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Thousands of people in one of the most conservative counties in South Carolina clamored when Donald Trump promised to cut federal funding on "Day 1" for schools that instill what he called "transgender madness" in children.
The former president has repeatedly mocked transgender people during his campaign, and uses language about gender identity that advocates of the LGBT+ community consider wrong and harmful.
Others in the Republican field have attacked the participation of transgender people in sports and have proposed national bans on surgeries and hormonal therapies (gender affirmation procedures) for transgender minors.
Issues related to transgender people have perhaps become the biggest call to mobilization for Christian conservatives, more than the right to abortion or same-sex marriage.
This change worries advocates who point out that transgender people are already disproportionately prone to stress, depression, and suicidal behavior when forced to live according to their anatomical sex at birth.
The executive director of the Alliance for Full Acceptance, Chase Glenn, a transgender man, described as dehumanizing the politicization of his existence.
"It's really disgusting that these politicians think they can use trans people, and more specifically young trans people, as a political tool to score points," he said.
Many Republicans have been bothered by the way gender is sometimes talked about, part of a broader reaction against what conservatives see as a liberal tide in classrooms. Several people interviewed at a recent Trump rally argued that children were wrongly confronted with issues of gender identity.
Recently, state legislatures controlled by the Republican Party have taken steps to dictate many facets of transgender life. At least 22 states have enacted laws that restrict or prohibit gender affirmation healthcare for minors. Bills governing the use of school pronouns, participation in sports teams, and bathroom access return this year, as do actions to restrict drag shows.
In South Carolina, one of the few southern states without such health restrictions, the Republican-led Senate is considering a bill passed by the lower house to ban gender affirmation care for minors. Opponents unfurled the light pink, sky blue, and white stripes of the transgender flag along the Capitol stairs to protest this year against the measure.
Both Trump and Nikki Haley, his last major rival ahead of South Carolina's Republican primaries next Saturday, have leaned into anti-transgender rhetoric.
There is not enough research on the fairness of competitions that include transgender people. Virtually, there are no studies that determine whether transgender athletes have clear advantages over cisgender participants.
Trump has promised to implement a series of other anti-transgender policies if he wins a second term in the White House. Proposals include banning federal money for any hospital that provides gender affirmation care to minors, ordering federal agencies to end any program that promotes sex or gender transition, and pressuring Congress to ban chemical or surgical interventions for minors.
This despite the backing of major medical groups, including the American Medical Association and the American Academy of Pediatrics, that care for transgender youth is safe when administered correctly.
Transgender people represent five out of every thousand adults and 14 out of every thousand teenagers aged 13 to 17 in the United States, according to a June 2022 report from a group of legal experts at the University of California in Los Angeles (UCLA) that investigates public policies around sexual orientation and gender identity.
Data from this year's Republican elections and interviews with Republican voters indicate that the issue resonates among many members of the Republican Party.
According to AP VoteCast, a national electorate survey, about three-quarters of participants in the Iowa Republican caucus said their local public schools (from kindergarten to eighth grade) teach too much about gender identity or sexual orientation. In New Hampshire, seven out of 10 Republican primary voters felt that "too much" is taught about gender identity in local primary and secondary schools.
Chad Connelly, former director of religious engagement for the Republican National Committee, who now runs an organization that politically mobilizes evangelical pastors, said that many congregations are motivated by issues such as gender affirmation care for minors.
"Most of the pastors I know vehemently oppose it," he said. "They don't believe it's health care to allow eight and 10-year-olds to make decisions about permanently altering things that shouldn't be altered."
Guidelines from major authorities in gender affirmation healthcare state that surgery should be reserved for adults, with exceptions for older teenagers who meet certain criteria. Other treatments, such as puberty blockers, are not considered irreversible.
The access of transgender people to sports, bathrooms, and healthcare became the new key issue for the religious right after the U.S. Supreme Court approved same-sex marriage, said Jami Taylor, a professor of Political Science at the University of Toledo, who studies policies related to LGBT+ rights.
Two years ago, the high court also overturned a federally guaranteed right to abortion, which was a long-sought victory for conservatives, but opened a gap that Democrats have successfully centered their campaigns on ever since. Republicans have been divided over whether to push for a national abortion ban and Trump refused to publicly back the idea.
Between 2015 and 2020, party identification and religious attendance became much more predictive of someone's views on issues related to transgender people, according to research by Taylor and her colleagues. They found that those who frequently attend religious services and align with Republicans are less likely to support inclusive bathroom access.