Culture Wars Leave Biden’s Health Leadership Posts Vacant

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“There are a lot of people who might have trusted their instincts before, but that trust has been eroded,” Dr. Lurie said. “They need to be sure that they are doing the right thing and that if they step out and do something now that is perceived as risky that nobody is going to cut their neck off for it.”

Dr. Levine, a pediatrician and former secretary of health in Pennsylvania, has found herself targeted by Mr. Severino, who said he met with Dr. Levine early in his tenure at the department. At the time, he was considering whether to amend an anti-discrimination rule in the Affordable Care Act that the Obama administration had interpreted as protecting transgender people; the Trump administration ultimately cut back those protections.

While he said they engaged in a “very respectful dialogue and a good exchange,” he challenged Dr. Levine about whether she would favor hormone blockers or sex reassignment surgery for minors — topics that Senator Paul raised during Dr. Levine’s confirmation hearing.

“You’re willing to let a minor take things that prevent their puberty, and you think they get that back?” Senator Paul, who is an ophthalmologist, said angrily 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, “transgender medicine is a very complex and nuanced field with robust research and standards of care.”

Detractors have seized on a 2017 speech that Dr. Levine gave describing hormone therapy as a standard of care for transgender youth, and also on a Twitter post she made in January 2020 about a study showing that transgender youth with access to puberty blocking drugs are at decreased risk of suicide.

After the hearing, Senator Chuck Schumer of New York, the majority leader, denounced Republicans for “their attacks on trans people,” which he called, “just mean, mean and show a complete lack of understanding, a complete lack of empathy.” In a statement on Wednesday, Senator Bob Casey, Democrat of Pennsylvania, said Senator Paul’s “questioning was transphobic and a source of pain for many Americans, particularly transgender youth.”

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