There was a joke about the suspected Chinese spy balloon’s preferred pronouns; claims that Democrats believe there are “millions” of genders and a menacing call for “transgenderism” to be “eradicated”.

From the main stage of the Conservative Political Action Conference (CPAC), far-right activists, members of Congress and the former president of the United States waged an aggressive assault on transgender rights last week, raising the issue in speeches and unrelated panel discussions, often under the guise of protecting children.

Headlining the conference on Saturday, Donald Trump drew some of the wildest applause of his more than 90-minute address when he pledged to stop the “chemical castration and sexual mutilization [sic]”​ of children if re-elected in 2024 while endorsing a national ban on transgender medical treatment for young people.

A day earlier, Congresswoman Marjorie Taylor Greene of Georgia, one of Trump’s staunchest allies, rallied attendees with a speech devoted to the issue, unveiling her plan to reintroduce a bill that would criminalize doctors for providing gender-affirming care to a minor.

Left unsaid was that leading medical organizations, including the American Medical Association and the American Academy of Pediatrics, consider gender-affirming care to be medically necessary and potentially lifesaving for children and adults diagnosed with gender dysphoria.

Much of the anti-trans discourse was aimed at liberals, who, according to the Republican senator John Kennedy of Louisiana, believe children “should be able to change their gender at recess” and “hyperventilate on their yoga mats if you use the wrong pronoun”. The remarks elicited peals of laughter from the audience.

Advocates say the vitriolic rhetoric on display at CPAC is reflective of the increasingly hostile movement among conservatives that seeks to regulate the lives of transgender Americans and marginalize vulnerable young people.

“People like Marjorie Taylor Greene will not be satisfied until every LGBTQ person is forced into the shadows,” said Geoff Wetrosky, campaign director for the Human Rights Campaign, an LGBTQ advocacy group. He added: “There’s really no legislative purpose other than discrimination in these bills.”

In state legislatures across the country, Republican lawmakers are pursuing a barrage of new restrictions related to transgender youth’s medical care, sports participation and bathroom use.

So far this year, anti-trans legislation has been proposed in 39 states, including 112 measures that focus on medical care restriction and 82 that pertain to education-related issues, according to the website Track Trans Legislation.

Last week, the Republican governor of Tennessee signed into law a bill prohibiting gender-affirming care for minors as well as one imposing new limits on drag performances, which have become a target for Republicans. Mississippi also enacted a ban on treatment for transgender youth while Republican state lawmakers in Kentucky advanced a similar measure, following a charged debate over a separate proposal allowing teachers to refuse to use students’ preferred pronouns.

Until recently, most legislation banning transgender healthcare was aimed at minors, but Republicans are increasingly pushing proposals that would limit treatment for adults.

Health experts and LGBTQ advocates say many of these anti-trans bills being pushed in state legislatures are not rooted in science – or reality.

Gender-affirming care is defined by the World Health Organization as “social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity”.

While treatment for transgender youths seeking care is highly individualized, experts say most begin with “social transitioning”, or presenting publicly in their preferred gender. Adolescents may consider puberty-blockers to temporarily pause sexual development, often before hormone therapy or sex reassignment surgery, which is not typically offered until age 18 or later. Research suggests regret is rare.

Toxic rhetoric and political actions can have profound consequences for LGBTQ Americans, especially transgender youth for whom suicide rates are high.

More than 70% of LGBTQ young people, including 86% of trans and/or nonbinary youth, say the political debate around trans issues has negatively affected their mental health, a 2022 survey by The Trevor Project found.

Harassment, intimidation and violence against LGBTQ Americans is rising, fueled, experts say, by a rise in online hate speech and an intensifying political debate. Hundreds of transgender people have been killed over the past decade, often in targeted shootings, with Black trans women at especially high risk.

“By spreading this propaganda, they’re creating more stigma and discrimination and violence against LGBTQ people,” Wetrosky said. “There are real repercussions and real world violence as a result of this rhetoric.”

Angelo Carusone, president and chief executive of Media Matters for America, which monitors rightwing media, said far-right influencers have helped stoke the present hysteria over trans rights. Some of the attacks pull from the online “fever swamps”, he said, merging discussions of gender identity with conspiracy theories about pedophilia and age-old tropes falsely accusing LGBTQ people of “grooming” children.

Increasingly, Republican politicians and party leaders see the issue of trans rights as a way to rile their base. It’s a strategy that seeks to capitalize on the conservative “parental rights” movement, which emerged in opposition to pandemic-era school polices requiring remote-learning and mask-wearing but quickly shifted to target classroom instruction related to race, sexual orientation and gender identity as well as transgender students’ bathroom use and sports participation.

“When that anti-education wave … started to talk about trans issues, the numbers were already there and their audience responded to it in a really visceral way,” Carusone said.

While the backlash may have helped Republicans claw back power in Virginia – a state thought to be increasingly out of reach for the party – their disappointing showing in the 2022 midterms suggests it has limited appeal.

But it was a central theme at CPAC, where panelists repeatedly mocked and misgendered transgender people, including Rachel Levine, who serves as the assistant secretary for health and is the highest-ranking transgender official in the US government.

On a panel dedicated to the issue, a former college athlete who competed against a transgender swimmer warned that there was an effort under way on the left to “fully eradicate women”.

A male panelist joked about “transitioning” into his female co-panelist, Chaya Raichik, who runs “Libs of TikTok”, an anti-LGBTQ social media account. Another lamented that students in China are taught calculus while American students learn that there are “72 genders”.

But the speech that LGBTQ advocates found the most chilling came from Michael Knowles, a rightwing political commentator for the Daily Wire, who declared that “for the good of society … transgenderism must be eradicated from public life entirely”. A range of voices, including public officials, experts and observers of rightwing rhetoric, condemned the remarks as inflammatory and dangerous, with some calling them “genocidal”. (Knowles insisted on Twitter that he was not referring to trans people, but “transgenderism” which he has described as a “false” ideology.)

Yet the intense focus on transgender rights at CPAC this year – nearly every speaker raised it – suggests it is likely to be an animating issue in the coming presidential election.

Governor Ron DeSantis of Florida, seen as Trump’s strongest potential rival for the Republican nomination, was not at CPAC this year but has aggressively targeted trans rights in his state.

He signed into law Florida’s so-called “Don’t Say Gay” bill as well as another measure that bans trans women and girls from competing in some school sports in the state. He has also sought to limit gender-affirming care for transgender youths and recently faced sharp criticism for requesting information about students who sought or received such care at public universities in Florida.

Meanwhile Republican presidential candidate Nikki Haley, as well as possible 2024 contenders including the former vice-president Mike Pence, former secretary of state Mike Pompeo and the South Dakota governor, Kristi Noem, have all emphasized their opposition to trans rights.

Wetrosky, of the Human Rights Campaign, said he anticipates the emerging Republican presidential field will continue to embrace the anti-trans rhetoric and policies on offer at CPAC. And though it may boost them in their quest to win the party’s nomination, he predicted it would backfire in a general election.

“The vast majority of Americans support LGBTQ equality,” Wetrosky said, “and the people who are speaking at this conference are on the wrong side of history.”