By: Keith D. Elston, Legal Director Kentucky Youth Law Project October 9, 2025 Yesterday, the U.S. Supreme Court heard oral arguments in Chiles v. Salazar, a case that could significantly change how states protect LGBTQIA+ youth. The issue is whether states can ban licensed mental health professionals from subjecting children to so-called “conversion therapy.” From the questioning, most justices seem ready to strike down these bans, arguing that conversion therapists are simply engaging in protected speech with their clients. That framing is dangerously incomplete. Licensed professionals like therapists, doctors, and lawyers are not ordinary speakers. When we earn a professional license, we also accept restrictions on our speech during practice. These restrictions exist for a reason: words can cause serious harm when spoken with professional authority. If a doctor advises a patient to drink bleach to cure a cold, or a lawyer counsels a client to commit perjury, neither can hide behind the First Amendment. Professional speech is held to standards of competence and ethics because the stakes involve life, liberty, and health. The same holds true in mental health practice. Conversion therapy is not a harmless exchange of ideas between equals. It is based on the discredited belief that LGBTQIA+ identities are disorders to be fixed. All major medical and mental health organizations, including the American Psychiatric Association, the American Psychological Association, and the American Academy of Pediatrics, have condemned conversion therapy as ineffective, unethical, and harmful. These groups warn that the practice raises the risks of depression, substance abuse, family rejection, and suicide. Conversion therapy is a form of psychological abuse, particularly when forced upon minors. State regulation of professional practice is well-established. States regularly define limits on what licensed professionals can and cannot do. We prevent doctors from prescribing unsafe or unproven treatments. We discipline lawyers who provide fraudulent or harmful advice. Therapists are also required to follow standards that mandate evidence-based practices and prioritize client safety. Conversion therapy fails these standards, and states have both the right and obligation to protect children from it. The Court’s apparent willingness to prioritize the free speech rights of practitioners over the health and safety of minors overlooks that balance. The First Amendment has never been an absolute shield against professional responsibility. Treating it as such would lead to a cascade of unintended consequences. If speech alone were the standard, what would prevent a financial advisor from selling fraudulent schemes under the guise of “speech”? What would stop a physician from prescribing quack remedies with no scientific backing? Regulation of professions has always required more than blind deference to free expression. The consequences of overturning these bans will be severe. Children themselves rarely seek conversion therapy. It is imposed on them by parents or guardians, often influenced by religious or ideological groups. These young people do not give informed consent before attending therapy. They are forced into sessions that promote shame and self-hatred. Research indicates that LGBTQIA+ young adults who faced high levels of family rejection are more than eight times as likely to attempt suicide compared to their peers from supportive families. Loosening state bans now would risk exploitation by professionals under the guise of constitutional liberty. The Court should avoid oversimplifying this issue as merely a conflict between free speech and censorship. The case involves professional standards, public safety, and the legitimate role of the state in preventing harm. Personal opinions belong in the public square where disagreement is protected. However, when a licensed professional advises a client, that speech is not just free expression but professional conduct with ethical duties and legal limits. Ignoring this distinction risks enabling harm and diminishes the authority of states to protect vulnerable youth. The First Amendment deserves robust protection, but not at the expense of children’s lives. The Constitution should not be distorted into a weapon that protects malpractice.
Civil Society Is Under Threat: Why Nonprofits Must Be Defended
By: Keith D. Elston, Legal Director Kentucky Youth Law Project September 16, 2025
Following Charlie Kirk's murder, we have observed a disturbing increase in rhetoric from top officials of the current federal government. Nonprofits, especially those involved in advocacy or serving marginalized groups, are now being broadly labeled as “terrorist organizations.” This isn’t just reckless talk; it’s an intentional attempt to discredit civil society and silence organizations that hold the government accountable. Nonprofits are not a luxury. They are vital infrastructure. They offer youth services, legal aid, housing support, education, health care, and civil rights advocacy. They bridge the gaps that government and private industry cannot or will not address. In Kentucky, as across the nation, nonprofits serve as lifelines for vulnerable people, especially young individuals facing discrimination or instability. Calling these organizations "terrorists” ignores their essential role. Moreover, it turns fear into a tool for political advantage. Threatening to shut down nonprofits is not only misguided, but also unconstitutional. The First Amendment guarantees freedom of speech and association. Due process requires fair procedures before any organization can be dissolved or penalized. Equal protection demands that enforcement not be used as a political weapon. When lawmakers target nonprofits, they attack the very freedoms that support civic life. The Kentucky Youth Law Project will not remain silent. We pledge to oppose, using all legal means available, any attempt to silence, criminalize, or dismantle nonprofit organizations. If laws or regulations are passed that infringe on constitutional rights, we will challenge them in court. If arbitrary enforcement targets nonprofits because of their viewpoints or mission, we will fight back. Additionally, we will collaborate with partners across the state and nation to ensure that civil society stays strong and free. This isn't a partisan issue; it's what keeps our democracy vibrant. Without nonprofits, the voices of everyday people are silenced, and the needs of vulnerable communities go unmet. Silencing nonprofits means silencing the people they serve. We will not allow political expedience or fearmongering to weaken civil society. Nonprofits are here to stay, and we will do everything we can to defend them.
