Worlds Behind Words 7: Michigan Conversion Therapy Ruling, Gender-Affirming Care Restrictions, and LGBTQ+ Safety

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/12/31

William Dempsey, LICSW, is a Boston-based clinical social worker and LGBTQ+ mental-health advocate. He founded Heads Held High Counselling, a virtual, gender-affirming group practice serving Massachusetts and Illinois, where he and his team support clients navigating anxiety, depression, trauma, ADHD, and gender dysphoria. Clinically, Dempsey integrates EMDR, CBT, IFS, and expressive modalities, with a focus on accessible, equity-minded care. Beyond the clinic, he serves on the board of Drag Story Hour, helping expand inclusive literacy programming and resisting censorship pressures. His public scholarship and media appearances foreground compassionate, evidence-based practice and the lived realities of queer communities across North America.

In this wide-ranging exchange, Scott Douglas Jacobsen and William Dempsey examine how U.S. politics and institutions shape LGBTQ+ lives. They discuss a federal appeals court decision blocking Michigan’s ban on conversion therapy for minors, weighing First Amendment arguments against the medical consensus that the practice is harmful. They then turn to proposed federal limits on gender-affirming care funding and access, including downstream impacts for Medicaid/CHIP families and ripple effects in liberal states like Massachusetts. The conversation also touches on faith-driven judicial nominees, pluralism, and the lived experience of safety and acceptance across generations.

Scott Douglas Jacobsen: A federal appeals court on Wednesday blocked Michigan’s ban on conversion therapy for minors who are LGBTQ+ in Michigan because it violates the First Amendment rights of therapists and counsellors. It was a two-to-one decision, and the court said it illegally restricts speech that reflects therapists’ moral or religious beliefs. 

Now they must be emphasizing that article—and I am reading it—moral belief, not empirical belief. That distinction is crucial. I think about some things that could be put in place around licensure based on evidence, whether doing something can be immoral, and that is fine. It is like abortion care or something. But in terms of evidence, major medical and mental-health organizations have concluded that conversion therapy is not supported as an effective treatment and is associated with harm, so it is not merely a moral question. 

First of all, you have to have the evidence to make it a yes-or-no decision about whether you do it on moral grounds. Judge Raymond Kethledge wrote, and was joined by Judge Joan Larsen, stating, “The Michigan law discriminates based on viewpoint,” meaning the law permits speech on a particular topic only if the speech expresses a viewpoint that the government itself approves. 

In one dissent, Judge Rachel Bloomekatz said the Sixth U.S. Circuit Court of Appeals should have waited for the Supreme Court to resolve a related case in Colorado that could settle the issue more broadly. And Democratic Governor Gretchen Whitmer stated in 2023 that conversion therapy is a “horrific practice.” That assessment is consistent with the position of major professional associations and with research findings that link conversion therapy to increased risks such as depression and suicidality. Any thoughts?

William Dempsey: First of all, it sounds like they are going off what they feel is ethical. There have been numerous crackdowns on conversion therapy from the APA and other leaders in mental health.

Jacobsen: The American Psychological Association, the American Medical Association, and the American Psychiatric Association, all three. And this was from months ago now.

Dempsey: Yeah. And potentially the marriage and family group—the AAMFT, the American Association for Marriage and Family Therapy—the family therapy organization as well. All of them. I do not think any of them ever approved it, and, more importantly, they have openly said it is harmful. And again, fact-check me on this, but I believe there have been studies showing that the majority of people who are doing this are not actually therapists. I cannot say the majority are not licensed therapists as a general fact; conversion therapy has been practiced by a mix of licensed providers and unlicensed religious counsellors, and Michigan’s law specifically targets licensed mental-health professionals. 

So, for that to be quoted as if it only concerns licensed therapists is not true; many people providing “conversion” efforts are clergy or other unlicensed counsellors, but licensed professionals have also been involved historically and in some settings. So while the argument of free speech can still be made, framing it under the guise of therapists’ free speech is absurd, frankly. And without getting too sidetracked, this speaks to a larger conversation. 

