Two Republican presidential candidates, former Vice President Mike Pence and businessman Vivek Ramaswamy, vowed at Wednesday night’s debate in Simi Valley to ban gender-affirming care — and not just for trans kids, but also for adults.

None of the other five Republicans onstage criticized Pence and Ramaswamy’s proposals, which would amount to a major federal intervention in American adults’ ability to work with their doctors to decide what medical treatments are appropriate for themselves and their children.

The two candidates’ rhetoric is an indication of how far the Republican Party’s consensus on trans rights has moved in recent years. After the Supreme Court legalized same-sex marriage in 2015, much of the national conversation around LGBTQ+ rights shifted to focus on transgender rights.

In 2016, a debate took shape over the so-called “bathroom bill” in North Carolina, which required transgender people to use public bathrooms that matched the sex assigned to them at birth. The law was eventually repealed after widespread backlash.

But since then, social conservatives have whipped up outrage and concern about gender-affirming care for trans kids. In a 2021 Fox News poll, 62% of Republicans said they saw “overly accommodating” transgender policies in schools as a major problem.

When the same question was posed to voters in April, that number had climbed to 71% of Republicans — even as only 2% of Republicans identified “wokeness/transgender issues” as the most important issue facing the country. Less than 1% of Americans identify as transgender.

In the years since the repeal of the bathroom bill, North Carolina and 21 other states have banned gender-affirming care for kids, according to Human Rights Watch — and some states, such as Oklahoma, Texas and South Carolina, have considered banning it for transgender adults. Many of the laws are entangled in legal battles.

The discussion at Wednesday night’s debate was triggered by a question that moderator and FOX News host Dana Perino posed to Ramaswamy about whether parents should be notified if their kids change their gender identity at school.

“Students … have the ability to change their identity without parental notification,” Perino said, noting that fellow candidate Chris Christie, former governor of New Jersey, had vowed to pass a law “protecting parental rights.”

“Would you do the same?” she asked.

But rather than responding to the question, Ramaswamy took aim at transgender rights more broadly.

“I have to be very clear about this: transgenderism, especially in kids, is a mental health disorder,” he said, adding, “Parents have the right to know.”

“It is not compassionate to affirm a kid’s confusion. That is not compassion; that is cruelty,” Ramaswamy said, sharing an anecdote of two people who regretted getting double mastectomies and a hysterectomy. If he becomes president, he said, he will “ban genital mutilation or chemical castration.”

Although some transgender people opt for gender-affirming medical care, many never use medication or surgery to transition. Studies have shown that few choose to detransition, or reverse the process and go back to the sex they were assigned at birth.

Former Vice President Mike Pence doubled down on Ramaswamy’s proposal.

“We’re going to pass a federal ban on transgender chemical or surgical surgery anywhere in the country,” Pence said. “We’ve got to protect our kids from this radical gender ideology agenda.”

Ramaswamy’s and Pence’s statements indicate they’d go further than former President Trump.

The frontrunner in GOP polls has said he would ban facilities that provide gender-affirming care from receiving federal funding. But since most hospitals and major medical centers depend at least in part on funds from Medicare, Medicaid or federal health and science agencies, Trump’s proposal would likely dramatically reduce access to gender-affirming care nationwide.

An April poll by NBC indicated that 79% of Republicans think the nation has “gone too far” in accepting transgender people, compared with 19% of Democrats and 50% of independent voters. In a similar poll by the Pew Research Center, 66% of Republicans said the country has has gone too far in accepting transgender people, while roughly 6 in 10 Democrats said society hasn’t gone far enough.

“No one should have their very right to exist debated on a national stage,” Ash Orr, National Center for Transgender Equality spokesperson, said in a statement Thursday. “What we saw last night was a group of extremist politicians repeating the same tired rhetoric about transgender people, unsupported by actual facts.”

“The truth is that transgender youth know who they are and deserve to be accepted, loved, and supported,” Orr added. “Research shows that the onslaught of rhetoric against our community is directly harming the physical, mental, and emotional wellbeing of our community.”

Orr said that political leaders should instead focus on other issues facing youth, such as underfunding of education, lack of teacher support and school shootings.

In California, several school districts have said they will notify parents if their child starts identifying differently than the gender they were assigned at birth.

In July, Chino Valley Unified School District in San Bernardino County became the first district in the state to adopt a parental notification policy, followed quickly by Murrieta Valley Unified, Temecula Valley Unified, Rocklin Unified, Anderson Union High School District and Orange Unified.

Last week, Democratic Gov. Gavin Newsom vetoed a bill that would have asked judges in custody hearings to consider a parent’s support for their child’s gender identity.