Adm. Rachel Levine is optimistic about the future of trans Americans. I’m not convinced.

“I think some of my most positive moments are when I am in meetings, roundtables, and discussions with trans youth, their families, their medical providers, and with trans and non-binary adults,” says United States Assistant Secretary of Health Admiral Rachel Levine.

Our Zoom conversation, held shortly after International Transgender Day of Visibility, was both illuminating and disheartening. It reminded me of the great strides we’ve made by having a prominent trans woman advocating for LGBTQ+ rights in the federal government, but also of the endless barriers we face on a daily basis. 

The topics we discussed resonate today on GLSEN’s Day of (No) Silence. Started nearly 30 years ago by two college students, the original Day of Silence asked students to spend the day not talking, then culminated in rallies to promote inclusivity. But the organization is flipping the script, advocating for student-led demonstrations to call attention to the 800+ anti-LGBTQ+ bills introduced in the past two years.  

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These bills aren’t anything to scoff at. In Ohio, HB 68 passed and will severely limit gender-affirming care for minors, along with a bathroom ban moving through the legislature. Even as we hit the end of legislative sessions for many states across the country, the LGBTQ+ community still faces bills like Alabama’s HB385, a drag ban, and Kansas’s SB394, an online age verification bill for websites containing 25% or more content considered “harmful to minors,” which under statute refers to “sexual content,” and, in turn, the state’s categorization of homosexuality.

In theory, elected and appointed government officials should serve the interests of the greater good. But as the country becomes more polarized, journalists like me are challenged to have an unbiased and critical eye for actions that are both popular and unpopular with the general public.

I’ve long been an admirer of Adm. Levine. As a trans woman myself, it’s inspiring to see someone like me in such a prominent position. Especially as someone born in Pennsylvania, seeing a trans woman from my home state in her position is nothing short of amazing. This appreciation drives me to question and challenge the issues facing our community.  

When asked about the actionable steps the Department of Health and Human Services (HHS) is taking to improve transgender care, Adm. Levine said, “We are working on some key HHS policy initiatives to advance health equity for the LGBTQI+ community. One example would be our work to end the HIV epidemic in the United States with a focus on health equity. We have many, many medical advances that we’re working to implement, including PrEP, including ART [antiretroviral treatment] with U=U [undetectable = untransmittable]. But we’re still struggling to get these medical advances to the people who need them most. And so we need to continue to do that.”

She also emphasized how divisions within HHS have done research into the harms of conversion therapy, improvements for transgender care, non-discrimination procedures within the HHS, and are attempting to combat sexually transmitted diseases in marginalized communities, although with many challenges on the road. 

Academics have long known about barriers to getting people the kinds of care they need. Issues like the stigma against HIV care, mental health issues, inability to physically access care, and disparities in Black and Latine communities all make it difficult to provide care for those in need.

Not everyone is satisfied with the work HHS has done. 

“During the pandemic, in a race to maintain continuity of care, HHS relaxed telehealth restrictions across state lines. The majority of these sunsetted after the emergency was declared over,” Jessica Kant, a clinical social worker and Boston University lecturer, told LGBTQ Nation. “One unexpected outcome of this was that LGBTQ+ youth had a brief window of expanded access to essential care… There are obvious steps that the federal government could take to expand that access and get support to kids in most-impacted regions. The rationale for not doing so is confusing and frankly quite frustrating.”

Kant also mentioned the need for the “Drug Enforcement Agency (DEA) to change testosterone’s schedule III status,” emphasizing how this has been proposed and discussed before by politicians like Senator Ed Markey in 2022. Schedule III status refers to the classification and regulation of testosterone as a regulated drug, which can create barriers to access for trans people.

I asked Admiral Levine how she would respond to critics who say that the current administration’s actions aren’t enough. Policy experts like Harper Jean Tobin have publicly criticized the administration for not taking enough necessary steps to advance LGBTQ+ rights, saying Biden’s 2022 Pride Month order is “a lot less than we need” and that “the pieces seeking to respond to state-sponsored discrimination and it’s [sic] impacts could have been much more specific, with clear timelines, and also acknowledged this crisis is inextricably related to rising violent extremism.”

Adm. Levine believes that visibility is a powerful tool. 

“The Biden-Harris administration is going to do everything that we can to help transgender and nonbinary people throughout our country,” Adm. Levine said. “We are working in many different avenues and lanes — one is advocacy. I go out and speak about these issues. I meet with trans youth. I meet with their families. I meet with their medical providers almost everywhere I go.”

