President Biden’s assistant secretary of health is the highest-ranking openly transgender person ever to serve in the federal government.,

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WASHINGTON — Dr. Rachel Levine was not a particularly aggressive football player at the elite all-boys school she attended in Massachusetts four decades ago. She loved drama and glee club, but when it came to football, she said, “I told the coach, ‘Well, I’ll tackle, but I don’t want to hurt them.’ “

Dr. Levine returned to Belmont Hill School as a guest speaker in 2016 and offered a little life advice to the boys clad in the same blue blazer and khaki pants uniform that she once wore: “Don’t make any assumptions.”

Dr. Levine, a former Pennsylvania health secretary, is now President Biden’s assistant secretary of health, the first openly transgender person ever confirmed by the Senate, and she has taken office in the middle of something of a transgender moment. A culture war is intensifying, waged largely by Republicans who have sought in state after state to restrict transgender rights and block transgender girls from participating on girls’ sports teams.

At the same time, a transgender woman, Caitlyn Jenner, the former Olympic decathlete and reality television star, announced last month she was running for California governor as a conservative Republican, a campaign that counts Brad Parscale, the former campaign manager for Donald J. Trump, as an adviser. Elliot Page, an Oscar-nominated actor, recently opened up about his gender-affirming surgery, telling Oprah Winfrey, “I do believe it’s been lifesaving.”

And Dr. Levine is the highest-ranking openly transgender person ever to serve in the federal government.

“It’s political — some people feel that this could be a wedge issue in the upcoming elections,” Dr. Levine said of the Republicans’ efforts, in one of her first interviews since taking office. “It is also that transgender people have become more prominent, so I think maybe some pushback for that. But I think at its heart, this is politics.”

Dr. Levine has suffered through her own share of false assumptions and attacks. A radio reporter insisted on calling her “sir.” Firefighters raised money at a county fair in Pennsylvania by putting a “Dr. Levine impersonator” — a man wearing a dress and a wig — in a dunk tank. Senator Rand Paul, Republican of Kentucky, grilled her about “genital mutilation” at her confirmation hearing.

The prominence of transgender issues in politics is remarkable considering what a tiny sliver of the population transgender people represent. An estimated 1.4 million adults and 150,000 youths ages 13 to 17 identify as transgender in the United States, according to the Williams Institute, a research group at the law school of the University of California, Los Angeles. That is slightly more than one half of 1 percent of the population.

As assistant health secretary, Dr. Levine has other pressing items on her agenda — not least the coronavirus pandemic that has taken 580,000 lives in the United States.

Still, the push to restrict transgender rights is impossible for her to ignore.

Hundreds of bills intended to restrict the rights of transgender and other L.G.B.T.Q. people have been introduced in state legislatures around the country, prompting the Human Rights Campaign, an advocacy group, to declare that 2021 was on track to become “the worst year for anti-L.G.B.T.Q. legislation in recent history.” Many of those measures are directed at transgender youths, who are especially vulnerable to suicide and depression.

In March alone, three Republican states — Tennessee, Arkansas and Mississippi — enacted legislation aimed at restricting transgender girls from playing on girls’ sports teams. Montana’s governor signed a similar bill on Friday, a week after signing another bill making it harder for transgender people to change the sex listed on their birth certificate. Arkansas recently became the first state in the country to ban gender transition treatment for people under 18.

Senator Paul and other critics have pressed Dr. Levine on her views on medical treatment, including surgery, for young people experiencing gender dysphoria — the diagnosis given those whose gender identity conflicts with their sex at birth. The subject is too nuanced and complicated, she has said, to sum up in a quick conversation.

During her confirmation hearing, she offered to meet with the senator one-on-one for a more thorough discussion; he has not taken her up on it, she said. Her critics accuse her of dissembling.

“Dr. Levine absolutely dodged the questions,” complained Roger Severino, a former Trump administration official who led efforts to advance anti-transgender regulations.

