It was easy to think that the diatribe about school transgender policies Donald Trump voiced during his presidential campaign was his most “deranged and despicable,” as I described it at the time.

Do you remember? At an event with Moms for Liberty, the far-right gang of book-banners, Trump said the following: “Think of it. Your kid goes to school and comes home a few days later with an operation. The school decides what’s gonna happen with your child. And you know, many of these childs [sic] 15 years later say, ‘What the hell happened? Who did this to me?’ They say, ‘Who did this to me?’”

None of this existed in the real world; one would have to be bereft of cognitive capacity to believe Trump’s picture of children being kidnapped, held for days so they can be operated on by their school, then to wake up 15 years later to discover their sex had been changed.

As we now know, however, Trump was only getting started. With the issuance of executive orders starting on his first day in office, Trump wiped out policies aimed at protecting transgender adults from discrimination, and moved to outlaw gender-affirming medical therapies for anyone under 19 — which includes 18-year-olds who are legally adults — by cutting off federal funding for healthcare institutions that provide such care.

Trump is no longer claiming that K-12 schools were subjecting children to involuntary operations, but once you’ve said that you’ve said everything. He banned transgender individuals from serving in the military and ordered the Federal Bureau of Prisons to move transgender inmates into the general populations consistent with their birth genders, which exposes them to physical assault. (Federal Judge Royce Lamberth of Washington, D.C., on Wednesday blocked the government from transferring three transgender women into the male prison population or terminating their hormone treatments.)

He declared that the federal government recognizes only “two sexes, male and female,” which are “not changeable and are grounded in fundamental and incontrovertible reality,” and has forbidden health plans serving federal employees to cover gender-affirming care for people under 19.

This all amounts to what legal commentator Mark Joseph Stern of Slate accurately labels “the biggest, broadest, most vicious assault on transgender existence we’ve ever seen,” a campaign of “unfathomable” scope.

Trump’s attacks on transgender individuals and their care were part of his drive to portray himself as a political strongman. But they’re just the opposite: They’re expressions of cowardice, because he well knows that his targets have little political power.

Who are the targets of these orders? They’re not a large group. About 1.6 million U.S. adults, or one-half of 1%, and 300,000 adolescents aged 13 to 17, or 1.4%, identify as transgender, according to a study by UCLA law school. A study by Harvard researchers found that fewer than 1% adolescents with private health insurance received either puberty blockers or hormone treatments.

“We are not seeing inappropriate use of this sort of care,” Landon Hughes, the study’s lead author, told the Associated Press. “And it’s certainly not happening at the rate at which people often think it is.”

Yet transgender care, especially for adolescents, has become an ideological litmus test for conservatives and Republican politicians. Restrictions on gender-affirming therapies for those under 18 have been enacted in 26 states; the rules imposed by Tennessee are under consideration by the U.S. Supreme Court, which heard oral arguments in the case Dec. 4.

These laws purport to be based on sound medical concerns. But that’s a smoke screen, since leading medical associations and physicians involved with pediatric and adolescent care support the therapies outlawed by the states as the legitimate standard of care for their patients.

One can always identify bullies by the targets they choose, and that’s the case here. As I wrote during Trump’s first term, when his anti-transgender policies were still in the gestational state, “There is no conceivable reason to support discrimination against transgender individuals other than to show one can target any community, as long as it doesn’t have a strong political voice or political power. These are the actions of bullies and cowards, pretending to be strong.”

Over recent years and decades, the roster of targets the right wing could exploit to keep its base unified has been shrinking.

Open racism became no longer socially acceptable (though it made a strong comeback in the first Trump era). The list of ethnic groups that could be stereotyped as undesirables had shrunk. It was no longer respectable to laugh at or denigrate the mentally ill, the homeless, the disabled.

Gays and lesbians had moved into the mainstream of culture and society. Even conservative and Republican families had come to accept gay and lesbian siblings, children and parents as deserving of their love.

Most importantly, gays and lesbians had acquired a political voice; gay-bashing would no longer work for a political candidate as it had in the past, except perhaps in the most benighted corners of American society.

So who’s left? Transgender individuals, who are still so scarce in our lives and culture, and still so relatively powerless, that politicians can demonize and demean them without much fear that they can strike back.

Trump’s executive orders explicitly reflect this mindset. He doesn’t accept that adolescents can experience gender dysphoria unless they’ve been subjected to “radical indoctrination” by schoolteachers. He says that gender-affirming treatments are imposed only on “impressionable children”—never mind that their parents have consulted with medical professionals and support their judgments.

He says transgender recruits “cannot satisfy the rigorous standards necessary for military service” and aren’t committed to “an honorable, truthful, and disciplined lifestyle.” He says transgender individuals make “the false claim that males can identify as and thus become women and vice versa, and [require] all institutions of society to regard this false claim as true.”

Trump’s attacks on transgender rights and medical care aren’t like the performative horseplay he engaged in over tariff policy and the global economy; in that case Wall Streeters acted as if they knew he wasn’t really serious, and the government leaders of Canada and Mexico foresaw that he would look for a way to declare victory and back down.

There’s nothing abstract about transgender policies, by contrast. They’re aimed directly at vulnerable individuals whose lives he has disrupted. That disruption began with Trump’s inauguration, and continues to that day, due in part to the capitulation of healthcare institutions to his fact-free and possibly illegal policymaking.

On Tuesday, Childrens Hospital Los Angeles said it was “pausing the initiation of hormonal therapies for all gender affirming care patients under the age of 19” while it evaluates Trump’s executive order on gender care “to fully understand its implications.” The hospital said it would continue care for patients who were already receiving it.

The hospital referred me to its formal statement, in which it asserted that “physical and mental health, safety, and well-being of all of our patients remains our highest priority.” That’s a pretty serving of boilerplate, but it’s obviously in conflict with its “pause,” since placing the well-being of all its patients conflicts with its decision to bow, even if temporarily, to Trump’s orders.

In any case, the hospital was crisply informed by California Atty. Gen. Rob Bonta that state law prohibits what appears to be its discriminatory treatment of transgender patients, since it provides cisgender patients with hormone treatments and other therapies named by Trump if they’re provided for transgender patients. Bonta also told the hospital by letter that a federal judge already has blocked Trump’s effort to freeze federal funds that don’t conform to his own priorities.

Federal agencies have no basis “to threaten or revoke your federal funding,” Bonta wrote, whatever Trump says. “California families seeking gender affirming care, and the doctors and staff who provide it, are protected under state laws.” CHLA didn’t answer my question about how it plans to respond to Bonta’s advisory.

Other institutions around the country have also capitulated to Trump’s grandstanding, affording him the opportunity for a victory lap. In a news release issued Monday, he bragged about all the healthcare providers that have canceled appointments for gender-affirming care for patients under 19 or paused, suspended or ended gender-affirming treatments.

How long can Trump’s campaign go on? Perhaps not very long. Two organizations that support gender-affirming care, five transgender minors and three transgender adults filed a federal lawsuit Tuesday specifically asking a federal judge in Maryland to declare Trump’s executive orders on gender unconstitutional and unlawful, and to block his cutoff of federal funds for providers of such care.

They may succeed in blocking Trump’s funding freeze, for a time, but that would be only a procedural victory. Trump and his acolytes have injected a poisonous, partisan and ideological view of transgender individuals and their medical needs that may infect American politics for a long time. The providers who bowed to Trump’s threats will deserve a good measure of blame for that.