These ads still play a key role in the election, however. They’re an attempt by Trump to not only control the conversation, but turn voters against trans people as a whole. According to Ground Media, these ads notably increase voter disapproval of trans people, further increasing isolation for the trans population.

Ground Media’s survey showed a link between the ads and anti-trans disapproval, decreasing support for access to gender-affirming healthcare by 3.7 points, decreasing acceptance of trans people by 3.1 points, and decreasing the number of people who say they know a trans person by 3.5 points.

Vox also drew parallels between these ads and the rising tide of fascism in the United States, referring to trans rights as a “canary in the coal mine” for other issues that are becoming increasingly divided.