In several congressional races, Republican ads are claiming that Democratic candidates support “sex changes” for children or support taxpayer money being used for such surgeries. But the allegations of support for those claims are flawed.

Some of the ads cite politicians’ votes against measures that went beyond prohibiting surgeries. Also, it’s worth noting that gender-affirming surgeries typically take place after age 18, according to experts and studies on the prevalence of gender-affirming care, as we’ve reported before.

Republican politicians and outside groups are spending millions on TV, streaming and digital ads pushing these claims. Our search of AdImpact’s ad-tracking database identified more than $100 million in spending on more than 200 ads since Aug. 1 that contain the words “sex change.” In federal Senate races alone, the spending totaled more than $77 million.

We’ll look at ads in three toss-up Senate races:

• In Ohio, ads from the Senate Leadership Fund, a super PAC connected to the Republican Senate majority leader, say that Democrat Sherrod Brown “supports sex changes for minors,” citing a 2023 TV interview in which Brown said that “a child’s health care decisions are between them, their parents, their families, their doctors — not politicians.” One ad, featuring a woman who is suing her medical providers in Texas, leaves the false impression that she had surgery as a minor without her parents’ consent.

• In Texas, ads from an SLF-associated group, Texas PAC, say that Democrat James Talarico “supported using taxpayer dollars for sex change surgeries on young children.” The ads cite his vote against state legislation that went beyond that, broadly prohibiting gender-affirming care for kids. Talarico, a state representative, voted for an amendment that would have restricted the bill to banning surgeries.

• In Alaska, ads from No Going Back PAC Inc., which is linked to the MAGA Inc. super PAC, claims that Democrat Mary Peltola “voted against prohibiting taxpayer funded sex changes for minors,” citing her votes on amendments that pertained to gender-affirming medications or surgeries. In another vote cited by the PAC, Peltola, a former U.S. representative, voted against a defense spending bill because of an amendment that would have limited abortion access for military personnel.

These ads are a continuation of Republican messaging during the 2024 presidential campaign and reflect President Donald Trump’s repeated claims that Democrats want “transgender for everybody.” Some of the messages being pushed in the midterms suggest that surgeries are performed on children, even young children, without parental consent. “The law generally requires the consent of a parent before medical care can be provided to a minor,” according to the National Center for Youth Law. There are exceptions, such as state laws allowing minors to consent to emergency care and care for certain services, including abortion, contraception and substance use care.

People who are transgender — meaning they identify with a gender that doesn’t match the sex they were assigned at birth — make up a small percentage of the U.S. population. A 2025 report by the University of California, Los Angeles School of Law’s Williams Institute estimated that more than 2.8 million people in the U.S. age 13 and older identify as transgender. That’s 0.8% of adults and 3.3% of youth ages 13 to 17.

We’ll look at ads in three Senate races in which the Democrats are hoping to flip the Republican seats.

Ohio Ads

Several ads attacking Brown in the Senate race in Ohio claim that he supported “taxpayer-funded sex changes” on children, citing an interview he did with WSYX-TV in Columbus on July 19, 2023.

Brown didn’t say he supported that. Rather, he was asked about a broader federal bill, introduced by then Sen. JD Vance, that aimed to “prohibit gender-affirming care on minors,” defined as both surgeries and medication, including hormones and puberty-blocking drugs. The bill called for fines and/or prison time for anyone prescribing or administering such care. It also aimed to prohibit federal funding being used for any gender-affirming care.

In a 21-second clip of that interview, posted online by the Senate Leadership Fund, Brown says: “A child’s health care decisions are between them, their parents, their families, their doctors — not politicians. I will never agree with anybody that wants to bring politics into the family situation with health care, period.”

Vance’s bill never received a vote.

In 2024, SLF PAC made similar claims about Brown and also pointed PolitiFact to a March 2023 letter nine Democratic senators, including Brown, sent to then President Joe Biden. But that doesn’t show Brown necessarily supporting “sex-change surgeries for minors” either. Instead, the senators expressed concern about discrimination against LGBTQ+ individuals and state laws blocking gender-affirming care for youth and adults. As we’ve explained, gender-affirming care encompasses counseling, social transitioning and medication — in addition to surgery.

Two SLF PAC ads feature Soren Aldaco, who is suing her medical providers over the “top surgery,” or double mastectomy, she had at age 19 in Texas. One ad leaves the false impression that Aldaco had surgery as a minor without her parents’ consent. She was an adult at the time.

