Dr. Rachel Levine made history in 2021 as the highest-ranking outtransgender federal official ever confirmed by the U.S. Senate. But her legacy goes far beyond that milestone.
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A pediatrician by training, Levine had already built a reputation for science-based public service as Pennsylvania’s physician general and later as the state’s secretary of health under Gov. Tom Wolf. During the COVID-19 pandemic, she became a steady, fact-driven voice amid political chaos. But her four-year tenure as assistant secretary for health under President Joe Biden was defined not just by her visibility — but by her mission to advance health equity for the most marginalized.
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“There’s no shortage of news,” Levine told The Advocate in an interview shortly after the hundredth day of President Donald Trump’s second term. “And no shortage of work to be done.”
That work is being dismantled with alarming speed. Since returning to power, the Trump administration has rolled back many of the inclusive, data-driven policies Levine championed, replacing them with erasure, distortion, and overt discrimination.
That agenda includes the nomination of Brian Christine to replace Levine as assistant secretary for health. A urologist from Alabama with a record of anti-transgender statements, Christine has publicly denounced gender-affirming care for transgender youth as “damaging” and part of a so-called leftist assault on traditional values.
Levine described her work at the Department of Health and Human Services, now helmed by Robert F. Kennedy Jr., a vaccine skeptic who once suggested poppers caused AIDS, as operating across three lanes: overseeing 10 core offices, leading the U.S. Public Health Service Commissioned Corps, and coordinating efforts across siloed agencies like the Centers for Disease Control and Prevention, Food and Drug Administration, and National Institutes of Health. Her team called it the “connective tissue” of the department. “Personally, I was hoping for the beating heart of the department, but we got connective tissue,” she said.
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Her offices tackled urgent national health crises: syphilis, HIV, blood safety, nutrition, environmental justice, and long COVID. Under her leadership, the Office of Infectious Disease and HIV Policy became a cornerstone of the Ending the HIV Epidemic initiative, which was started under the first Trump administration and significantly expanded under Biden. “When I graduated from medical school in 1983, I never imagined I’d become the syphilis czar,’” she said. “Or czarina, if I may say.”
During her tenure, Levine often spoke of the importance of screening for syphilis as part of routine sexual health. Last year, she attended a screening clinic in downtown Washington, D.C., that drew many people who signed up for testing.
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But many of the staff who built that infrastructure are now gone. “They’ve been criticized, castigated, and DOGE'd,” Levine said, referring to the wave of forced departures under Elon Musk’s Department of Government Efficiency. On April 1, HHS announced 10,000 layoffs, with another 10,000 workers already forced out via early retirement. The FDA’s drug safety division lost more than 800 staffers. Many were locked out of their offices without warning.
HHS Assistant Secretary for Health Adm. Rachel Levine's visit to Watkins School, speaking with fifth-grade students during National Nutrition Month in March 2023.HUM Images/ Universal Images Group via Getty Images
Levine also served as the nation’s blood safety officer, steered national policy on smoking cessation, and built new offices focused on climate and health. She emphasized that health equity wasn’t an afterthought — it was the foundation. “It wasn’t something we worked on only on Friday afternoons,” she said. “It was baked into everything we did.”
That included expanding SOGI (sexual orientation and gender identity) data collection, substantiating gender-affirming care, and elevating LGBTQ+ health at a federal level. “One of the aspects of health equity, which I leaned into, was LGBTQIA+ health equity,” Levine said.
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That entire framework is now under attack.Under RFK Jr., the administration has dismissed non-partisan presidential advisors on HIV, defunded health equity programs and opposed care for transgender people.
Scout, executive director of the National LGBT Cancer Network, called the rollback “catastrophic.”
“A generation’s worth of LGBTQI+ health research has been canceled,” they told The Advocate. “Federal websites have been scrubbed. The data is disappearing.”
Scout credited Levine with fostering policy changes that never would have been possible under the current administration — from cancer screening guidelines tailored for LGBTQ+ populations to the collection of sexual orientation and gender identity on communicable disease forms. “She created the environment where we could fix things — and she acted on it,” he said.
Now, Scout warned, the gains are vanishing. “We’re rapidly moving back to the 1960s, when the tobacco industry was effectively setting public health policy. The projects are gone. The researchers are gone. Even the transgenic mice study that could’ve told us how hormones interact with cancer was mocked.” During this year’s address to a joint session of Congress, Trump claimed that the NIH was spending money studying transgender mice. Those do not exist. Transgenic mice are genetically modified to mimic human hormones.
The Trump administration’s first executive order declared that the federal government would no longer recognize transgender people. Sex would be defined as binary and immutable. HHS websites were rewritten accordingly. Many now open with disclaimers denouncing “gender ideology.”
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“When a trans person sees that, the amount of damage it causes is immeasurably high,” said Dr. Carlton Thomas, a gastroenterologist and popular health influencer on social media known for his content on sexual health, particularly for men who have sex with men and LGBTQ+ issues. Thomas worked closely with Levine on sexual health initiatives. Levine started critical progress in queer health equity, including national guidelines on DoxyPEP and anal cancer screening protocols, he said. “She was incredibly powerful for our community,” Thomas added. “I don’t think many people know what she did for us behind the scenes to correct those disparities. And now it’s all being taken away.”
