Anti-transgender campaigns resulted in the online harassment of 24 different hospitals and health care providers in 21 states over a recent four-month period, according to a report from Human Rights Campaign shared first with Axios.

The big picture: Despite being uniformly recommended by major medical organizations including the American Medical Association and the American Academy of Pediatrics, gender-affirming care has been under fire from a variety of directions, including via legislative attacks and online threats.

Driving the news: The report finds that the process of transforming online threats into real-world harm typically follows five steps.

1. A prominent account, such as Libsoftiktok or Matt Walsh, posts an inflammatory message, spreading disinformation about gender-affirming care and pointing to a specific hospital or doctor.
2. The targets start getting harassing and threatening messages online, often nearly immediately.
3. The harassment spreads offline, including threats at home, at work, or both.
4. Politicians join in the campaign, repeating false information and further spreading the messages to extreme members of their base.
5. Health care providers have to alter their practices, ranging from temporary cancellations to permanent halts to services. Some have also removed online resources due to risk for patients and staff.

What they’re saying: “As threats against the transgender community continue to rise — especially impacting Black, Brown and young transgender people — it is crucial that we look at who are the major players fueling this campaign of hatred,” said Kelley Robinson, president of the Human Rights Campaign, in a statement to Axios.

• “This report confirms what we have suspected for some time: these dangerous accounts are playing a major role in causing harm to health care providers and patients,” Robinson said, with the online campaigns leading directly to real world threats and violence.
• The AMA and other groups have called on the Justice Department to investigate threats to health care providers.