This is another in my occasional series on the pediatric trans industry.

Imagine a 14-year-old walks into a therapist’s office and announces she has bipolar disorder. She read about it online, she says. The symptoms match. She wants an antipsychotic prescription medication.

No competent therapist anywhere would write the prescription. The therapist would do what therapists are trained to do, explore family history, the circle of friends, the social media diet, the possibility that what the 14-year-old has concluded is bipolar disorder might be anxiety, depression, trauma, or simply the ordinary adolescent turbulence. That careful, skeptical, exploratory process is not an obstacle to good care. It is the care.

Now imagine the same 14-year-old announces instead that she is a boy.

In that case — and only in that case — the rules of therapy are inverted in the United States. The patient’s self-diagnosis is the diagnosis. The therapist’s job is to affirm it. And if a bill now moving through the California legislature becomes law, a therapist who asks too many questions could be sued for it — and minors can file claims until they turn 40.

Senate Bill 934: Litigation as Ideology Enforcement

This week, Senate Bill 934 cleared the California Assembly Judiciary Committee on a 7–3 party-line vote. The bill is authored by state Sen. Scott Wiener, a San Francisco Democrat now running for Nancy Pelosi’s congressional seat. The ultra-progressive lawmaker is responsible for several controversial bills, including measures restricting parental involvement in their children’s ‘gender affirming care’ and a separate effort to narrow sex-offender registration requirements. Wiener’s latest bill allows former patients to bring malpractice suits against licensed therapists for so-called “conversion therapy.” It has a statute of limitations unlike almost anything else in civil law. Patients who were minors at the time of treatment can sue until they turn 40. Adults get 10 years from their last session, or five years from “discovering harm.” In other words, the moment they decide the therapy harmed them.

Plaintiffs can seek damages for medical expenses, mental health treatment, lost wages, pain and suffering, emotional distress, and loss of enjoyment of life. And, of course, attorney’s fees and, in cases of alleged fraud, punitive damages.

Wiener has been candid about why he authored the bill. In April, the Supreme Court ruled 8–1 in Chiles v. Salazar that state bans on talk therapy touching sexual orientation and gender identity must survive strict scrutiny. That is the Constitution’s most demanding test. Justice Gorsuch wrote the majority opinion, and the case was remanded to lower courts.

Chiles v. Salazar put California’s own 2012 ban, the nation’s first, on shaky legal ground. Wiener acknowledged as much to California Senate committee: there have “already been rumblings” of a legal challenge to the California law, “so here we are.”

What to do if the courts will not allow the state to ban a category of speech between therapists and patients? Wiener noted publicly that Gorsuch’s opinion did not cover malpractice suits and therefore he designed a statute-by-litigation workaround by which the state will make practicing standard talk therapy when it comes to gender, financially ruinous. What the First Amendment forbids by statute, SB 934 accomplishes by litigation exposure.

The Definitional Sleight of Hand

The bill’s defenders and sponsors include prominent LGBT advocacy groups, Equality California, Lambda Legal, the National Center for LGBTQ Rights, and the Trevor Project. They invoke the genuinely discredited practices that the phrase “conversion therapy” conjures: the aversion treatments, the oppressive religious boot camps, the electroshock horrors of decades past. Wiener slams it all as “psychological torture.”

Historically, that discredited legacy was abusive and is rightly condemned.

If SB 934 targeted only that, it would be unremarkable. Those practices are denounced by every major medical association, already banned for minors in California, and already grounds for professional discipline. Wiener has used that concept as a cudgel, saying the bill gives victims “the right to hold charlatans accountable for this debunked torture.”

But that is not how the bill is written. Its definition of prohibited “change efforts” sweeps in any attempt by a licensed mental health provider to direct a patient toward “a particular sexual orientation or a particular gender identity.”

That language is the critical hinge of the bill. The chilling effect isn’t a side effect but rather its mechanism. A therapist who spends six months helping a gender-distressed 13-year-old examine whether her confusion might be rooted in autism, internalized homophobia, or social contagion — and who watches that distress resolve without a single medical intervention — has, in the eyes of a plaintiff’s lawyer, “directed” the patient “toward” her birth-sex identity. That is not conversion therapy.That is therapy. For every other condition in the diagnostic manual, it is called the standard of care.

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The Chilling Effect Is the Point

Clinical psychologist Joseph Burgo said it plainly at last Tuesday’s committee hearing: “In supervising therapists today, I constantly hear their anxiety over their legal exposures or risks to their license if they do just that — practice traditional exploratory psychotherapy. These are not conversion therapists. These are honest clinicians who want to practice traditional psychotherapy with gender-distressed young people, but they’re afraid to do so.”

SB 934 bakes that fear into statute. Few therapists in private practice can absorb the cost of defending a malpractice suit, even a winning defense — and no malpractice insurer will look kindly on a clinician whose patient population carries a two-decade liability tail. The rational response for a therapist is to choose not to explore or question, not to have “watchful waiting,” what used to be considered the gold standard for treating minors with questions about their gender.The safest path will be to affirm the child’s self-diagnosis, write a referral letter, and move the child along to the endocrinologist. The medical pipeline of puberty blockers, cross-sex hormones, and surgery becomes not just the path of least resistance, but the path of least litigation.

Among those who testified against the bill was Jonni Skinner, a 23-year-old detransitioner. Skinner grew up in a devoutly religious family in small-town Michigan. He described being a feminine boy who constantly was bullied and later diagnosed with high-functioning autism. Skinner told lawmakers he encountered trans influencers online as a teen: “They said, ‘Change your body and your life gets better. Don’t, and it gets worse.’”

Skinner told the committee that doctors told his mother that he would kill himself if he was not allowed to transition. The therapy he needed, the kind that might have asked and challenged whether an autistic, gender-nonconforming, bullied kid was actually a girl, is precisely the therapy SB 934 makes legally radioactive.

A child like Skinner has no comparable remedy. The bill creates a 22-year window to sue any therapist who counsels caution. Meanwhile, it is not intended to create an equivalent window to sue the clinic that prescribed puberty blockers, cross-sex hormones, or irreversible surgical interventions to a confused minor. Under SB 934, it is caution that carries potential liability. The scalpel may not.

How We Got Here

None of this happened overnight. Two years ago, I traced the history in “Who Put the Kids in Charge?” — how gender dysphoria entered the diagnostic manual only in 2013, the first time the disorder was applied to minors; how a Dutch protocol built on a handful of patients, and underwritten in part by a pharmaceutical company holding a puberty-blocker patent, became the global template; and how American gender clinics adopted the most permissive interpretation of it, multiplying from a single Boston clinic to dozens of dedicated pediatric gender centers over a decade.

The therapist’s predicament was then compounded by the profession’s own gatekeepers. In 2024, the American Psychiatric Association published Gender-Affirming Psychiatric Care, the first textbook of its kind — and, as I wrote in the New York Post, it is less a clinical reference than a handbook for affirmation-only practice. Its 26 chapters, each featuring at least one author who identifies as transgender, non-binary, or “gender-expansive,” instruct the next generation of psychiatrists that their role is to affirm, facilitate, and refer — not to explore. A young clinician trained on that textbook, practicing under SB 934, will not need to worry about the law’s liability because that clinician will only wave patients as fast as possible from the therapy couch into the pediatric gender pipeline.

The Rest of the World Is Walking This Back

What makes California’s timing so remarkable is that it comes as the countries that pioneered pediatric gender medicine are retreating from it. England’s National Health S...