In the 1970s, my brother and I were raised as twins. He’s a year older than me, but we wore matching denim outfits, had thick side-parted hair, and worshiped The Beatles. Near identical though we were, only one of us was queer. And America was lying in wait.

When I was a toddler, the American Psychiatric Association de-pathologized homosexuality, but nearly 40 percent of its members fought that decision. Many of those who did were likely still in practice when I started medical school. Phyllis Schlafly mobilized opposition to the Equal Rights Amendment by tying women’s rights to the legalization of gay marriage and adoption, and Jerry Falwell, declaring “war on homosexuality,” warned that “gay folks would just as soon kill you as look at you.” American citizens, both ordinary and prominent, found me objectionable, yet I could never have imagined that they’d one day force me to consider leaving the country, which I have.

During the 1980s, I started worrying about where and how I’d build a life for myself. High school classmates would call each other “cum dripping anuses” and “homos,” and when I came out to my best friend, he told me he “didn’t really care if I wanted to be a faggot.” We never spoke again. My parents’ friends would crack gay jokes at our dinner table, and teammates would pester me about why I “hadn’t gotten laid.” I spent those years mostly in hiding.

And then came AIDS.

The story of the plague isn’t mine to tell; I missed the worst of it by several years. But most gay men my age assumed we’d never see 40. At the time, little credible information was available, and the virus was mowing gay men down. National leaders behaved as though we didn’t count. Ronald Reagan didn’t publicly mention AIDS until 1985 — by which point over 16,000 Americans had been diagnosed — and his press secretary ridiculed a reporter who asked him about the administration’s response to the pandemic. Larry Kramer wrote that the government’s lethargic response to the plague felt like an effort to eradicate gay men. Many of us agree.

When in the early ’90s, Bill Clinton was elected president, my queer friends and I felt safe. Even as candidate Clinton promised to open military service to LGB Americans, Senate candidate Mike Huckabee described homosexuality as “aberrant, unnatural, and sinful,” and Pat Buchanan — addressing the Republican National Convention — called gay and lesbian equality “amoral.” It felt as though the president would shield us from these terrifying people.

Shortly after taking office, however, Clinton signed “Don’t Ask, Don’t Tell” (DADT), permitting queer people to serve in the military only if they remained closeted. A poor triangulation between patriotic Americans and … well … Mike Huckabee’s ilk, DADT led to 13,000 LGB people being discharged from service. The law took 17 years to overturn, and only 8 Republican senators supported its repeal.

During the early Aughts, George Bush staked his re-election bid on a constitutional ban on gay marriage. His favorability ratings were unpromising, and he knew this discriminatory plank would appeal to … well … Mike Huckabee’s ilk. With America focused on an engineered threat rather than on the Second Gulf War, Bush narrowly won a second term, and California passed Proposition 8, which limited marriage to heterosexual unions. Supported by a number of religious organizations and “moderate” Republicans John McCain and Mitt Romney, this law took five years to overturn.

When the Supreme Court narrowly legalized gay marriage, many in the queer community sensed that our enemies (yes, enemies) had finally been subdued. If we’d been given equal standing in our relationships, surely more robust non-discrimination legislation would follow. Such was my confidence in this belief that I chatted with LGBT friends about lending our energies to other causes. To help similarly oppressed people achieve more equal footing in America.

My goodness, were we naive.

Donald Trump encouraged people to say out loud what they would once only have whispered. Even so, the recent tsunami of anti-LGBT sentiment has taken many queer people by surprise. But perhaps it ought not to have. Over the five decades of my life — and certainly before — a sizable portion of the American public has either tolerated or actively engaged in an assault on our personhood. They have never stopped hating us. These renewed homophobic and transphobic campaigns aren’t novel, but they seem meaner and more dedicated than ever.