Aldaco, who has said she was “gaslit” into receiving gender-affirming care, says in the ad: “Sherrod Brown supports sex changes for minors, irreversible surgery on kids. Like me. At 11, I was groomed by strangers online. At 15, a doctor told my family I was transgender. Hormone injections, then surgery without my parents’ consent. I was a kid. I was confused.”

We asked SLF PAC about the ad’s suggestion that Aldaco wasn’t an adult when she had surgery. Communications Director Chris Gustafson pointed us to information about when Aldaco received medication, not surgery. He pointed to Aldaco’s February commentary piece in the Wall Street Journal, in which Aldaco said a nurse practitioner prescribed testosterone and estrogen blockers when she was 17. Also, in an interview with Fox News, Aldaco said her stepmother took her to that appointment, but the nurse practitioner should’ve gotten consent from her biological mother.

In the ad, Aldaco says, “Ohio’s kids deserve better.” But gender-affirming care, defined as both medication and surgery, for minors is illegal in the state. The law, with exceptions for children with sex development disorders, was enacted in 2024, after the Ohio Legislature overrode Republican Gov. Mike DeWine’s veto. The state Supreme Court is considering a lawsuit challenging the legislation.

In vetoing the bill, DeWine said, “These are gut-wrenching decisions that should be made by parents and should be informed by teams of doctors who are advising them,” while noting that he was against surgeries before age 18. Among the families he spoke to before deciding to veto the bill, “none of them … talked about surgeries,” DeWine said. “I think that’s frankly a fallacy that’s out there that it goes right to surgery. It just doesn’t. All of the children’s hospitals say, we don’t do surgeries.” (See the 17:45 mark of the video.)

One response ad from the Brown campaign makes the point that these surgeries are illegal in Ohio for kids. A second response ad shows an image from the Aldaco ads and says they’re “a complete lie. Records show not only is this woman actually from Texas, she didn’t have any surgery as a minor.”

(The ad goes on to misleadingly say that Brown’s opponent in the Senate race, Republican Sen. Jon Husted, voted to block the released of the Epstein files, a claim we’ve written about before.)

Texas Ads

In the Senate race in Texas, an ad from Texas PAC, which is affiliated with SLF PAC, says, “Talarico supported using taxpayer dollars for sex change surgeries on young children.” It, as well as other ads making such a claim, cites Talarico’s vote against a 2023 state law that, like the law in Ohio, prohibits gender-affirming medications and surgeries for minors and using state money for it. In Texas’ version, doctors could lose their medical licenses if they violate the law. The state Supreme Court upheld it in 2024.

The ad above includes “puberty blockers” on screen, but the narrator only says that Talarico supported “sex change surgeries.” Another ad by the same group says he “supported using taxpayer dollars for sex change surgeries on kids.”

JT Ennis, press secretary for Talarico’s campaign, told us: “These ads are lies. As James has said, he opposes gender reassignment surgery for minors.”

Talarico said that in June in a podcast interview.

In September, Talarico told Fox News that he opposed the 2023 Texas legislation because it was “overly broad” and that at the time he “voted for a major amendment to limit the bill to banning surgeries for minors.” He did vote in favor of such an amendment, which failed. He also told Fox News that he would “absolutely” support a national prohibition on gender-affirming surgery for minors.

In 2023, Talarico said the state law “would deny, many times, life-saving healthcare from our trans youth” and that “the reason that I opposed that bill is because I trust parents and doctors to make decisions for kids and not politicians in Austin.”

The Texas law included exceptions for administering treatment for certain medical conditions, such as premature puberty or sex development disorders, but, according to the Texas Tribune, at least one family had trouble accessing such care after their physician was sued by state Attorney General Ken Paxton, Talarico’s opponent in the Senate race.

Alaska Ads

In Alaska, Peltola, a former U.S. representative for the state, is being attacked over several votes. But as in the other races, the ads misrepresent her votes. Pelota is running against incumbent Republican Sen. Dan Sullivan.

Two ads from No Going Back PAC, a super PAC linked to Trump, claim that Peltola “voted against prohibiting taxpayer funded sex changes for minors.” One ad says she did this “time and again,” citing three votes.

