Republican candidates and allied organizations have made transgender policies a centerpiece of their advertising strategy in the final weeks of the 2026 midterm campaigns.

Data from AdImpact shows more than $100 million spent since August 1 on over 200 ads containing the phrase "sex change," with over $77 million in U.S. Senate races alone. Elon Musk's America PAC has committed roughly $100 million to the effort, focusing on competitive contests in Texas, Ohio, Iowa, and Alaska.

In Texas, ads attack Democratic Senate candidate James Talarico over his positions on transgender youth medical care and sports participation. Similar spots in Ohio target Democrat Sherrod Brown, accusing him of backing taxpayer-funded procedures for minors. Iowa and Alaska races feature comparable messaging against Democratic hopefuls.

The ads emphasize concerns over biological males competing in girls' sports, medical interventions for minors, and parental rights in education. Groups such as the American Principles Project have long advocated for this focus, arguing it resonates with voters prioritizing traditional values and child protection.

Critics from left-leaning outlets claim the messaging misrepresents Democratic records or fails to address economic pressures. Yet Republican strategists point to polling showing majority opposition to males in female athletics and skepticism toward puberty blockers for children.

Democratic responses include counter-ads portraying the GOP focus as a distraction from inflation and foreign policy. Some Democrats have distanced themselves by adopting positions against males in women's sports.

With early voting underway in several states and Election Day less than two weeks away, the volume of these ads underscores Republicans' bet that cultural issues will drive turnout among their base.