The Highest-ranking Transgender Official In Government Is Still Optimistic

In her waning days as assistant secretary for health at the Department of Health and Human Services, Rachel Levine thinks back fondly to attending a 2022 Pride Month reception at the White House.

As the highest-ranking openly transgender person to serve in the U.S. government, Levine’s name was called by a speaker recognizing members of the LGBTQ+ community in the Biden administration. She then noticed that President Joe Biden was motioning for her to rise.

“And so I stood up, and I got applause,” she said. “For the president to notice me and gesture at me to stand up, that really stuck in my memory.”

Less pleasant was seeing her image used in anti-trans ads by Republicans during the presidential campaign. The Trump campaign spent more money criticizing Vice President Kamala Harris on her support fortransgender rights than any other issue in the runup to the election, and Levine was caught in the middle.

“I found it very challenging,” she said. “But you know what? I’m a strong and resilient person, I’ll be fine. What I worry about are other members of our community.”

A uniformed admiral in the U.S. Public Health Service Commissioned Corps, Levine came to Washington after serving as Pennsylvania’s health secretary and was originally trained in psychiatry and pediatrics.

In an exit interview with POLITICO Magazine, Levine discussed her work on health policy — she led much of the department’s work on long Covid research as well as the health effects of climate change — and frequently spoke up on ongoing political debate over youth access to gender-affirming care. She says she’s still optimistic about making progress on trans rights despite the political backlash.

This interview has been edited for length and clarity.

Thinking back nearly four years ago, when you became the highest-ranking openly trans person to serve in the U.S. government, what’s something you wish you had known going into the job?

It has been a tremendous honor to assume my commission and the uniform of the United States Public Health Service Commissioned Corps.

I had very good experience in public health when I was the secretary of health of Pennsylvania, as well as the president of the Association of State and Territorial Health Officials. It’s a really good training ground to take this position.

When I started, we were in the midst of the acute phase of the Covid-19 pandemic. But the topics were very familiar to me.

This [she gestured to her uniform, which she was commissioned to take in 2021] was completely new, and it's a choice for the assistant secretary for health. I absolutely wanted to assume my commission and take the uniform.

Republicans have been making their anti-trans stance a bigger focus lately. What do you make of that? And were you surprised to find yourself targeted in anti-trans ads during the presidential campaign? 

I found it very challenging. But you know what? I'm a strong and resilient person, I'll be fine. What I worry about are other members of our community. I worry about those young people. I worry about their families, and I worry about the doctors that treat them. I worry about adults as well in the LGBTQI+ community, broadly, as well as specifically in the transgender and non-binary community.

They might have had my visage up there, but they're the ones that are going to be targeted.

A growing number of states have imposed restrictions on gender-affirming care for young people. How concerned are you that the new administration is going to take further action to ban or limit care?

I can't really comment on the incoming administration. I don't know what they'll decide to do, but I'm very proud of the work that we have done in support of health equity. In terms of transgender medicine for youth, it is performed primarily at our nation's fantastic children's hospitals.

The way I think of it is: If you have a child who has diabetes, then you would see a pediatric endocrinologist, probably at the local children's hospital. If you have a child with depression or anxiety, you might see a child psychiatrist or a child psychologist at the local children's hospital. If you have a child with an eating disorder or perhaps a gynecological issue, you might see the adolescent medicine specialist — like me — at a local children's hospital.

So if you have a young person with gender issues, you would see the gender specialists at the children's hospital who might be exactly the same people I just discussed — the pediatric endocrinologist, the child psychologist, the child psychiatrist or the adolescent medicine physician. It is extremely, completely appropriate to see these specialists for the other conditions, but the legislatures in those states are prohibiting it for this issue.

To be frank, it has really been a strategy of think tanks from Washington based on ideological and political purposes with a well-developed playbook that has gone through many of the states of our country with draft legislation.

Now we'll see what happens when it happens nationally.

I think it is really challenging and potentially harmful to young people and their families and their medical providers. Yet, I remain a positive and optimistic person. I remain positive enough to continue my work and I think that eventually things will change. I don't know when that will be, and I think I’ve got to be very realistic of the challenges that exist now in half the country, and could exist in other parts of the country in the future, but I think that the wheel will eventually turn. Although it's going to be a while.

Do you think HHS did enough to protect policies you’ve pushed on transgender youth, including strengthening anti-discrimination regulation in health care? 

I think that we are leaving it in the strongest place possible with a transition of administrations.

You spent a lot of time at HHS focused on how climate change affects health care as well as the federal response to long Covid. Both initiatives are in jeopardy by the new Congress and administration. Where are you leaving this work? 

All these [natural disasters, like ongoing wildfires in Los Angeles] are exacerbated by and stoked by climate change, and all of these have impacts on health. It is really going to be extremely important now, and in the future, to be addressing these health impacts. However a new administration wants to describe it, I still think these health issues will need to be worked on and addressed. Extreme heat is extreme heat, however you want to talk about it, and so we're going to need to address the health impacts [of climate change.]

One of the things that we have said is that we know long Covid is real. Long Covid might not be one thing. It would be easier if it was, but it might actually not be one thing. It might be a constellation with different causes. We have a clinical definition of long Covid that was published by the National Academy of Sciences, Engineering and Medicine. And so I think that we have made progress. I think one of the biggest things that we've worked on is long Covid centers that I think are really important, multidisciplinary centers throughout the country that serve as referral centers, as well as hub and spoke centers, to the community.

How worried are you about the future of the country’s public health with vaccine skepticism rising and someone like Robert F. Kennedy Jr. nominated to lead HHS?

I can't comment on the next administration overall. I remain a positive and optimistic person, but I choose to do that because I think that that's how the work gets done. Public health is public health and is not political.

I know that there are differences as we change administrations in terms of certain policy — and that's how our system works — but the basic public health work will need to continue, and we have fantastic civil servants and full-time public health employees that will continue that work, as well as the Public Health Service Commissioned Corps.

Vaccinations are one of the victories of public health in the 20th and 21st century. All those immunizations for youth and adolescents and adults are absolutely critically important to public health. Smallpox has been eradicated from the world. And so I have complete faith in our fantastic vaccine programs.

Has anyone from the incoming administration been in touch to talk about the work you do?

No. This happens with our full-time leadership staff. And so I have nothing to do with that as a political appointee.

Do you have any regrets from your time in office?

I'm not a person who has regrets about anything. I don't think it's very useful to have regrets. None of us are perfect, and we all do the very best we can. I have done the very best I can for the common good and for the health and welfare and public health of our nation. I am very proud of my service in Pennsylvania and here. What could be a more rewarding job, right?

What’s next for you?

I’m going to go home to Central Pennsylvania. I'm going to take a long nap, rest and center myself, and then I'm going to consider what my next steps are.