report leans heavily on discredited sources like the Cass Review and Society for Evidence-Based Gender Medicine (SEGM), two efforts widely criticized for promoting anti-trans policies under the guise of scientific neutrality.
We know where this road leads: increased suicidality, broken families, and queer youth who learn to dissociate from themselves just to survive.
We don't need this exploration the government is claiming to offer. In fact, as writer Katelyn Burns pointed out in an op-ed for MSNBC, 'therapy is already a major requirement for gender transitions of people of all ages, and especially for children.' We need affirmation. We need accountability. We need to stop calling cruelty a treatment model.
As both a psychiatrist and someone who was once a queer kid trapped in a system that didn't see me, I say this with everything I've got: transgender youth don't need to be changed. It's the systems harming them that do.
Originally Appeared on Teen Vogue