We will fight: KYLP vows to quash subpoenas for gender-affirming care records New rapid-response effort aims to defend providers, patients, and the principle of medical confidentiality in Kentucky.
By Keith D. Elston, Legal Director Kentucky Youth Law Project September 10, 2025 Recently, healthcare providers across the country have reported receiving subpoenas from federal and state law enforcement agencies demanding access to the private records of transgender and nonbinary youth receiving gender-affirming care. These subpoenas are not only invasive, they are dangerous. To our knowledge, Kentucky providers have not yet faced such demands. However, considering the national climate and the hostility of some state officials toward gender-affirming care, it would be naive to think the Commonwealth will remain unaffected. That is why the Kentucky Youth Law Project (KYLP) has launched a Rapid-Response Initiative: a comprehensive plan to oppose, in court, any effort to force the disclosure of these records. Let us be clear: providing gender-affirming care to minors in Kentucky is not a crime. However, a law passed in 2023 by the General Assembly, known as SB 150, threatens healthcare providers who treat minors with gender-affirming medications or procedures with the loss of their professional licenses. This law seems to punish doctors rather than protect patients. It also creates opportunities for political actors to weaponize subpoenas against providers—not to investigate actual crimes, but to intimidate families and discourage care. The stakes are incredibly high. Medical records are some of the most sensitive documents anyone holds. For a transgender or nonbinary minor, those records include not just diagnoses and prescriptions but also detailed notes from doctors and therapists—notes that, if leaked, could reveal their identity to schools, employers, neighbors, or even hostile family members. Once such information is exposed, the damage cannot be undone. A young person could face stigma, bullying, harassment, or worse. HIPAA and Kentucky law both recognize that not all records are equal. Psychotherapy notes, reproductive health information, and HIV status are all given special confidentiality. Gender-affirming care should be treated the same way. These protections are in place because lawmakers and courts understand that some disclosures do more than breach privacy; they can endanger lives. Our Rapid-Response Initiative is centered on three key pillars. First, legal action: KYLP will file motions to quash overbroad subpoenas, advocate for protective orders that anonymize records, and seek emergency injunctions if needed. Second, provider training: we are equipping clinics, hospitals, and community health centers with tools to respond calmly and lawfully if a subpoena is received. This includes front-desk scripts, subpoena logs, and legal hotlines to prevent providers from releasing records without review. Third, community support: families need reassurance that they are not alone. If their provider receives a subpoena, KYLP will stand with them in court. This initiative is supported in part by a generous grant from the Charles and Jack Fund for LGBTQ+ Advancement, a fund of the Community Foundation of Louisville. Their support enables us to build infrastructure ahead of time—to prepare Kentucky’s providers and parents, rather than scramble afterward. Critics might argue that law enforcement is simply “doing its job.” However, conducting fishing expeditions into children’s private medical records is not a legitimate form of investigation. When regulators suspect billing irregularities, they can review insurance claims and administrative data. What they cannot justify is rifling through a 14-year-old’s therapy notes in the name of hunting for “fraud.” At KYLP, we know what is really at stake: whether Kentucky’s transgender and nonbinary youth can receive medically recommended care without fear. Whether families will feel safe walking into a doctor’s office. Whether providers will be free to follow medical ethics rather than political dictates. We are not naive about the challenges ahead. The same forces pushing these subpoenas are working to eliminate access to gender-affirming care entirely. But preparing now sends a message: Kentucky will not be caught off guard. Providers, families, and youth will understand their rights. Courts will hear consistent, well-founded arguments for confidentiality. And law enforcement agencies will learn that subpoenas are not a shortcut to political gains. Confidentiality is the foundation of medicine. Without it, trust falls apart. If Kentucky starts forcing the disclosure of transgender youth’s medical records, we risk not only breaking the law but also destroying that trust. Families will stop seeking care. Doctors will be forced to choose between protecting their patients and protecting their licenses. And children, the very people the law is meant to protect, will suffer subpoenas. Our message is simple: protect privacy, protect kids.