From Florida Bill 1557 (aka: “Don’t Say Gay” ): “A school district may not encourage classroom discussion about sexual orientation or gender identity in primary grade levels or in a manner that is not age … or developmentally appropriate for students. A parent of a student may bring action against a school district [over a] procedure or practice [that] violates this paragraph.”

At which age, exactly, would someone who considers queer people to be “aberrant, unnatural, and sinful” find a discussion of (homo)sexuality appropriate? Likely never.

From Tennessee Bill 0003: “It is an offense for a person to engage in adult cabaret performance on public property where it could be viewed by a person who is not an adult. Adult cabaret performance is defined as one that features ‘topless dancers, go-go dancers, exotic dancers, strippers, male or female impersonators who provide entertainment that appeals to a prurient interest.'”

A topless male jogger may well appeal to my prurient interests. Will he be prosecuted? And is watching a drag performance more damaging to a teenager than being bullied or called a “cum dripping anus?”

From Oklahoma Bill 2177: “It shall be prohibited for any public funds in this state to be used … for the provision of [gender affirming care] to any minor or adult … No facility that receives public funds shall allow its staff or facilities to be used to perform [gender-affirming care].

Nearly every facility in every state receives public funding. Oklahoma is preparing to ban gender-affirming care for both minors and adults.

These bills’ proponents camouflage their bigotry. “Don’t Say Gay” is actually named “The Florida Parental Rights in Education Act” and is ostensibly part of a movement to empower parents — though, seemingly only conservative ones — to control local curricula. And legislators banning public drag shows have baselessly argued that such performances threaten young people by “grooming” and sexualizing them. RuPaul isn’t a threat. She’s a national treasure.

Lesbian, gay, bisexual, and trans youth are four times as likely as their straight peers to consider suicide. In a recent survey, 45 percent of them had considered killing themselves in the prior year. Queer people aren’t naturally prone to self-harm. Our genomes don’t have a suicide sequence. But perhaps being perpetually demeaned by one’s community and elected officials does the trick. It’s not LGBT people who pose a public threat. It’s those who attempt to erase us.

I’m a middle-aged man with personal and professional security. I am also cis-gender and white, so I face fewer threats than my friends who are trans and/or of color. Even so, I no longer feel safe in America. Terror is sneaky: mobs coalesce, bigots gain traction, and “mainstream” politicians capitulate to unstable upstarts. We have witnessed all these phenomena in America and now have a generation of Republicans launching unchecked attacks against the LGBT community. My husband and I — and most of our queer friends — worry that we’ll eventually have to flee this country. We are horrified by what we’re witnessing and fear legislative and violent escalation.

I wrote this essay specifically for my peers. I love being a physician and am proud to be part of an ethical professional community. I have wondered if physician work stoppages might convince bigoted legislators to rethink their positions. What would happen, for instance, if a physician organization at a private medical school in Tennessee temporarily paralyzed health care across a swath of that state? But this is not our style. We don’t deny patients care in order to advance even a right-minded agenda. Those are the tactics of bullies who put LGBT constituents in harm’s way to help win elections.

Physicians can pressure our professional organizations to forcefully and publicly denounce anti-LGBT bills. Lay people don’t read position papers, but they certainly see media campaigns, public debates, and television interviews. We also need national health care leaders to develop and amplify a coordinated response to homophobic and transphobic laws. A working group of hospital CEOs has convened to address gun violence. Why hasn’t the systematic victimization of the LGBT community been met with similar urgency? Finally, medical organizations ought not to meet in states run by bigots. We all know which they are, and conferences planned in any of them should be rescheduled to where attendees will feel safe, valued, and respected.

Physicians are a politically diverse bunch, yet we overwhelmingly believe that LGBT Americans ought to be treated fairly. This is one of our shared values. Queer people in this country are under a vicious coordinated assault, and the perpetrators have faced no consequences. It is time that physicians put our efforts and our money where our morals are.

Mike Stillman is an internal medicine and rehabilitation medicine physician.