While an unpopular incumbent president and the specter of inflation helped Donald Trump win the election, his use of anti-transgender advertisements helped him paint his opponent, Vice President Kamala Harris, as “dangerously liberal” and out of touch with everyday voters, according to a report from The New York Times.

During their only debate, Trump deployed a racist and transphobic attack line, accusing Harris of supporting “transgender operations on illegal aliens that are in prison” — a crude restatement of her 2019 ACLU questionnaire answer that all federal prisoners, including trans immigrants detained by border agents, deserve medically necessary care.

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Afterward, Trump invested millions into airing anti-trans TV ads that repeated his debate line; showed pictures of Harris next to a drag queen, a trans woman, and a nonbinary person; and ended with the tagline, “Kamala is for they/them. President Trump is for you.”

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Trump’s co-campaign manager Chris LaCivita told NBC News that the ads successfully held Harris accountable for her position. “It’s the last thing on Earth they want to talk about,” he said. “So we’ll talk about it for them.”

Trump aired the ads repeatedly during televised sporting events, mostly aiming to reach male voters (including Black and Latino men) — 54% of men ended up voting for Trump, according to preliminary exit polling. His campaign also hoped the ad would connect with suburban white women fearful about trans athletes in girls’ sports.

Former President Bill Clinton reportedly told a Harris campaign aide that she needed to respond to the attacks, and the campaign even created a response ad. But ultimately, the campaign felt that Trump’s ads weren’t having any effect, so the campaign never aired its response. In interviews, Harris just pointed out that the U.S. is legally required to provide life-saving care (including gender-affirming care) to inmates and that Trump had abided by the same policy during his presidency.

The Human Rights Campaign has repeatedly said that such ads are a waste of money that don’t connect with voters, citing that only 4% of voters listed trans issues among their primary concerns. But after the ads aired, the race shifted 2.7 percentage points in Trump’s favor, according to an analysis by Harris’s leading super PAC Future Forward.

The ads were also part of larger anti-trans attacks against Harris. Trump and his running mate, Sen. J.D. Vance (R-OH), lied about Harris’ running mate, Minnesota Gov. Tim Walz (D), allowing his state’s government to “kidnap children” from unsupportive parents to change their gender. Walz never signed any such law or order, nor are state officials legally authorized to take trans kids away from unsupportive parents.

Trump has claimed that schools are conducting surgery on trans youth without parental consent — another lie. No schools provide such (or any) surgeries, minors almost never get such surgeries at all, and the standards of care for trans youth stress parental involvement. Moreover, the Trump-Vance campaign was unable to name an example of this ever happening.

The Republican platform pledged to“end Left-wing gender insanity,” “ban Taxpayer funding for sex change surgeries,” “keep men out of women’s sports” and cut federal funding for any schools “pushing radical gender ideology” or “promoting gender transition.”

The Trump campaign’s other attack ads showed Harris laughing and dancing in a colorful blouse and pink pants. Altogether, the ads sought to portray her as an “unserious, foolish” “lightweight” who was “outside the political mainstream,” the Times reported.

While Trump won the election, it doesn’t necessarily mean that anti-trans ads were the deciding factor or that they particularly resonated with voters nationwide. Polls consistently showed that voters cared more about numerous other issues, and voters ended up electing numerous trans and nonbinary candidates nationwide.

But experts say that the anti-trans stigma created by such political attacks linger long after elections end and harm the mental wellbeing of trans people (particularly young ones). The attacks have also gotten some Democratic politicians and pundits to argue that Democrats should start opposing trans rights to appeal to more voters.

The countervailing view holds that Democratic candidates should stand up for the dignity and inclusion of all people, tell Republicans to stop trying to regulate people’s personal medical decisions, and hammer the poor records of their political opponents while acknowledging voters’ economic concerns. This, trans journalist Erin Reed says, can help rebuff transphobic political attacks and win elections without abandoning the trans community.

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