By Keith D. Elston, Legal Director Kentucky Youth Law Project, Inc. (KYLP) August 28, 2025 The U.S. Department of Health and Human Services (HHS) has now warned Kentucky schools that they must remove any mention of gender identity, gender expression, and pronouns from federally funded sex education, or risk losing $1.4 million in PREP grant funding. This directive adds to a Kentucky law already banning instruction that has the “goal or purpose” of students studying or exploring gender identity, gender expression, or sexual orientation. Together, these measures do more than regulate curriculum. They try to erase LGBTQIA+ students from our classrooms, policies, and even our vocabulary. Let’s be clear: erasing LGBTQIA+ students from the curriculum does not erase them from Kentucky classrooms. These students are already here—learning, striving, and facing challenges. What these restrictions erase is recognition, dignity, and support. The harm is real. Research shows that LGBTQIA+ youth in supportive schools face less bullying, lower depression rates, and better academic performance. In contrast, schools that silence these identities create isolation, fear, and despair. When government officials silence LGBTQIA+ identities, they put young people at risk. From a legal perspective, the situation is equally concerning. Conditioning federal funding on excluding gender identity raises significant constitutional issues. Title IX forbids sex-based discrimination in education programs, and federal courts have increasingly recognized that this includes discrimination against LGBTQIA+ students. Meanwhile, Kentucky’s law seeks to bypass even basic acknowledgment of these students’ existence. School districts are caught in a conflict between state restrictions and federal mandates, with students’ well-being caught in the crossfire. At KYLP, we believe schools should be safe, supportive, and inclusive for every student. That means affirming LGBTQIA+ students, protecting them from bullying and harassment, and ensuring they have access to accurate, age-appropriate information about health and identity. We will provide legal guidance to districts, support educators, and, when necessary, challenge policies that harm students in court. This moment tests whether Kentucky values all its young people. Do we let politicians decide who counts as “real” students, or do we stand for every child's right to dignity, safety, and respect? The outcome will affect not only LGBTQIA+ students but also the moral character of our schools and communities. KYLP’s stance is clear: every Kentucky student deserves safe, supportive schools. No exceptions.
The Supreme Court just legalized censorship in public schools
By Keith D. Elston, Legal Director Kentucky Youth Law Project, Inc. Friday, June 27, 2025
Today, the U.S. Supreme Court made a decision that should alarm anyone who believes public education ought to serve all children, not just the ones whose parents shout the loudest. In Mahmoud v. Taylor, the Court ruled that school districts must accommodate parents who object to LGBTQ+ literature in school libraries on the grounds of their religion. The ruling requires schools to provide advance notice and opt-out opportunities for materials that may conflict with a family's religious views. In plain terms, it lets a handful of parents decide which stories the rest of us are allowed to read. Let’s be honest about what’s really going on here. This isn’t about religious liberty. It’s about censorship. And the Court just gave it constitutional cover. The decision hands power to anyone who believes that simply acknowledging LGBTQ+ lives is inappropriate for the classroom. That’s not protecting kids: that’s erasing them. It tells schools to tread carefully or risk being dragged into court. The likely result? Queer books quietly disappear from the shelves. Not because they’re harmful, but because they’re controversial. Or worse, because they exist at all. Justice Sonia Sotomayor’s dissent gets to the heart of the issue. “The Constitution does not permit schools to become battlegrounds for ideological purification,” she wrote. But with this ruling, that’s exactly what we risk becoming. Instead of being places where young people learn about the world and each other, schools may now become spaces where only the most sanitized, inoffensive, and increasingly narrow stories are allowed to survive. This is not a mere hypothetical concern. LGBTQ+ students already face disproportionately high rates of bullying, isolation, and mental health struggles. Representation in school libraries isn’t a luxury—it’s a lifeline. Taking away those stories doesn’t protect anyone. It sends a message that queer identities are something to be hidden, debated, or silenced. That they don’t belong. That they are dangerous. The First Amendment is meant to protect us from government overreach, not to be wielded as a bludgeon to suppress ideas some people dislike. And yet, this ruling turns that principle on its head. It elevates individual offense over shared civic values. It says the fear of discomfort should dictate the boundaries of what we teach, read, and understand. This isn’t a win for parental rights. It’s a loss for every student who deserves to see their world reflected in a book. It’s a loss for teachers and librarians who want to provide an honest and inclusive education. And it’s a loss for the very idea of public schooling as a space where we prepare kids for life in a pluralistic democracy, not a curated echo chamber. But, if we are being honest, isn't the destruction of public schools a primary goal of Christian Nationalists' anti-education, anti-diversity, anti-inclusion, anti-democracy movement? To turn the United States, a nation founded by people fleeing religious intolerance, into a theocratic country where only the "right" kind of Christians get to decide what those who don't believe and see the world PRECISELY as they do can say who they can love, where they can live, what jobs they can hold, what books they can read? Frankly, that's my idea of hell on earth, and it's certainly not how I want my children to be taught. But perhaps that's their goal. Maybe the only parental rights that truly matter now are those rights that harm anyone who disagrees with them. We should all be angry about this. Because what the Court sanctioned today isn’t neutrality—it’s capitulation. And if we want our schools to be places of honesty, courage, and empathy, we will have to fight harder than ever to maintain that integrity.
