Donald Trump and the leading super PAC for Senate Republicans have spent millions on political ads this election cycle, stoking fears about transgender people in sports and gender-affirming care for immigrants and incarcerated people.

Since August, the GOP has spent more than $65 million on television ads about transgender issues in states with competitive races, according to an analysis of AdImpact data from The New York Times.

Republicans are betting that anti-trans rhetoric will resonate with voters in the race for the White House, as well as in races for the Senate and House in what is set to be the most expensive election of all time with a projected $10.2 billion spent across all media and advertising.

In the last election cycle, anti-trans messages did not bring big wins for conservatives. In the 2022 midterms, a wave of Republicans who based their platforms on fighting trans-inclusive policies lost their races.

Last month, the Trump campaign unveiled its most-aired ad, with the slogan “Kamala is for They/Them.” The ad targets Vice President Kamala Harris’ support of gender-affirming care for all people, including for people in prison and immigration detention who rely on state insurance.

In the ad, Harris is seen explaining that she supports gender-affirming care for incarcerated people in a 2019 interview with Mara Keisling, the then-director of the National Center for Transgender Equality.

That same year, in response to a candidate questionnaire from the American Civil Liberties Union, Harris noted that she supported policies to ensure that federal prisoners can access surgical and other gender-affirming care.

During the Sept. 10 presidential debate, Trump, in a now-viral moment, criticized Harris’ answer to the questionnaire, accusing her of supporting “transgender operations on illegal aliens that are in prison.”

Harris faced criticism from LGBTQ+ voters during her 2020 bid for president for the exact opposite reason. When she was California’s attorney general in 2015, she fought to block access to gender-affirming surgery for a transgender woman in prison. She later said that she took “full responsibility” for the legal briefs filed during her tenure as attorney general that attempted to stifle that access, and has repeatedly affirmed her support for LGBTQ+ people and women to be able to have the freedom to make decisions about their own bodies.

Taxpayers shoulder a variety of costs associated with keeping federal prisons open, including paying for the medical care of incarcerated people. And under the Constitution, states are required to provide adequate medical care to incarcerated people. In theory, that includes gender-affirming care — though in reality, trans people in prison face numerous hurdles to accessing it.

This year’s slate of ads boosts anti-trans rhetoric at a time when anti-LGBTQ legislation is at a record high and the legality of bans on gender-affirming care for trans youth, passed in more than half the country, currently rests in the hands of the conservative Supreme Court. The high court will hear arguments over a challenge to Tennessee’s ban later this term.

More than half of U.S. states have enacted bans on trans students participating on sports teams that best align with their gender identity. Trump has vowed to roll back trans-inclusive Title IX protections and to punish doctors who provide gender-affirming care for minors. His running mate JD Vance introduced legislation in the Senate to criminalize that care altogether.

Restriction of trans rights has become a rallying cry for Republicans at every level of government, with the party pledging to keep “men out of women’s sports” — an attack on trans women — in its 2024 platform.

As the GOP races to take control of the Senate by targeting vulnerable incumbent Democrats, it has run ads focused on transgender people in states like Montana, Ohio, Pennsylvania, Texas and Wisconsin. Many of the ads have been funded by the Senate Leadership Fund, a Republican super PAC affiliated with Mitch McConnell.

The super PAC has spent more than $500,000 in Facebook advertisements alone since July, targeting voters in five states on issues ranging from trans rights to immigration to the economy, according to an analysis of advertising data by HuffPost. These ads focus primarily on trans people’s participation in sports and their use of women’s locker rooms, and on minors’ access to gender-affirming care.

In Ohio, the Senate Leadership Fund has run an ad against Sen. Sherrod Brown, accusing the Democrat of supporting “biological men” in girls’ sports and “sex-change surgeries” for minors. However, WKYC, a Cleveland NBC affiliate, noted that the ad mischaracterizes Brown’s voting record and his comments on trans health care in the Senate.

Brown has not explicitly spoken about gender-affirming care for minors but has stated that politicians have no place making health care decisions for children. He also voted against an amendment in the American Rescue Plan Act in 2021 that would have stripped federal funding from schools that allow transgender people to participate in women’s sports.

Similarly, in Montana, the Senate Leadership Fund has unveiled five ads about transgender women in sports and bathrooms as Republicans hope to unseat incumbent Democratic Sen. Jon Tester.

Republican strategists have said that focusing advertisements on transgender issues is popular with the GOP’s base. Fifty-eight percent of Republicans in Michigan, Ohio and Wisconsin — the Midwestern states that swung blue for Biden in 2020 — believe that society should not accept transgender people, according to a September poll from The New York Times and Siena College.

Republican attack ads against Harris and other Democratic candidates up and down the ballot have used the images of several prominent LGBTQ+ figures in recent weeks to take aim at trans people’s participation in sports, drag and their overall existence.

The trans people featured in the advertisements have expressed concern and frustration at the nonconsensual use of their images.

In a recent campaign mailer, the Texas GOP attacked Colin Allred, a Democrat hoping to unseat Republican incumbent Sen. Ted Cruz, using a semi-blurred image of a transgender male wrestler. “Colin Allred failed to protect women’s sports, supporting boys competing with girls,” the mailer reads.

Mack Beggs, the trans man and wrestler whose image is in the ad, made headlines in 2017 after winning a state championship in girl’s wrestling despite his pleas, public uproar and a lawsuit to try to enable him to compete in the boys’ division. However, the University Interscholastic League, the group that oversees sports in Texas public schools, ordered Beggs to compete in the girls’ division.

When Beggs first saw the mailer, he said he was concerned about his family’s safety. “It’s sickening,” he said on Instagram. “But I’m not surprised.”

He told the Houston Chronicle that he reached out to the ACLU to request legal advice on the party’s use of his image.

Drag queen and environmental activist Pattie Gonia and Jonathan Van Ness of “Queer Eye” also unexpectedly found themselves in the Trump campaign’s attack “Kamala is for they/them” ad.

Gonia, whose non-drag name is Wyn Wiley, denounced the ad last week on social media.

“The Trump campaign did not have my permission to use my name or likeness. Yes, we are reviewing our legal options,” Wiley said in an Instagram post that featured the activist dressed as the Statue of Liberty. “And yes, I’m going to do what queer people always do, turn our pain into something positive.”

Wiley directed their social media followers to donate to two LGBTQ advocacy groups, Point of Pride and Trans Lifeline.