Thomas said Levine brought a level of competence and compassion rarely seen at the highest levels of government. “This is a Harvard-educated woman who is incredibly brilliant and the kind of person you want in this role,” he said. “She understood what our community needed and set everything in motion. And now, with everything being rolled back, it’s really frustrating.”
He described the current administration’s changes to HHS websites as dangerous and disheartening. “You can’t rely on them anymore for accurate information,” he said. “Now I direct people to archived versions of CDC recommendations so that they can get science instead of ideology.”
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Thomas said much of his work today involves correcting misinformation on social media — addressing issues like site-specific sexually transmitted infection screening and the erasure of queer health needs in national data. “Simple but critical things are being lost,” he said. “And when a trans person goes to a website now and sees a disclaimer that says their identity is not real, it does emotional damage.”
The backlash, he added, is also profoundly personal. “I saw firsthand the hate she receives just for existing,” Thomas said. “She put herself out there in a way most of us couldn’t. And now we owe it to her — and each other — to show up for every part of our community because they come for trans people first. Who will be there for us if we’re not there for them?”
Levine said the disclaimers send a chilling message. “Basically, they’re saying that we don’t exist,” she said. “And it does challenge the scientific veracity of information coming out of HHS.”
She blasted a recently released 400-page report from HHS that discredited gender-affirming care and promoted “exploratory therapy.” “It was politically and ideologically motivated,” she said. “And it was not a well-written or good report.”
One of the most concerning rollbacks of the Trump administration is efforts at HIV prevention. Levine’s understanding of HIV isn’t academic — it’s personal. She started her pediatric residency in 1983 in New York City, witnessing the devastation of AIDS firsthand. “We saw babies, children, teens, and their parents all dying,” she recalled.
She called medications for pre-exposure prophylaxis or PrEP, the understanding that U=U (undetectable equals untransmittable), and antiretroviral treatments “medical miracles,” but warned they remain out of reach for too many. “We have to get those medical miracles to the people who need them most,” she said.
Despite a 10-fold increase in PrEP use between 2012 and 2021, a study published in Lancet Regional Health – Americas found stark inequities in access. In 2021, the PrEP-to-need ratio was lowest for Black people, despite their higher HIV risk. White residents in the South had higher access to PrEP than Black residents in the Northeast. Female uptake lagged far behind male uptake nationwide. And while overall numbers improved, the U.S. South still had the lowest rates of equitable PrEP use.
“All of those prevention efforts—and the research for a vaccine and a cure—are now at risk,” Levine said.
She said the current wave of anti-trans policy is no accident. “This is a result of a specific strategy by conservative think tanks in Washington that started in 2021 to impact our community,” she explained. “They pivoted from marriage equality to attacking trans athletes, then trans and nonbinary youth, and now all trans and nonbinary people.”
She added, “If they have the opportunity to go for the rest of the Rainbow family, they’ll do it.”
Jesse M. Ehrenfeld, president of the American Medical Association; Admiral Rachel L. Levine, the 17th assistant secretary for health for the U.S. Department of Health and Human Services; and Charlotte Clymer, writer, transgender activist, and military veteran, speak onstage during Learning With Love: The 2023 PFLAG National Convention.Paul Morigi/Getty Images for PFLAG National
Dr. Susan J. Kressly, president of the American Academy of Pediatrics, said Levine brought deep expertise and moral clarity to her role.
“The AAP greatly appreciates Dr. Rachel Levine’s dedication to children and adolescents, Kressly said in a statement to The Advocate. As the assistant secretary for health of the U.S. Department of Health and Human Services during the Biden administration, she has driven key initiatives to improve the health and well-being of young people. Under her leadership, the Office of the Assistant Secretary for Health advanced the needs of adolescents, including working to protect their access to reproductive health care, and to ensure gender diverse and transgender youth could access evidence-based health care,.
"Dr. Levine has been a long-standing champion for comprehensive, evidence-based health care for all children, adolescents, and young adults. Having a pediatrician in this role was especially meaningful. Dr. Levine’s expertise helped shape policies to advance child and adolescent health, whether by promoting teen mental health and social media use, elevating public health expertise during the COVID-19 pandemic, or her achievements throughout her impressive career in academic medicine. She is a shining example of what it means to be a pediatrician advocate for EVERY child. We are grateful for her dedicated public service and are fortunate to have her as a long-standing member of AAP.”
Despite the backlash, Levine isn’t retreating — she’s recharging. She’s writing a memoir, giving public talks, and urging people not to succumb to despair.
“I am a positive and optimistic person because I choose to be,” she said. “That fuels my work — and it fuels everyone’s work.” She said public support has kept her grounded. “People thank me for my service. They share their fears. And I try to meet them with hope.”
Levine has a clear message to those feeling overwhelmed: “We are stronger together. Our LGBTQIA+ community is stronger together — and that includes our allies. They are trying to pit us against each other. We cannot let that happen.”
And she’s confident the backlash won’t last forever. “The wheel will turn. I don’t know when, but it will. Justice will win out. But we have to work for it.”