U.S. Supreme Court's Skrmetti decision is a direct assault on civil liberties, parents' rights, and human dignity
By Keith D. Elston, Legal Director Kentucky Youth Law Project, Inc. Wednesday, June 18, 2025
The United States Supreme Court's decision in U.S. v. Skrmetti is not only a grave miscarriage of justice but also a direct assault on civil liberties, parental rights, and human dignity. It reflects a chilling willingness to prioritize right-wing misinformation over medical science, legal precedent, and, most alarmingly, the lives of transgender and nonbinary children. This ruling, cloaked in the language of judicial restraint, is anything but neutral. It empowers state legislatures to intrude into the most personal decisions a family can make: the health and well-being of their child. It allows politicians — not doctors, not parents — to decide what care a child can receive, and in doing so, denies families the right to pursue evidence-based, life-affirming medical treatment for their children. Let us be absolutely clear: gender-affirming healthcare is not experimental. It is recognized and endorsed by every major medical and psychological association in the United States. By upholding bans on such care, the Court has declared that transgender youth, already some of the most vulnerable in our society, are undeserving of the same rights to physical and mental health care given to others. But this decision goes beyond just trans kids. If the Court can deny gender-affirming care today, what's to stop it from blocking access to reproductive care, as it did in Dobbs, tomorrow? From taking away the rights of older adults to Medicare or Medicaid? From targeting any group whose health needs don't fit the political agenda? We must acknowledge the threat: this ruling is not an isolated incident. It's part of a larger effort to redefine who deserves care. If we let any government decide whose bodies deserve dignity and protection, we've abandoned the principles of equality and freedom that this country is built on. So, to those who ask why we care about such a "small minority," consider this: your healthcare is next. When rights are stripped from the margins, the center eventually collapses. Today it's trans children; tomorrow, it could be your daughter, your parent, or you. Healthcare is a civil and human right ... for everyone.
Don’t Be Misled: The HHS Anti-Trans Report Endangers Kentucky’s Youth
By Keith D. Elston, Legal Director Kentucky Youth Law Project Friday, May 2, 2025
In a deeply troubling move, the U.S. Department of Health and Human Services (HHS) has released a report that questions the legitimacy of gender-affirming medical care for transgender youth. Disguised as a neutral review of the evidence, this document is in fact a calculated and ideologically driven attempt to roll back hard-won health protections for some of the most vulnerable young people in our society. As Kentuckians who care about liberty, dignity, and science-based healthcare, we must not be misled. The report’s central claim is that there is insufficient evidence to support puberty blockers, hormone therapy, and gender-affirming surgeries for minors. But that claim rests on a selective and misleading interpretation of the available research. In truth, every major U.S. medical and mental health association, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society, endorses gender-affirming care as the standard of care for transgender and gender-diverse youth. The HHS report leans heavily on isolated international reviews and anecdotes, such as the United Kingdom’s Cass Review, while ignoring the reality that the overwhelming majority of trans youth who receive medical care experience improvements in mental health, school performance, and quality of life. The report even admits that its conclusions differ from U.S. guidelines but fails to acknowledge that these guidelines are based on decades of clinical experience and peer-reviewed research. Let’s be clear: gender-affirming care is not rushed, nor is it undertaken lightly. In Kentucky, as in most of the country, transgender youth typically undergo extensive mental health evaluations and are supported by multidisciplinary teams before any medical intervention is considered. Puberty blockers—often demonized in political rhetoric—are reversible treatments that provide time for youth to explore their identity. Cross-sex hormones and surgeries, when they occur, follow strict protocols based on individual needs and informed consent, often involving years of prior counseling. The HHS report claims that trans youth are being misled or hurried into transition, yet it provides no credible evidence that this is happening in any systemic way. It raises alarm about “detransitioners” but offers no balance by highlighting that regret rates are exceedingly low—far lower than regret rates for many other medical procedures. More dangerously, the report minimizes the real risks of withholding gender-affirming care. Trans youth face disproportionately high rates of depression, anxiety, and suicide—not because they are trans, but because they are stigmatized and denied support. Research has consistently shown that access to gender-affirming care significantly reduces these risks. In fact, a 2022 study found that access to puberty blockers during adolescence was