If you've had your eyes on a screen in the past month, you've probably seen an anti-transgender attack ad from Republicans.
The GOP has sunk tens of millions into the advertisements, which attempt to paint Vice President Kamala Harris's support of transgender people's legal rights and health care as "extreme." Here's all the context you need that's missing from the commercials.
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Gender-affirming care encompasses any combination of social, psychological, behavioral, and medical therapies that are meant to validate a person's gender identity, according to the World Health Organization. It can be as simple as someone changing their wardrobe and haircut, or seeing a talk therapist.
Common medical care includes hormone replacement therapy, also known as gender-affirming hormone therapy, which involves a patient taking either feminizing (estrogen) or masculinizing (testosterone) hormones for the purpose of altering their appearance, typically in the form of an injection.
While genital-reconstructing surgeries are an option, the gender-affirming surgical procedures most commonly performed are breast reductions and augmentations, according to a report in the National Library of Medicine. Chest surgeries are performed about twice as often as genital surgeries, with chest surgeries accounting for 8 to 25 percent and bottom surgeries accounting for 4 to 13 percent of procedures among transgender adults.
While transgender people are often portrayed to be the only recipients of HRT or gender-affirming surgery, cisgender people also largely use the care — in fact, 146 out of 151 (97 percent) breast reductions performed on American minors in 2019 were performed on cisgender males, according to a recent study in JAMA.
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When the state incarcerates a person, it becomes legally responsible for their health care, according to the U.S. Marshals Service. Prisoners are legally entitled to health care, as the U.S. Supreme Court ruled in the 1976 case Estelle v. Gamble that ignoring a prisoner's medical needs violates the Eighth Amendment, which forbids cruel and unusual punishment.
While gender-affirming care can seem cosmetic, it is crucial to its recipients' mental health and overall well-being. TheAmerican Medical Association, theAmerican Psychiatric Association, theAmerican Academy of Pediatrics, theAmerican Academy of Child & Adolescent Psychiatry, theWorld Medical Association, and theWorld Health Organization all agree that gender-affirming care isevidence-based and medically necessary not just for adults but minors as well.
Several states have also upheld the right of inmates to receive the gender-affirming care in recent years.
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As incarcerated people in the U.S. have the right to health care, which includes gender-affirming care, Harris said in a recent Fox News interview that she “will follow the law" when it comes to ensuring transgender inmates have access to care such as hormones and surgical procedures. That is also currently the policy of the Biden administration.
When she first campaigned for president in 2019, Harris faced criticisms from Democrats for enforcing "discriminatory laws" against trans inmates during her time as attorney general of California that denied them such care. Harris responded at the time, "It was [the California Department of Corrections'] policy. When I learned about what they were doing, behind the scenes, I got them to change the policy."
"I commit to you that always in these systems there are going to be these things that these agencies do. And I will commit myself, as I always have, to dealing with it," Harris said.
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The official policy of the Trump administration provided inmates with gender-affirming care, in compliance with U.S. law. A 2017 manual from Trump's Department of Justice specifically addressed how to best care for trans inmates, stating, "Hormone or other medical treatment may be provided after an individualized assessment of the requested inmate by institution medical staff."
The manual even went on to say that "In the event this treatment changes the inmate’s appearance to the extent a new identification card is needed, the inmate will not be charged for the identification card." It also explicitly said that staff "will not be disciplined" for using inmates' preferred names and pronouns.
When agreeing to "follow the law" in her Fox News interview, Harris was correct in noting that "it’s a law that Donald Trump actually followed" as well.
Republicans have spent more than $65 million on attack ads against the trans community since August, according to a recent report from The New York Times. The television advertisements have mostly been repeated in battleground states — airing heavily during college sports games — pushing false claims about gender-affirming care and transgender athletes.
There are approximately 1.6 million people in the U.S. ages 13 and up who identify as transgender, according to a report from the Williams Institute, accounting for just 0.6 percent of the overall population. There are about 5,000 incarcerated transgender people in the country, according to a report fromNBC News, accounting for just 0.4 percent of the 1,230,100 inmates recorded nationally in 2021.
Several politicians and celebrities have pointed out the absurdity of spending over $65 million to target 0.6 percent of the population, including Harris in her Fox News interview, who focused on Trump's ads worth around $20 million .
“I think [Trump] spent $20 million on those ads trying to create a sense of fear in the voters because he actually has no plan in this election that is about focusing on the needs of the American people,” Harris said. “$20 million on that ad, on an issue that, as it relates to the biggest issues that affect the American people, it’s really quite remote. And again, his policy was no different.”