“The Biden-Harris administration is going to do everything that we can to help transgender and nonbinary people throughout our country.”

United States Assistant Secretary for Health Admiral Rachel Levine

But meeting with constituents around the country and speaking about these issues isn’t enough. We’ve heard for the past three years that the Biden-Harris administration is doing all that it can to protect trans people, but yet we’re still in the midst of the biggest attack on transgender rights in our country’s history. Talking to people, while having the potential to be hugely impactful and inspiring, does not protect the lives of transgender people. Stronger federal action against state laws that violate people’s medical rights and nondiscrimination needs to be passed.

Adm. Levine further emphasized her visits to many different parts of the country to talk to constituents, saying, “The Department of Justice has participated in many amicus briefs and other briefs in lawsuits. Our Office of Civil Rights within HHS is involved. And there are rules and regulations that are being promulgated as well. So we’re going to do everything we can to support these young people, their families, and their medical providers throughout the country.”

In response to specific critics like Tobin, Adm. Levine emphasized her belief that the Biden administration is doing all that it can for the LGBTQ+ community, concluding, “I think that the president, vice president, and the administration have shown their support for our community and will continue to do so.”

But not all people agree that the Biden administration is doing all that they can. “Biden has continued to claim that he has the backs of transgender people, but he hasn’t really had much of a backbone on issues that affect transgender individuals,” Allison Chapman, legislative researcher and activist, told LGBTQ Nation. 

“While he has done some good things, especially in the past few months with the defeat of the anti-LGBTQ+ riders and his unwavering support during Transgender Day of Visibility, it still remains lacking,” said Chapman. “His support tends to lean more towards the performative and the easy small wins for his campaign and not pushing for any real major change. With the constant attacks on LGBTQ+ rights across the country, it has left me and other LGBTQ+ questioning if he really has our backs or just wants our votes.”

Nevertheless, there are advocates in favor of Biden’s approach to LGBTQ+ rights. For instance, Rodrigo Heng-Lehtinen, executive director of the National Center for Trans Equality (NCTE) said in a statement, “Without question, the Biden Administration has been the strongest advocate for the needs of transgender Americans of any presidential administration in American history.”

Related:

Trans lives are at risk. Rodrigo Heng-Lehtinen says this is how to protect them.

The National Center for Transgender Equality executive director says the LGBTQ+ community is only as strong as the coalitions we form.

Clearly, reception to the Biden administration within the LGBTQ+ community is mixed at best. The fact that there are dissatisfied individuals is a testament to the work that needs to be done. We need stronger protections for gender-affirming care, strong non-discrimination policies, and national legislation to safeguard librarians and teachers from harmful restrictions like book bans or “Don’t Say Gay” bills.

This can be especially disheartening as the LGBTQ+ community faces an immense threat across the country. There are nearly 500 anti-LGBTQ bills in state legislatures right now, and many more states are implementing legislation rapidly, albeit less quickly than last year. My home state of Ohio has passed legislation that is forcing many to uproot their entire lives, myself among them.

When asked how people can safely and legally continue gender-affirming care, Adm. Levine said, “It’s very difficult in those states that have taken those actions and passed those laws for youth to be able to obtain their care. So my heart goes out to them. I think that there are some avenues to telemedicine, but also through the ability to go to a contiguous state.”

Still, Adm. Levine expressed optimism that the tide will turn on the anti-trans wave seen throughout the country.

“The wheel will change on this. I do recognize and I’ve spoken to many personally, about how challenging it is right now,” she said. “And so I think we’re going to all have to continue to work on it so they can provide the care that they need…. We have in the United States now medical refugees who cannot obtain the care they need in their states. I think that things will get better, but it makes it very difficult now and we acknowledge that.”

“The legal and political climate where people live now is itself now a social determinant of health,” Adm. Levine continued. “The social determinants of health are the different social factors that influence one’s health that aren’t just medical care, including the environment, education, economic opportunity, transportation, housing, nutrition, and others.”

It’s likely that medical refugees will increase as more anti-LGBTQ+ laws are introduced and implemented across the country. How we as a country respond remains to be seen and will be heavily influenced by the 2024 elections. 

In honor of the GLSEN’s Day of (No) Silence, let’s continue speaking out and being vocal. Whether you’re supportive or critical of President Biden, there is undoubtedly still work to be done. It’s our job to hold elected officials accountable, no matter where they stand on the political aisle and at every level of government.