Josh Turek, Iowa's Democratic candidate for the U.S. Senate, released an ad recently titled "Stop the Nonsense." In it, he said he opposed "males competing in female sports" and was against "taxpayers paying for sex changes." He framed both positions as common sense, positioned himself as the adult in the room between two extremes, and invited Iowans to focus on lowering costs instead. The ad drew immediate criticism from One Iowa Action, the state's main LGBTQ+ advocacy organisation. It also drew criticism from his Republican opponent, Ashley Hinson, who said he was lying about his record and was actually more supportive of trans rights than he was letting on.

So here is where things stand: a Democrat running for Senate in Iowa is being attacked by trans advocates for being too hostile to trans people, and simultaneously attacked by Republicans for not being hostile enough. That is what "bipartisan criticism" means in practice here. It is not a sign that he has found a sensible middle ground, but a sign that two very different groups of people are angry about two completely different things.

The criticism from One Iowa Action is the one that carries real weight. Max Mowitz, the organisation's executive director, said in a statement that his group "unequivocally condemn[s]" the ad and the policy shift it represents. Keenan Crow, the director of policy and advocacy, was precise about why: other Iowa Democrats have put out ads referencing trans issues, but Turek's was the first to call directly for a policy change banning Medicaid coverage of gender-affirming surgical care. That is not a rhetorical nuance. That is the difference between using trans people as a political backdrop and actively committing to remove healthcare from them. Mowitz put it plainly: on the specific question of Medicaid coverage, "there is no light between Hinson and Turek. Their policies on this issue are the same."

That matters. Medicaid is not an abstract policy instrument. It is how low-income Iowans access healthcare. When a candidate says he opposes Medicaid funding for gender-affirming care, he is saying that trans Iowans who cannot afford private care should go without. The framing of "taxpayers paying for sex changes" is designed to make that sound like fiscal responsibility. What it actually describes is denying medically necessary care to people based on who they are. Iowa Republicans attempted a Medicaid ban in 2019; a court struck it down, finding it violated the Iowa Constitution and the Iowa Civil Rights Act. Republicans came back in 2025 and removed "gender identity" as a protected class in the state's civil rights code entirely. Turek voted against that measure. And yet here he is, in his own words, calling for the policy outcome Republicans have been trying to legislate for years.

The Republican criticism is a different animal. Hinson said at a campaign rally that Turek was lying about his record, citing his votes against legislation banning trans students from using school restrooms that matched their identity. Republicans have also run ads, some funded by Elon Musk's America PAC, claiming Turek "voted to spend our tax dollars on sex change surgeries for children." Turek has explained that his vote against an Iowa Health and Human Services appropriations bill was due to concerns about Medicaid waitlists and provider shortages, not support for gender-affirming care. The Republican criticism, in short, is that he is not as anti-trans as he is now claiming to be. That is a political attack, not a defence of trans rights.

Some of Turek's Democratic colleagues have tried to hold the tension. Adam Peters, the Democratic nominee for Iowa House District 97, said he voted for Turek and would do so again, while disagreeing with the ad. His reasoning was practical: he could talk to Turek, make his concerns heard, and point to Turek's vote against stripping gender identity protections from Iowa's civil rights code. "That record matters, even as we ask him to do better." Iowa Rep. Aime Wichtendahl, the first trans Iowan elected to the state Legislature, was less forgiving. She said the talking points would not gain Turek anything with voters. She is probably right: there is very little evidence that Democrats running hard on anti-trans messages win over Republican voters who were always going to vote Republican anyway.

What strikes me most is the specific language Turek chose. "As a kid in a wheelchair, I faced my share of bullying. That's why I believe that no Iowan should face discrimination." He said this, and then in the same ad used language about trans women that trans people hear as deeply dehumanising. The juxtaposition is not an accident: it is a rhetorical move that uses a personal history of exclusion to give cover to policies that exclude others. I do not doubt that Turek's experience of disability and bullying is real and formative. But the logic does not follow. Knowing what discrimination feels like is not the same as refusing to inflict it.

When both parties are attacking the same ad from opposite directions, the question for trans Iowans is not which attack is correct. It is simpler and harder than that: what, exactly, are trans Iowans being offered? One Iowa Action has said it clearly. On the specific policy that would remove Medicaid coverage for gender-affirming care, Turek and Hinson are the same. Trans Iowans who rely on Medicaid are not being offered a choice between support and opposition. They are being offered a choice between two candidates who have both said no.

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Dr Helen Webberley is a Gender Specialist, Medical Educator, and advocate for trans rights and gender diversity.