This year has set a number of historic milestones in the push to ban conversion therapy—a loosely-defined range of practices that includes everything from talk therapy to shock treatment—nationwide. It has been condemned as harmful and ineffective by every leading U.S. medical authority, including he American Medical Association, American Psychiatric Association, and American Psychological Association. In 2019, four states passed legislation banning efforts to change the sexual orientation or gender identity of LGBTQ youth at the statewide level: Colorado, Maine, Massachusetts, and New York.

When openly gay governor Jared Polis signed Colorado’s conversion therapy bill into law on May 31, it made the Centennial State the 13th to outlaw conversion therapy since 2017 and the 18th overall.

But even as state and local legislatures across the U.S. make enormous progress on the issue, queer and transgender youth remain vulnerable to conversion therapy in the majority of America’s largest cities. NewNowNext surveyed the country’s 100 biggest metropolitan areas and found that 55 had no laws on the books protecting LGBTQ young people from discredited treatments intended to “cure” them of their sexual orientation or gender identity.

Light map of the U.S.

These include eight cities which rank in the top 20 by overall population: Houston (no. 4); Phoenix (no. 5); Dallas, Texas (no. 9); Austin, Texas (no. 11); Jacksonville, Florida (no. 12); Fort Worth, Texas (no. 13); Charlotte, North Carolina (no. 16); and Indianapolis (no. 17).

Sam Brinton, head of advocacy and government affairs for The Trevor Project, says these protections are critical for LGBTQ youth.

“Local protections send a clear message to LGBTQ youth that the government closest to where they live sees them for who they are and is willing to step up to protect them from harm,” Brinton tells NewNowNext. "Particularly in places that haven't passed statewide laws, local ordinances and resolutions condemning the practice of conversion therapy can help build momentum and further the conversation for broader protections.”

The state with the most top 100 cities without a conversion therapy ban in place is Texas, by a wide margin. The Lone Star State has 13 cities—all with populations over 200,000 people—which permit therapists to perform “pray the gay away” treatments on young people. Aside from those already mentioned, others include El Paso (no. 22), Arlington (no. 48), and Corpus Christi (no. 59). At the time of writing, not a single city or county government in Texas has taken action on the issue.

Next on the list is Arizona, where six top 100 cities have yet to outlaw orientation change efforts. Among them are Mesa (no. 35), Scottsdale (no. 85), and Glendale (no. 87). While no city in Arizona has banned conversion therapy outright, Tuscon is covered by a county-wide ordinance.

Surprisingly, Florida ties North Carolina for third place. While the Sunshine State claims more cities and counties than any other U.S. state which have passed local protections against “pray the gay away” therapies, it’s also the third most populous state. Six Florida cities that rank among the 100 largest in the nation, and only one of those, Miami, has a conversion therapy law on the books after Tampa’s ban was lifted by a court injunction this year. Orlando (no. 71) and St. Petersburg (no. 79) do not.

According to Shannon Minter, legal director at the National Center for Lesbian Rights, these findings illustrate that LGBTQ advocates have a lot of work left ahead of them in ensuring that conversion therapy is banned in all 50 states.

“We’ve made incredible progress since California enacted the first statewide law protecting youth from conversion therapy in 2012, but, we still have a long way to go to bring this life-threatening practice to an end,” Minter tells NewNowNext. “Activism at the local level has been a huge driver of progress. We need more LGBTQ people and allies to educate themselves about this issue and to push their local and state governments to take action.”

But even in areas that do safeguard LGBTQ youth from conversion therapy, there are troubling loopholes that could be exploited. Forty-five of the cities where conversion therapy is banned only have those protections because lawmakers took action at the country or the statewide level. If California were to overturn its conversion therapy ban for some unforeseen reason, young people in cities like Los Angeles (no. 2), San Diego (no. 8), San Jose (no. 10), and San Francisco (no. 15) would be left vulnerable.

Just three top 100 cities have protections at both the local and state level against “gay cure” treatments. These are New York City (no. 1), Seattle (no. 18), and Denver (no. 19).

The Empire State Building lit for Pride.

Meanwhile, just two cities in the entire U.S. ban conversion therapy on LGBTQ adults: New York City and Washington, D.C. (no. 20). The latter ordinance, which was passed this year, applies specifically to adults under the care of a conservator or guardian, however. Although California was one signature away from becoming the first state to outlaw orientation change efforts for all people, Assemblyman Evan Low (D-Campbell) tabled the proposal in 2018 following conservative backlash.

There is much reason for optimism, however. Since the beginning of 2018, 20 cities and counties have moved to prohibit conversion therapy from being performed on minors.

And when looking at the overall population of each metropolitan area on the list, 56% of LGBTQ youth in America’s largest cities are protected from orientation change efforts. This is largely due to the influence of New York City. The largest metropolitan area in the U.S., which is home to more than 8 million people, also has the strongest conversion therapy protections of any city on this list.

Mathew Shurka, co-founder and chief strategist for Born Perfect, says LGBTQ advocacy groups must keep working to expand protections in all areas across the country.

“It is vital that we continue to pass these laws, city ordinances, and resolutions,” Shurka tells NewNowNext. “We need to let LGBTQ youth know they are not mentally ill or broken, and that the law cares about their well-being.”

See full breakdown of city conversion therapy protections below.