Dr. Rachel Levine was confirmed as President Joe Biden’s assistant secretary of the Department of Health and Human Services Wednesday, marking the first time in U.S. history that a transgender person has been confirmed to a Cabinet-level position by the Senate in a 52 to 48 vote.

“Dr Levine’s confirmation by the Senate today sends a strong message, especially to the LGBTQ people of this country: please step forward to serve — your nation needs you and your expertise,” said Liz Seaton, policy director of National LGBTQ Task Force Action Fund. 

Levine, who departs her role as Pennsylvania’s secretary of health, secured confirmations from a Republican-controlled Senate in her home state three times. In 2015, Pennsylvania lawmakers from both parties unanimously approved her appointment as Pennsylvania physician general. 

In a statement announcing the pick in January, President Joe Biden praised Levine as a “historic and deeply qualified choice” for the role.

“Dr. Rachel Levine will bring the steady leadership and essential expertise we need to get people through this pandemic — no matter their zip code, race, religion, sexual orientation, gender identity, or disability — and meet the public health needs of our country in this critical moment and beyond,” Biden said. “She is  to help lead our administration’s health efforts.” 

Levine was a professor of pediatrics and psychiatry at the Penn State College of Medicine as well as the president of the Association of State and Territorial Health Officials. But as secretary of health in Pennsylvania, anti-trans animus tested her as much as the COVID-19 pandemic the past year. 

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Levine served as the face of Pennsylvania’s response to COVID-19, taking the heat for business closures against a backdrop of taunts about her gender. As she appeared daily on social media livestreams, she faced a barrage of hateful anti-trans comments

The nation got a taste of that transphobia during her confirmation hearings when Sen. Rand Paul questioned Levine about her support for gender-affirming medical care for youth.

Paul, who appeared to confuse hormones prescribed to transgender adults with puberty blockers — which allow trans kids to temporarily pause puberty until they reach an age where they can consider medical transition — equated transition-related surgeries to “mutilation.”  

“I’m alarmed that you won’t say with certainty that minors should not have the ability to make the decision to take hormones that will affect them for the rest of their life,” Paul said. 

“Transgender medicine is a very complex and nuanced field, and if confirmed to the position of assistant secretary of health, I will certainly be pleased to come to your office and talk with you and your staff about the standards of care and the complexity of this field,” Levine replied.