associated with a 73% lower risk of suicidality in trans adults. By promoting psychotherapy as the primary or exclusive treatment for gender dysphoria, the HHS report echoes rhetoric once used to justify “conversion therapy,” an approach discredited for its ineffectiveness and harm. The suggestion that affirming a young person’s identity is somehow experimental or dangerous is not only wrong, it’s cruel. This report does not exist in a vacuum. It reflects a broader political strategy to erase transgender people from public life and undermine their right to bodily autonomy. Here in Kentucky, we’ve already seen the consequences: recent legislation banning gender-affirming care for minors has caused clinics to close, families to leave the state, and young people to live in fear. We must resist this regression. Kentucky’s transgender youth deserve access to the same evidence-based, compassionate care that every other child is entitled to. They deserve to be heard, believed, and supported—not reduced to talking points in a culture war. Science is not on the side of the HHS report. Neither is compassion. We owe it to our young people to reject this thinly veiled attempt at government overreach and stand up for healthcare rooted in truth, ethics, and respect for human dignity. Let us be a Commonwealth that chooses care over cruelty—and facts over fear.
Legislating Hate – the Assault on Transgender Rights in America
By Keith D. Elston, Legal Director Kentucky Youth Law Project, Inc. Friday, April 12, 2025
In recent years, a dangerous and coordinated wave of state and federal legislation has emerged, targeting transgender and nonbinary individuals under the guise of protecting children, women’s sports, or religious liberty. Behind these euphemisms lies a stark truth: these laws are not about protection. They are about erasure, control, and fear. Across dozens of states, lawmakers have introduced or passed laws that ban gender-affirming care for transgender youth—care that leading medical organizations such as the American Academy of Pediatrics and the American Medical Association recognize as safe, effective, and often life-saving. These bans, many of which criminalize doctors and threaten parents with prosecution, are rooted not in medical consensus but in political opportunism. The message to trans youth is clear: your identity is not real, and your health does not matter. The attacks don’t stop at the doctor’s office. Bathroom bans have resurfaced, barring trans people—particularly students—from using facilities that align with their gender identity. These policies serve no public safety purpose. Instead, they stigmatize and isolate. Forcing a trans child to choose between holding their bladder or risking harassment is not about decency. It is cruelty, codified. Sports bans, meanwhile, target trans girls and women with sweeping generalizations and bad science, implying that trans athletes are threats to fairness in competition. But these policies often ignore the complexity of hormone levels, training, and skill, and they disproportionately affect children and teens just trying to play with their friends. Rather than fostering inclusion or wellness through sports, these bans weaponize athletic participation to further marginalize a vulnerable group. Some of the most chilling efforts go even further: seeking to criminalize the mere act of being transgender. Bills in multiple states have proposed labeling gender-affirming care as “child abuse,” equating the support of a trans child with harm. Others aim to ban drag performances in vague, sweeping terms that threaten trans people’s ability to exist in public life. In some states, educators are forbidden from discussing gender identity or pronouns, silencing trans students and their allies alike. This isn’t just political theater—it’s a civil rights crisis. These laws violate basic freedoms: the right to privacy, the right to equal protection, the right to access medical care. They create a chilling effect for teachers, doctors, and families who want to support trans youth. And perhaps most insidiously, they embolden discrimination, hatred, and violence. Trans and nonbinary youth already face staggering rates of depression, anxiety, and suicide—not because of their identities, but because of a society that refuses to see them, let alone support them. Studies consistently show that affirming environments reduce these risks dramatically. The stakes could not be clearer. These legislative attacks are not happening in a vacuum. They are part of a broader culture war that seeks to divide and distract, targeting some of the most marginalized people in America for political gain. It’s a playbook we’ve seen before: scapegoating minorities to rally a base. But history will remember who stood on the side of inclusion—and who stood for persecution. To lawmakers backing these bills: trans people are not a problem to be solved. They are our children, our siblings, our neighbors. They deserve safety, dignity, and respect. And to the trans community: you are not alone. There is a growing chorus of voices, across political lines and state lines, saying enough is enough. The arc of the moral universe may bend toward justice—but it does not bend on its own. It bends because people stand up, speak out, and demand better. Now is the time to do just that.