Nearly every major medical group has condemned the discredited practice of trying to change people’s sexuality or gender identities.

Multiple recent studies have concluded that conversion therapy harms the mental health of those subjected to it, but a report published Monday is the first to quantify the economic cost of the discredited practice.

Efforts to change LGBTQ people’s sexual orientation and gender identities cost the U.S. an estimated $9.23 billion each year, according to a peer-reviewed study in the journal JAMA Pediatrics. Casey Pick, a senior fellow for advocacy and government affairs for The Trevor Project, which conducted the research in partnership with the multinational clinical trial organization Cytel, said the estimate is “conservative.”