Election fact check: Donald Trump, Kamala Harris on transgender issues

Millions of dollars from Republican groups and figures are being poured into anti-transgender ads criticizing policies that support the trans community, despite these issues being among the least important concerns motivating voters heading into the 2024 election, according to a recent Gallup poll.

LGBTQ advocates fear the intensified campaign will sow fear and hate against a group that makes up less than 1% of the U.S. adult population, per an analysis of Centers for Disease Control and Prevention data -- and which already experiences high rates of discrimination and violence.

"After the election, trans Americans will have to deal with the dangerous fallout from the shameful lies and misinformation that far too many political candidates are intentionally spreading," GLAAD President and CEO Sarah Kate Ellis said in a statement.

In the ads, former President Donald Trump's campaign has said he will end transgender care in prisons and jails, and restrict access to gender-affirming care and transgender participation in sports, and more.

In interviews, Vice President Kamala Harris -- who has been touted by some LGBTQ groups as being part of the most "pro-LGBTQ" administration -- has said she will follow the law when it comes to transgender care and has expressed support for the Equality Act, a bill that would protect LGBTQ Americans from discrimination.

Here's what we know about the issues and how each candidate expects to legislate transgender policies.

Claim about 'transgender operations' in prisons, jails

Trump's campaign has seized on Harris' past comments affirming her support for transgender inmates to receive care.

In 2019, she did support "providing essential medical care to deliver transition treatment."

The Harris campaign, however, hit back against recent criticism from Trump, noting that the Bureau of Prisons under the Trump administration had a policy in place to allow incarcerated transgender people to receive gender-affirming medical care if it's required based on an individual assessment of needs. BOP documents confirm the policy.

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

"I will follow the law, a law that Donald Trump actually followed," Harris said. "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 the American Civil Liberties Union, of the hundreds of incarcerated transgender people in BOP custody each year, no one had 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 ever obtained surgeries.

Claims of transgender 'operations' for children at schools

Trump has often depicted hypothetical or unfounded scenarios about children getting an "operation" at school without parental permission while on the campaign trail. The former president has repeatedly claimed, without any proof, that schools purportedly secretly send students for surgeries, saying: "There are some places, your boy leaves for school, comes back a girl. OK? Without parental consent."

According to Planned Parenthood, parental consent is needed for any form of gender-affirming care given to minors, including puberty blockers or hormone therapy.

A study by researchers at the Harvard T.H. Chan School of Public Health found little to no usage of gender-affirming surgeries by transgender and gender-diverse minors in the U.S., instead finding that cisgender minors and adults had substantially higher utilization of such gender-affirming surgeries than their transgender counterparts.

In trans teens ages 15 to 17, the rate of gender-affirming surgery was 2.1 per 100,000, the study found -- a majority of which were chest surgeries. Physicians and researchers have told ABC News that surgeries on people under 18 happen rarely and are considered only on an individual basis.

Physicians say they 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 said receiving this care is typically a lengthy process.

Numerous medical organizations -- including the American Medical Association, the American Academy of Child and Adolescent Psychiatry and the CDC -- have said access to gender-affirming care is essential to the health and wellness of gender-diverse people.

Harris, when asked in October during an NBC News interview about whether transgender Americans deserve to have access to gender-affirming care, said she would "follow the law," later adding that such care "is a decision that doctors will make in terms of what is medically necessary."

Additionally, vice presidential candidate Tim Walz signed an executive order as Minnesota governor protecting and supporting access to gender-affirming health care for LGBTQ people in the state in March 2023.

Claims about transgender athletes

In a podcast with former professional wrestler The Undertaker, or Mark William Calaway, Trump also pushed false claims about the controversial Olympic boxing match between Italian boxer Angela Carini and Algerian boxer Imane Khelif.

Khelif was the target of controversy after reports falsely surfaced claiming Khelif is a transgender woman; she is not and was assigned female at birth, according to the International Olympic Committee.

Carini abandoned the Olympics bout after only 46 seconds, further sparking false accusations. The Algerian Olympic and Sports Committee (COA) and the IOC spoke out about the misinformation on Khelif's gender and sex.

"The Algerian boxer was born female, was registered female, lived her life as a female, has a female passport," the IOC said during a press conference.

Trump then referenced a San Jose State women's volleyball game against New Mexico, falsely claiming a trans athlete on San Jose State's team -- as he repeatedly misgendered her -- injured other female players with the ball. San Jose State told the Los Angeles Times that the ball bounced off the shoulder of the student-athlete, and the athlete was uninjured and did not miss a play.

"They had the one guy on the one team, and he was so high in the air, and he smashed that ball, you know, you don't see that, and this ball came at her at a speed that he's, you know, she's never seen -- get really whacked her. But other volleyball players were hurt," Trump said.

Trump has additionally vowed to "keep men out of women's sports" in many of his stump speeches, making it a key issue in his campaign.

LGBTQ advocates say claims that trans women are "taking over" women's sports are misleading -- with sports advocacy group Athlete Ally estimating to CNN that trans women make up less than 40 athletes of the 500,000 in the NCAA.

For more insight into the candidates' LGBTQ policy history, read here.