Two of those votes were against amendments in 2024 to prohibit gender-affirming surgeries or medication for minors under two military healthcare programs. One of those programs — TRICARE — was already “explicitly prohibited from covering gender-affirming surgical care for beneficiaries,” according to a 2023 report from the Congressional Research Service. Both amendments, which were attached to the fiscal year 2025 National Defense Authorization Act, a defense spending bill, passed.

Peltola’s campaign pointed us to statements by an advocacy group for LGBTQ+ service members, which said the amendments would hurt military readiness and retention. The campaign also noted that Peltola was one of six Democrats who ultimately voted for the final House version of the NDAA that year.

The third vote cited in the ad was in July 2023 against passage of a version of the NDAA that year. But as we explained previously, Peltola specifically criticized Republican amendments, including one that would have limited abortion access for military personnel.

“We shouldn’t be pitting pay raises that they [military members] deserve against the reproductive freedoms that they also deserve,” Peltola said in a prepared statement at the time. “That is a false choice, created for purely political reasons, and I look forward to negotiations with the Senate’s version of the bill where this issue will be discussed further. I will advocate strongly to return to the bipartisan, policy-focused bill that came out of committee, and will gladly vote for a bill that fully protects our troops and their families.”

Democrats had objected to the limitation on abortion and several other amendments that they called “poison pill riders,” including one prohibiting gender-affirming surgeries or hormones under TRICARE. Peltola didn’t mention the latter amendment in her statement.

The Senate didn’t pass the House version of the bill. Instead lawmakers negotiated a compromise defense bill that stripped out many of the Republican amendments. Peltola voted in favor of that.

In a statement, a spokesperson for Alaskans for Mary — her campaign committee — told us: “Let’s be clear: Mary does not support gender re-assignment surgeries for children, and she believes those decisions should be in the hands of parents and doctors, not DC politicians. Mary thinks both parties have spent far too long obsessing over this issue, and that’s why she’s focused on cracking down on corruption in both parties and lowering costs for Alaskans.”

In a response ad, Peltola also says: “I’m a mom, and I know that parents know what’s best for their kids. These attacks are lies. No, I don’t want kids getting surgeries to change genders.”

More Context on Gender-Affirming Care

As we’ve explained before, gender-affirming surgeries for children are rare. Before puberty, there are no medications or surgeries offered to children. Instead, families are offered counseling. Children may change their name, pronouns, or hair and dress as part of a social transition.

The American Academy of Pediatrics, the Endocrine Society and the World Professional Association for Transgender Health have published guidance recommending care at different ages. In terms of medication, puberty blockers, which delay the beginning of puberty, can be offered between ages 8 to 13 for girls and 9 to 14 for boys. Gender-affirming hormone therapy typically wouldn’t be given until around age 16.

In terms of surgery, one expert previously told us that older adolescents sometimes may be able to get surgery to remove their breasts, also known as top surgery, and may want to do this before college. But genital surgeries wouldn’t typically happen until age 18 or older. The Endocrine Society’s guidance for care specifies that surgeries involving removing the testicles, ovaries or uterus shouldn’t occur before age 18. In February, the American Society of Plastic Surgeons issued a position statement recommending that all gender-affirming surgeries be done at age 19 or later, while saying that “physicians should also use their personal and professional judgment.”

Studies have found that neither surgery nor medication is common for minors. “The politicization of gender-affirming care for transgender youth has been driven by a narrative that millions of children are using hormones and that this type of care is too freely given. Our findings reveal that is not the case,” said Landon Hughes, a fellow at the Harvard T.H. Chan School of Public Health and a co-author of studies published in JAMA journals in 2024 and 2025, on the utilization of care among transgender and gender diverse adolescents in the U.S.

In a study examining insurance claims in 2019 for tens of millions of U.S. adults and minors, Harvard researchers and colleagues found no gender-affirming surgical procedures in transgender and gender diverse minors under 12 years of age. Surgeries among older minors “were rare and almost entirely chest-related,” the study said. The rate of having a gender-affirming surgery among minors with a diagnosis of being transgender or gender diverse was 2.1 per 100,000 for ages 15 to 17 years and 0.1 per 100,000 for ages 13 to 14 years.

Another study of private insurance claims data by some of the same Harvard researchers found that, between 2018 and 2022, less than 0.1% of minors ages 8 to 17 with private insurance were transgender or gender diverse and received puberty blockers or hormones. No minor under age 12 received a hormone prescription.

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