There are theories that Gretchen Whitmer is running for the Democratic presidential ticket in 2028 and positioning herself as broadly electable; there is no reliable evidence that she is working closely with President Trump, so that part should be treated as speculation. On a personal level, it makes me wonder how much of this is performative. But Michigan is a swing state and a very divisive one, so this is her genuinely trying to support what her constituents want, or what she thinks they want. There are many people I do not know directly, but I know enough parts of Michigan that would agree with us. So I am willing to give her the benefit of the doubt.

Jacobsen: The other big news out of the states concerns the U.S. Health Secretary Robert F. Kennedy Jr. has moved to cut access to gender-affirming care for children. I do not know what age range is being used here, or where the cutoff is on either end for the definition of “children” in the United States, so I am not sure what this precisely implies. He is proposing rules to bar hospitals that deliver care through Medicare and Medicaid programs, as well as barring Medicare and children’s health programs from paying for it. So this affects both the delivery of care and its payment. 

He is targeting both taxpayer funding and the practice itself. If you could stop a practice outright, why would you also need to address payment mechanisms? All U.S. hospitals participate in Medicare programs for people aged 65 and older and people with disabilities, and more than half of U.S. children receive health coverage through the federally and state-based Medicaid and CHIP programs. These are primarily families with fewer resources than many in the American population. That is my reading of the situation, and these programs are being cut for a tiny minority of cases involving this type of care. Any thoughts? And have you dealt with kids or parents in this kind of situation?

Dempsey: I have not dealt directly with kids or parents in this situation. I have worked primarily with people who have commercial insurance, so, as you stated, they inherently have more privilege and access, especially in a state like Massachusetts, and in the Boston area specifically, which is very liberal and has no plans to revoke access to gender-affirming care. I have worked with teens who are on hormone replacement therapy or who were exploring that as an option before turning 18. I think this is part of an ongoing conversation. 

I have never encountered a situation in which youth are allowed to make these decisions without parental consent. For the government to take away the right of parents to provide consent for their own children seems like an invasion, and that is being generous. I try to be mindful and fair-minded here, because if I were to argue the same thing about something I personally disagree with, we might have a very different conversation. I keep that in mind when offering my perspective.

What concerns me more broadly is that in Massachusetts, there was recently a notice stating that even individuals under 21 were going to be restricted from receiving hormone replacement therapy. This occurred at a specific facility, but the justification given was that the decision had to be made in accordance with federal guidelines. This facility is one I used to work at. It is a queer-focused health center called Fenway Health, and it is one of the world leaders in LGBTQ health-care research. As you can imagine, many people in the Boston metro area receive their HRT there. To have legal adults—19- and 20-year-olds—unable to access that care is difficult even to describe. 

There is significant concern in the community that even where people may disagree with the initial restrictions on minors, there is a growing fear that this represents a slippery slope. The concern is that the government will continue to find ways to restrict access for legal adults, including 18-, 19-, and 20-year-olds. In the United States, adulthood begins at 18, which raises a serious alarm. As is often true across government on both sides of the aisle, there is a perception that small inroads are being made before larger moves follow. There is a growing concern that these are only the beginning steps of a broader plan of restriction, for lack of a better phrase.

Jacobsen: This is the last one. A Republican senator grilled a Trump judicial nominee over religious sermons. An Indiana lawyer nominated by President Donald Trump to become a federal judge faced sharp questioning after it emerged that he had delivered church sermons describing premarital sex as a category of “sexual perversions” and suggesting that wives should be subservient to their husbands. 

This should surprise no one. This is pretty standard fundamentalist ideology and a literalist reading of the Bible. Senator John Kennedy of Louisiana stated, “My obligation is to try to understand you, because this is a lifetime appointment.” He continued by asking whether the nominee believed that people with disabilities should not be able to marry, and whether Christian marriage requires women to be subservient to their husbands. Justin Olson, one of three district court nominees appearing before the Republican Senate Judiciary Committee, responded by stating, “My highest legal authority is my nation, and the United States Constitution governs that nation.” 

