Trump and allies are pouring millions into anti-trans election ads as election nears

Former President Donald Trump and some of his Republican allies are aggressively pushing anti-trans messaging in the final stretch of the 2024 election, with Trump in recent months frequenting campaign events involving socially conservative groups like Moms for Liberty, and Trump-aligned political groups flooding the airwaves with ads disparaging policies that support the transgender community.

Meanwhile, the Trump campaign and Republican groups have spent more than $21 million on anti-trans and anti-LGBTQ television ads as of Oct. 9, nearly a third of roughly $66 million television ad spending during that time period, media tracking agency AdImpact told ABC News.

However, transgender issues are among the least important issues motivating voters to head to the ballot box, according to a Gallup poll.

One of the top ads pushed by the Trump campaign this month attacked Harris for supporting "taxpayer-funded sex changes for prisoners," the ad stated. ABC News has reached out to the Trump campaign for comment on his ad spending.

These ads came up in a Fox News interview with Harris, in which she was asked about her past statements about access to gender-affirming care for people who are incarcerated or detained.

"Are you still in support of using taxpayer dollars to help prison inmates or detained illegal aliens to transition to another gender?" asked Fox News anchor Bret Baier.

"I will follow the law, a law that Donald Trump actually followed," said Harris. "You're probably familiar with now, it's a public report that under Donald Trump's administration, these surgeries were available on a medical necessity basis to people in the federal prison system."

According to a Bureau of Prisons Congressional Budget submission document from February 2018 -- during Trump's presidency -- offenders who self-identify as transgender are individually assessed for psychosocial and medical needs. The document states that transgender inmates may require access to individual counseling, emotional support, and medical care such as hormone therapy, surgery, and more while incarcerated based on their individualized assessment.

A more recent Bureau of Prisons Congressional Budget submission under the Biden administration adds: "Consistent with the community standard of care and BOP policy, the agency will provide gender-confirming surgery for transgender individuals found to be appropriate for this procedure."

According to the ACLU, of the hundreds of incarcerated transgender people in BOP custody each year, no one had ever received gender-affirming surgery until the first instance in 2023.

BOP officials told The Pittsburgh Post-Gazette that as of early October, only two federal inmates have obtained surgeries.

"I think he 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 in the Fox News interview. "Twenty million on an issue that -- as it relates to the biggest issues that affect the American people -- is really quite remote and again, his policy was no different."

Transgender people make up 0.5% of the U.S. adult population and 1.4% of U.S. teens between the ages of 13 and 17, according to UCLA Law LGBTQ research group The Williams Institute.

Despite the small size of the population, transgender issues have played a key role in many Republican campaigns on both the state and federal levels. Still, Trump's own political agenda, titled Agenda 47, is laden with transgender-based proposals, including a ban on transgender participation in women's sports, an end to gender-affirming care funded by federal or state dollars, and more.

His policy proposals reflect many of the 530 anti-LGBTQ bills that have been tracked by the ACLU in this year's legislative session alone, many of which were restrictions on pronoun changes in schools, gender-affirming care restrictions and more.

Many critics of anti-LGBTQ legislation said the rhetoric and legislative attacks have increased the levels of violence and discrimination facing the community. Federal officials have sounded the alarm on anti-LGBTQ extremist violence in recent years amid threats made to health care clinics, pride events or drag performances.

The former president has been repeating various anti-trans messaging on the campaign trail, in some cases depicting hypothetical or unfounded scenarios about children getting an "operation" at school without parental permission -- which physicians and educators say is not happening in any school.

Physicians and researchers have told ABC News in the past that physicians work with patients and their parents to build a customized and individualized approach to gender-affirming care for trans patients, meaning not every patient will receive any or every type of care. They also added that receiving this care is typically a lengthy process.

In a podcast released Monday with former professional wrestler The Undertaker, Trump also pushed false claims about the controversial Olympic boxing match between Italian boxer Angela Carini and Algerian boxer Imane Khelif. During the Olympics, reports falsely surfaced saying that Khelif is a transgender woman; however, she is not and was assigned female at birth, according to the International Olympic Committee.

"Men playing in women's sports is insane," Trump said on the podcast, later adding: "I'm going to terminate that immediately."