Dr Annie Andrews, a Democratic Senate candidate in South Carolina, has responded to persistent efforts by Republicans to make trans athletes in women’s sports a wedge issue in the race.

In a restrained direct-to-camera statement, Andrews – a pediatrician – outlined her opposition to “biological men playing in women’s sports”, as her party pushes back against Republican attacks.

“I want you to hear me loud and clear: I don’t support biological men playing in women’s sports, and I don’t support and haven’t ever performed gender surgery for minors,” Andrews said in a new ad.

Andrews’ video, in which she wears a white lab coat with a stethoscope around her neck, was in response to recent attacks from Donald Trump and an aggressive ad, paid for by a super political action committee (Pac) supporting her Republican opponent in South Carolina, Darline Graham. The ad claims Andrews “is for they/them” and frames a transgender person as predatory toward a child.

Republicans are using anti-trans issues, such as keeping trans women off women’s and girls’ sports teams, to try to thwart Democrats in the upcoming midterms.

Trump has pushed the issue for years. A landmark supreme court ruling earlier this year handed Trump a key “culture war” victory by upholding laws in two conservative states excluding transgender girls and women from competing in female sports.

Andrews, who has previously been vocal in her support of trans people, used her response ad to directly address Republican criticisms and claims as the party pushes anti-trans attacks against Democrats nationwide.

Some Democrats running in competitive districts have shifted their tone on the issue of trans rights, particularly on the issue of trans athletes in women’s sports.

Congresswoman Marcy Kaptur of Ohio, seeking re-election in a district that voted for Trump in 2024, recently aired an ad touting that she “voted with Republicans to keep transgender ideology out of our schools” and “boys should not play in girls’ sports”.

Congressman Don Davis of North Carolina, running for re-election in a district that also backed the president in 2024, released an ad saying: “There’s real concerns about fairness and safety; that’s what I believe states should decide what’s right for protecting women and girls.”

Blake Gendebien, the Democratic candidate running in a primarily Republican district in New York, released an ad stating that “boys shouldn’t play on girls’ sports teams” while also highlighting that the topic was a non-issue in the district.

“The thing is, in 20 years raising a family here, I haven’t heard this issue come up. Not once,” Gendebien said. “But internet trolls like [the Republican candidate] Anthony Constantino use it to rile people up.”

In 2024, pro-Trump groups seized on conservative opposition to the Biden administration’s trans inclusive policies to attack former vice-president Kamala Harris, the then Democratic presidential candidate.

“Kamala’s agenda is they/them, not you,” a voiceover said in one widely seen pro-Trump ad.

The ad attacking Andrews in South Carolina uses nearly identical language as the pro-Trump one two years ago.

How Democrats should respond to Republicans’ anti-trans attacks has divided some.

Equality Pac, the fundraising arm of the congressional equality caucus focusing on electing LGBTQ+ people, told Axios it disapproved of Kaptur’s handling of her response to the anti-trans attacks.

The Pac called Kaptur’s language “unacceptable” and said it was “absolutely not supporting her campaign at this time”, referring to her ad in which she called transgender girls “boys”.

Last month, the Human Rights Campaign – an LGBTQ+ advocacy group – wrote a Substack article to help guide Democrats on how to best respond to anti-trans rights attacks.

“Turning on a vulnerable community is not a winning political strategy – and it’s exactly what Trump, [Elon] Musk, and MAGA want,” it wrote. “It legitimizes their side and weakens ours. And it harms transgender people.”

The group pointed to Ohio senate candidate Sherrod Brown’s response to anti-trans attacks as a good example of how to handle those attacks. Brown released an ad last month featuring voters who dismiss the anti-trans issues, and instead redirected attention to affordability issues under Brown’s competitor, and the incumbent senator, Jon Husted.