Dr. Levine’s appointment speaks to how much Washington has changed under Mr. Biden. Not long ago, it was Mr. Severino who occupied a high-ranking position at the Department of Health and Human Services, where he ran the civil rights division. Early in his tenure, when he was considering whether to roll back civil rights protections for transgender patients, he invited Dr. Levine to meet with him in his office.

Both of them remembered the conversation as a good exchange, polite and respectful. Mr. Severino said he “learned a tremendous amount.” But this was no meeting of the minds: Last year, the Trump administration threw out an Obama-era rule that banned discrimination against patients based on gender identity. Dr. Levine was not surprised.

“I’m a positive and optimistic and hopeful person,” she said, describing how she felt after she left Mr. Severino’s office. “But you know, I was also skeptical that in the end it would make a difference because, again, I think it’s political.”

Dr. Levine does not advertise her personal story, nor is she shy about telling it. Growing up outside Boston, she said, she “recognized that things were different for me at a young age,” but she learned to compartmentalize those feelings.

“I’m a child of the ’60s and the ’70s,” she said in the interview, “so what would you say and who would you tell?”

After getting degrees at Harvard and Tulane University’s medical school, Dr. Levine trained in pediatrics at Mount Sinai Medical Center in New York before joining the staff of the Penn State Health Milton S. Hershey Medical Center. (She likes to joke that “the biggest transition I ever made was going from Manhattan to Central Pennsylvania.”) She married and had two children.

She also began looking inward — a process that took time, she said.

“It was an exploration for me,” she said. “Some people transition over two or three years, where I think I transitioned over 10 years.”

“Mine was slower than most, and that was important to me personally and professionally,” she concluded.

She is now divorced but remains close with her former wife and children.

While at Penn State, where she developed a division for adolescent medicine and eating disorders, she became active in the L.G.B.T.Q. advocacy movement, which drew the attention of Tom Wolf, a Democrat who was elected governor of Pennsylvania in 2014. The new governor named her physician general, the state’s top doctor when the health secretary is not a physician.

At the time, she said, there were “some attacks” on her, but “they were not that brutal.” But after she was elevated to health secretary and took a front-and-center position responding to the pandemic, the hate escalated.

“She told me she was at a gas station early on in the Covid lockdown and some guy in a pickup truck started driving around her screaming about medical tyranny,” said Mara Keisling, the executive director of the National Center for Transgender Equality.

At first, she tried to ignored it. But she drew the line at the dunk tank episode, and used her daily news conference to push back.

“While these individuals may think that they are only expressing their displeasure with me,” she said, they were hurting “thousands of L.G.B.T.Q. Pennsylvanians.”

As assistant secretary for health, Dr. Levine has a wide portfolio; the job is what you make it, and can be either the “most influential public health voice” in the nation, or “window dressing,” depending on the aspirations of its occupant, said Dr. Levine’s predecessor, Adm. Brett P. Giroir.

Dr. Levine said she intended to prioritize mental health, health equity and the opioid epidemic, a problem she also tackled while in Pennsylvania. Her “most urgent” priority, she said, is fighting the coronavirus, and especially addressing vaccine hesitancy.

But she also intends to advocate on behalf of transgender youth, and work to raise awareness, as she did during her visit to Belmont Hill. Her former math teacher, Michael Sherman, who has taught there for 48 years, said Dr. Levine was invited because the school wanted to emphasize diversity, and she is the only known female graduate.

“I asked the young boys about L.G.B.T.Q. issues and how they would feel about a gay student, how they would feel about a transgender student,” Dr. Levine recalled.

She told her audience she had been “somewhat bullied” in grade school, but that it would be “completely false” to think she was unhappy at Belmont Hill. That is one reason for her life advice.

Show “a healthy curiosity,” she said. Learn to “embrace people and to welcome people on their own terms.” Ask “appropriate questions.” But don’t make any assumptions.

They rewarded her with a standing ovation. She put her hand over her heart in gratitude.