Dr. Rachel Levine, President Biden’s nominee to be assistant secretary of health, stands to be the first openly transgender federal official confirmed by the Senate, and her nomination has been cheered by advocates for transgender rights.
But Dr. Levine’s confirmation hearing briefly turned combative on Thursday, when Senator Rand Paul, Republican of Kentucky, opened his questioning of the nominee with a tirade about “genital mutilation” and a demand to know whether she supported gender reassignment surgery and hormone therapy for minors. (An earlier version of this post misstated the day of the hearing.)
“You’re willing to let a minor take things that prevent their puberty, and you think they get that back?” Mr. Paul, who is an ophthalmologist, said at one point. “You give a woman testosterone enough that she grows a beard — you think she’s going to go back looking like a woman when you stop the testosterone?”
Dr. Levine replied calmly that “transgender medicine is a very complex and nuanced field with robust research and standards of care” that she would be happy to discuss with him.
The clash exposed the deep shift Washington is undergoing as President Biden settles into office, undoing the policies of his predecessor, former President Donald J. Trump, who worked aggressively to undermine transgender rights. Mr. Biden, by contrast, is seeking to make his administration more welcoming to the L.G.B.T.Q. community.
Mr. Biden has repealed Mr. Trump’s ban on transgender people serving in the military. L.G.B.T.Q. references are now commonplace, and visitors to the White House website are now asked whether they want to provide their pronouns when they fill out a contact form: she/her, he/him or they/them.
And while the Senate hearing unfolded, House Speaker Nancy Pelosi of California and Senator Chuck Schumer of New York, the majority leader, convened a news conference to call for Congress to adopt the Equality Act, which would amend the Civil Rights Act of 1964 to include protections for L.G.B.T.Q. people.
Since Mr. Biden nominated her, Dr. Levine has been subject to attacks on social media and from conservative news outlets that have asserted, without evidence, that she has advocated gender reassignment surgery for minors, which is generally not done in the United States.
Dr. Levine, a pediatrician who previously focused on eating disorders and adolescent mental health, was also the liaison for the L.G.B.T.Q. community for the Office of Diversity at the Penn State College of Medicine.
Her detractors have seized on a 2017 speech she gave describing hormone therapy as a standard of care for transgender youth, and also on a tweet she posted in January 2020 about a study showing that transgender youth with access to puberty blocking drugs are at decreased risk of suicide.
“This study is important because it’s the first to show this specific association,” Dr. Levine wrote.
No other Republican followed up on Mr. Paul’s line of questioning, and Democrats briefly ignored his comments until Senator Patty Murray, Democrat of Washington, who presided over the hearing, weighed in to praise Dr. Levine for her “thoughtful and medically informed response.”Ms. Murray added, “It is really critical to me that our nominees be treated with respect and our questions focus on their qualifications and the work ahead of us, rather than on ideological and harmful misrepresentations like those we heard from Senator Paul.”