The Senate on Wednesday made history when it confirmed Dr. Rachel Levine as assistant secretary of health in the Department of Health and Human Services.

Levine, who is male but identifies as a woman, became the first openly transgender official to be confirmed by the Senate.

The vote to confirm Levine was 52-48, with moderate Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska breaking ranks with other Republicans to support Levine, according to the Pittsburgh Post-Gazette.

Levine, who previously served as Pennsylvania’s secretary of health, was grilled during his confirmation hearings about his support for providing children with so-called gender reassignment surgery and hormone-blocking drugs.

“Dr. Levine, you have supported both allowing minors to be given hormone blockers to prevent them from going through puberty, as well as surgical destruction of a minor’s genitalia,” Republican Sen. Rand Paul of Kentucky said Feb. 25. “Like surgical mutilation, hormonal interruption of puberty can permanently alter and prevent secondary sexual characteristics.”

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The senator then asked, “Dr. Levine, do you believe that minors are capable of making such a life-changing decision as changing one’s sex?”

Levine avoided answering him, saying, “Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed.”

The nominee also faced questions about the state’s efforts to battle COVID-19.

Republican Sen. Pat Toomey of Pennsylvania said in a statement the state’s COVID-19 response was the reason he voted against Levine.

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“In Pennsylvania, the pandemic struck seniors in nursing homes disproportionately hard compared to other states. This was due in part to poor decisions and oversight by Dr. Levine and the Wolf administration,” he said.

“Moreover, the commonwealth’s extended economic lockdown that Dr. Levine advocated for was excessive, arbitrary in nature, and has led to a slower recovery,” Toomey said.

“While I appreciate Dr. Levine’s service and responsiveness to my office over the past year, she has not earned a promotion to help lead the U.S. Department of Health and Human Services and I cannot support her confirmation,” he said.

Toomey was not alone in criticizing Levine’s work.

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“Your state failed to adequately protect nursing home residents from the virus and is making unacceptable mistakes in the vaccine distribution process,” Republican Sen. Richard Burr of North Carolina said during Levine’s confirmation hearings.

Burr had said that 52 percent of Pennsylvania’s COVID-19 deaths came from nursing homes, according to the Post-Gazette.

“How can you assure that the same challenges that Pennsylvania experienced in testing, nursing home care, and, now, vaccinations will not occur when given the opportunity to serve in the public health policy area?” he asked.

Levine defended what he called the state’s “work to have a scientific, evidence-based response to COVID-19” and said that at the dawn of the pandemic, Pennsylvania lacked the resources to deal with the coronavirus.

“Things continue to improve,” he said.

Republican Sen. Mike Braun of Indiana also questioned the “draconian” lockdowns imposed by the state.

Last May, an incident took place in which Levine rebuked a reporter who addressed him as “sir” during a virtual news conference, PennLive reported.

“Please don’t misgender me,” he told the reporter, adding that being called a male was “really insulting.”

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