Thursday was a day of historic firsts, of alarm and outrage.

Rachel Levine, the physician nominated to become the Biden administration’s assistant secretary of health, came to her confirmation hearing prepared to politely discuss matters such as the covid pandemic, the opioid epidemic, behavioral health and racial disparities in medical treatment.

Sen. Rand Paul (R-Ky.), however, seemed more interested in talking about children’s genitals.

“Dr. Levine, you have supported [minors] being given hormone blockers, and surgical reconstruction of a child’s genitalia,” Paul said, in a tirade in which he also conflated genital mutilation (a horrifying practice that public health experts view as a human rights violation) with the transition-related surgeries chosen by some transgender individuals to help their bodies conform with their gender identity.

“You give a woman testosterone enough that she grows a beard. Do you think she’s going to go back looking like a woman when you stop the testosterone?” Paul demanded.

Sen. Rand Paul (R-Ky.) questioned nominee for assistant health secretary Rachel Levine about her position on gender-affirming care for minors. (The Washington Post)

Levine, who most recently worked as Pennsylvania’s top health official, is transgender. If her nomination succeeds, she will become the first publicly transgender federal official to be confirmed by the U.S. Senate. She would have been within her rights to be enraged by Paul’s ignorance, but she responded on Thursday by repeating a steady message: “Transgender medicine is a complex and nuanced field,” she said twice. It was composed of “robust research,” and standards of care. She would be happy, she said, to come to Paul’s office and discuss the issue in-depth.

She repeatedly thanked him for the opportunity to answer his questions, even the demeaning ones.

She kept her hands folded on the table, while Paul jabbed his finger in the air and dismissively scoffed, “If you’ve ever been around children — 14-year-olds cannot make this decision.” (Levine is a pediatrician who created the Penn State Hershey Medical Center’s adolescent medicine division. Paul is an eye doctor.)

Paul did not seem at all curious about the medical matter at hand, in which he had no expertise. He was instead “alarmed” and “outraged.” He claimed to be worried about the children, but paid no heed to guidance of medical organizations — including the American Academy of Pediatrics — that recommend treating gender-diverse children by affirming their gender identities.

In Paul’s telling, children chose to be transgender because of peer pressure, or pressure from doctors. In his world, those children would be fine if only doctors like Levine would deny them treatment.

Paul’s stand against medical treatment for transgender kids occurred on the same day that the House of Representatives was scheduled to vote on the Equality Act, a bill that would amend the Civil Rights Act to prohibit discrimination based on sexual orientation or gender identity.

That bill had inspired similar reactions from Republican lawmakers.

“Equality for who?” demanded Rep. Lauren Boebert (R-Colo.) from the House floor Wednesday night. “Where is the equality in this legislation for the young girls across America who will have to look behind their backs as they change in their school locker rooms, just to make sure there isn’t a confused man trying to catch a peek?”

Boebert then meandered on to “liberal indoctrination camps — also called colleges and universities — and “radical ideology,” and she warned that the left would “imprison” and “take [the] children” of anyone who disagreed with them.

Rep. Marjorie Taylor Greene (R-Ga.) gave a similar speech. After her across-the-hall neighbor Rep. Marie Newman (D-Ill.) posted a transgender pride flag outside of her office (Newman’s daughter is trans), Greene retaliated by hanging a poster outside of her own, reading, “There are TWO genders: Male & Female.”

Research has not shown an increase in violence or voyeurism when jurisdictions begin allowing transgender individuals to use whichever restroom they feel comfortable in. And a hypothetical man harassing girls in a locker room would be arrested under passage of the act, just as he would and should be now. Nondiscrimination laws don’t permit illegal behavior, they just give transgender kids a safe place to pee.

As for Boebert’s scaremongering about the left taking children away from their parents: She seemed to be alluding to a specific case that occurred in Ohio. A pair of grandparents were awarded custody of their 17-year-old transgender grandson, who had become suicidal after the boy’s parents had refused to call him by his chosen name or permit doctor-recommended treatment. The custody agreement mandated independent psychological evaluation before hormone treatment would be allowed to begin, and it encouraged parental reconciliation. Boebert didn’t mention any of that context.

In Boebert and Greene’s telling, transgender equity meant unleashing terrifying bad men pretending to be women. Their world, like Paul’s, was full of monsters determined to abuse, kidnap and mutilate kids.

The monster world is necessary to anti-transgender arguments, which depend on fear — fear of losing the things people hold most dear: their children, their safety, their faith, their sense of self.

And that fear depends on a lack of curiosity and an insistence on alarm and outrage. It depends on its propagators having the space to twist truths, to omit pertinent information, to revel in faux indignation, and to get away with it.

It depends on Sen. Rand Paul claiming that Rachel Levine isn’t answering his questions, simply because he doesn’t like her answer: that medical cases are complex, and there are fields of study and many experts who have dedicated their entire careers to thinking through ethical practices.

Levine’s nomination is historic, but it is also necessary. It is necessary because, as Sen. Patty Murray (D-Wash.) pointed out at the beginning of the hearing, we should have a government that represents the vast breadth of humanity.

It is also necessary because Levine spent three hours sitting behind a table, wearing a patterned blazer, a string of pearls, eyeglasses and a graying haircut. She occasionally sounded nervous, but always remained calm. She spoke humbly, admitted when she didn’t know answers, and stressed how honored and excited she would be to learn more and to work with everyone in the room. She was the opposite of terrifying.

If you watched her exchange with Paul, you might have seen someone behaving monstrously. But it definitely wasn’t her.

Monica Hesse is a columnist writing about gender and its impact on society. For more, visit