When questioned further, he said he was describing his church’s understanding of Christian marriage and added, “I believe every word of the Bible.” That is always an interesting statement. Any thoughts on this interrogation by a Republican senator—whether MAGA-aligned or not—and this fundamentalist Christian nominee, Mr. Olson?

Dempsey: My personal opinion is that people whose views most closely align with the Bible, or who cite the Bible as the justification for their opinions, are often among the most enormous hypocrites. That includes, but is not limited to, individuals who quote the Bible to support anti-queer legislation while engaging in queer sexual activity behind closed doors. 

From a psychological perspective, while this is not a universal truth, we are often most upset by people who represent parts of ourselves we are unhappy with. Off the record, I was reflecting on this recently with someone I was clashing with, and after further reflection, I realized that the things I disliked about them were also things I disliked about myself.

Jacobsen: That is not always true, though. It could be that something they do genuinely bothers you.

Dempsey: Sure. That is not a universal truth. Part of this involves taking time to be self-reflective and intuitive about who you are and engaging in self-discovery. To use a more extreme example, I could dislike someone for being racist, and that does not mean I dislike them because I am racist. Or I could dislike someone for being rude to a service worker, and that does not mean I share that trait. It is not a universal rule. However, there are many instances in which that dynamic does apply. 

This opens up a larger societal conversation that is very apparent in the United States and has always been: how to live in a large, pluralistic society with differing moral frameworks without feeling you are imposing your agenda on others, especially legislatively. I realize we are getting slightly off topic here, but if you have a more specific question, Scott, I am happy to get back on track.

Jacobsen: One other individual—an older gay man—has noted to me that, as an American, he has never felt entirely accepted, at a minimum, if not safe, or safe, if not accepted, at any point in his lifetime. He has not felt welcomed in the United States and has almost certainly not felt safe for most of his life as a gay man. Is that a common experience, and how do patients express that to you one-on-one?

Dempsey: How old is this person?

Jacobsen: He is in his sixties.

Dempsey: Yes. I think it is twofold. Having met many people from across the United States, part of it depends on where you were raised. Older generations of queer people tend to feel this more deeply because the trauma runs deep. They grew up in a time when bars were being raided, and more recently, when many of their friends were dying because the government and the medical establishment did not believe they were worth caring for or worth helping to survive. That is incredibly difficult to overcome, and it is understandable. You are going to feel unsafe.

For younger generations, including my own, it still depends heavily on where you grew up. I have friends who were raised in rural Texas who have a very different perception of safety than I do, having been raised just outside New York City. While I am aware of what might feel unsafe when travelling to certain places, I have not experienced or internalized fear in the same way that others I know have. That distinction is especially noticeable among gay men.

There are also significant safety concerns across the broader LGBTQ+ community. We see this most acutely with trans people, where rates of violence continue to rise year over year, including rates of murder, particularly among Black and Brown trans women. There is also what might be described as the gentrification of queer spaces. This can create tension and, at times, conflict—even violence—between gay men and queer women who are perceived as straight women encroaching on what had been safe spaces. As lesbian bars disappear and queer women search for alternative spaces, that friction can intensify, with some gay men perceiving this as a kind of erasure of queer-specific spaces.

Most importantly, the safety concerns related to violence, the loss of spaces that feel safe, and the inability to exist openly in public—experiences everyday for gay men in the 1960s and 1970s—closely parallel what we are seeing today with trans people. As a result, we see predictable psychological consequences: hypervigilance, anxiety, depression, and thoughts of suicide or self-harm. As we have discussed before, this can escalate into flight responses, where people begin seriously asking themselves, “Where can I move? Where can I go?” because it is not sustainable to live in a constant state of perceived threat.

Jacobsen: That is a lot of words for a purely trans week. Literally, that is what came up. It was all the news—every item—in the trans world.  We are doing this weekly, but we will be off for the next two weeks due to Christmas and New Year’s. See you then in the new year.

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