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Under normal circumstances, you would not expect a crowd of regular Americans—even those engaged enough to go to a political rally—to recognize an assistant secretary of health and human services. But the crowd at Donald Trump’s appearance earlier this month at the Santander Arena, in Reading, Pennsylvania, started booing as soon as Rachel Levine’s image appeared on the Jumbotron.

That’s because Levine is the highest-profile transgender official in the Biden administration, and she has become a public face of the American left’s support for medical gender transition by minors. Having heard the Reading crowd’s ugly, full-throated reaction to Levine’s mere image, I understand why the prospect of a second Trump term might alarm transgender Americans—or the parents of gender-nonconforming children. I also more clearly understand Trump’s strategy: to rile up voters over positions that he thinks the Democrats won’t dare defend.

Back in 2016, the Republican presidential nominee portrayed himself as a moderate on trans rights, saying that Caitlyn Jenner was welcome to use whatever bathroom she wanted to at Trump Tower. But Trump’s rhetoric has become steadily more inflammatory, and his positions have hardened. Many commentators have nevertheless been surprised by the ferocity of Republican attacks on this issue. In 2022, the party’s efforts to exploit trans-rights controversies for electoral gain repelled more voters than they attracted, and recent polling in three swing states shows that more than half of respondents agreed that “society should accept transgender people as having the gender they identify with.”

[Read: The slop candidate]

Yet polls have also detected considerable public skepticism on three specific points: gender-related medical interventions for minors, the incarceration of trans women in women’s jails, and trans women’s participation in female sports. In Pennsylvania, one attack ad is on repeat throughout prime-time television. It ends: “Kamala’s for they/them; President Trump is for you.” The Republicans have spent $17 million on ads like this, according to NPR. “Republicans see an issue that can break through, especially with Trump voters who’ve been supporting Democratic candidates for Senate,” Semafor’s Dave Weigel wrote recently.

Trump has always used his audiences as an editor, refining his talking points based on the raw feedback of boos and cheers. At the rally in Reading, the image of Levine—pictured in the admiral’s uniform she wears as head of the U.S. Public Health Service Commissioned Corps—was part of a montage dedicated to condemning what Trump called the “woke military.” This video juxtaposed clips from Stanley Kubrick’s Full Metal Jacket—meant to represent good old-fashioned military discipline—with more recent footage of drag queens lip-synching to Kylie Minogue’s “Padam Padam.” Never mind that Full Metal Jacket is an anti-war film showing how sustained brutalization corrodes the soul.

This video is part of Republicans’ larger argument that their opponents are big-city elitists who have attempted to change the culture by imposing radical policies from above and then refused to defend them when challenged—and instead called anyone who disagreed a bigot. Many on the left see transgender acceptance as the next frontier of the civil-rights movement and favor far-reaching efforts to uproot discrimination. Yet activists and their supporters have waved away genuinely complex questions: Some claim, despite the available evidence from most sports, that biological males have no athletic advantage over females—perhaps because this is an easier argument to make than saying that the inclusion of trans women should outweigh any question of fairness to their competitors.

Others default to the idea that underage medical transition is “lifesaving” and therefore cannot be questioned—even though systematic evidence reviews by several European countries found a dearth of good research to support that assertion. According to emails unsealed earlier this year in an Alabama court case, Levine successfully urged the influential World Professional Association for Transgender Health to eliminate minimum-age guidelines for gender-transition hormones and surgeries.

The Republicans are using trans issues as a symbol of “wokeness” more generally—what conservatives paint as a rejection of common sense, and as a top-down imposition of alienating values by fiat. In right-wing online echo chambers, Minnesota Governor Tim Walz is known as “Tampon Tim” for signing a state law calling for menstrual products to be placed in both girls’ and boys’ bathrooms. Throughout the speeches in Trump’s Reading event, talk of “men playing in women’s sports” and an exhortation to “keep men out of women’s sports” reliably drew the biggest cheers of the night. (Dave McCormick, the Republican candidate for Senate, brought up the issue, as did Trump himself.) The former president’s 90-minute speech had an extended riff on underage transition—and how schools might avoid telling parents about their child’s shifting gender. “How about this—pushing transgender ideology onto minor children?” Trump said, in an abrupt segue from a bit about fracking. “How about that one? Your child goes to school, and they take your child. It was a he, comes back as a she. And they do it, often without parental consent.”

Lines like this would not succeed without containing at least a kernel of truth. Under the policies of many districts, students can change their pronouns at school and use the bathroom of their chosen gender without their parents’ knowledge. A recent California law prohibits districts from requiring that parents be informed. In the presidential debate, many commentators laughed at the bizarre phrasing of Trump’s claim that Kamala Harris “wants to do transgender operations on illegal aliens that are in prison.” But the charge was basically true: While running for the 2020 Democratic nomination, Harris replied “Yes” to an ACLU questionnaire that asked her if she would use “executive authority to ensure that transgender and non-binary people who rely on the state for medical care—including those in prison and immigration detention—will have access to comprehensive treatment associated with gender transition, including all necessary surgical care.”

This year, Harris has mostly avoided such issues. She has tacitly moved her position from the left toward the center without explaining the shift or answering whether she believes she was previously wrong—a microcosm of her campaign in general.

As with abortion, a compromise position on gender exists that would satisfy a plurality of voters. Essentially: Let people live however makes them happy, but be cautious about medicalizing children and insist on fair competition in female sports. But Harris has been unwilling or unable to articulate it, and candidates in downballot races have followed her lead. You can see why: Even as polls suggest that many voters are more hesitant than the median Democratic activist, any backsliding by candidates from the progressive line alienates influential LGBTQ groups. In Texas, the Democrat candidate for Senate, Colin Allred, has faced such a barrage of ads about female sports from the Ted Cruz campaign that he cut his own spot in response. “Let me be clear; I don’t want boys playing girls’ sports,” Allred says in the clip. The LGBTQ publication The Advocate wrote this up as him having “embraced far-right language around gender identity.”

[Read: The improbable coalition that is Harris’s best hope]

Like Allred, the Harris campaign has realized, belatedly, that silence is hurting the candidate’s cause. When the vice president was interviewed by Bret Baier on Fox News last week, she made sure to raise a New York Times story about how the Trump administration had also offered taxpayer-funded gender medicine in prisons. “I will follow the law,” Harris said. “And it’s a law that Donald Trump actually followed.”

Is that enough to neutralize the attacks? Seems unlikely: The Republican ads have not disappeared from the airwaves, because they bolster the party’s broader theme that Harris is more radical than she pretends to be. Which is the real Kamala Harris—the tough prosecutor of the 2010s or the ultraprogressive candidate of 2019 and 2020?

Presumably her campaign believes that every day spent talking about gender medicine for teens is one not spent discussing Trump’s mental fitness or disdain for democratic norms. In the absence of her articulating a compromise position, however, the Republicans are defining the contours of the debate in ways that could prove fateful—for Harris, for trans people, and for the country as a whole.