番茄社区

In part three of this exclusive video interview, 番茄社区 editor-in-chief Jeremy Faust, MD, talks with Admiral Rachel Levine, MD, the assistant secretary for health at the Department of Health and Human Services (HHS), about her experience as the highest ranking U.S. transgender official and why youth transgender medicine is so important.

Watch part one and part two here.

The following is a transcript of their remarks:

Faust: In terms of teen mental health, I do want to just acknowledge you are the highest ranking official who is transgender. Transgender care is under attack for adults, but it's also really become a hot-button issue for younger people.

How do you think this conversation should proceed? Because there are people who are curious and there are people who maybe aren't actually engaging in good faith, but I think both of those types of people need to be brought into the conversation. How do you assess that conversation right now?

Levine: Well, transgender medicine is an established type of protocols and procedures and treatments. It is based upon decades of research. There is a new standard of care from the World Professional Association of Transgender Health published in September 2022. It is somewhat different than the standard of care in 2011 -- no different than the standard of care for any other condition in 2022 and beyond [being] different than the standard in 2011. It is based upon medical research that continues to evolve.

Transgender medicine for youth and adults is medical care, it's mental healthcare, and it can be suicide prevention care. It should be available in every state in this country. The laws and actions taken by many states have nothing to do with medicine. It is really politically and ideologically motivated against vulnerable transgender youth, their families, and their medical providers.

We want to continue our research on transgender medicine and make sure that any questions are answered, that protocols are refined, and allow people who need this potentially lifesaving treatment to get it.

Faust: Would you mind telling me what it's like to work on Capitol Hill, with some people you probably walk down the hallway with, and you know that their views don't really align with the life you're living? How do you deal with that?

Levine: I deal with it very easily. You know, I've been doing this for a while now. It's very easy to compartmentalize any thoughts or feelings I have about that and do the work I do for public health.

What I worry about are those vulnerable young people, their families, and their medical providers who are really suffering in states that have taken these ideologically and politically motivated actions. So we're going to do everything we can to support them. I'm a positive and optimistic person, and I think that the wheel will turn on this and that things will change.

Let me explain it this way, if you're a parent and you have a family and you have a young person with diabetes, you might seek a pediatric endocrinologist at a children's hospital for consultation. If they have heart disease, you'll seek a pediatric cardiologist. If they have a mental health issue, depression or anxiety, you would seek a child psychiatrist or psychologist. For an eating disorder, you might seek an adolescent medicine specialist. You would rely upon their knowledge and expertise and evidence-based protocols.

So why is it different in terms of transgender medicine? Most of the care of this is provided at our nation's children's hospitals -- except in states where it's become forbidden now -- by adolescent medicine specialists, pediatric endocrinologists, child and adolescent psychiatrists and psychologists, and their staff. So I don't see why it's different.

You know, these laws and actions in the state legislatures are getting in between a young person, their family, and their medical provider, and I don't see why they should be there.

Faust: I'd like to close with a little bit of a discussion about your personal journey and service -- excuse the windup on this question.

Let's see, you went to Harvard, where I teach, you went to get your fellowship at Mount Sinai, where I went to medical school and residency, and you did your MD at Tulane, where I was waitlisted. At what point along the way did you foresee a life of service like this where you'd be leveraging your expertise in public service at the highest levels?

Levine: I didn't, actually. I was very well-ensconced in academic medicine, first at Mount Sinai and then at Penn State. I went through the usual promotion process and did all of my missions of seeing patients, teaching clinical research, and administration.

But I had this unique opportunity in January of 2015 to become the physician general of Pennsylvania with Governor-elect Wolf at that time, and I thought that I could help people like I did in academic medicine, but from a different perspective and with a broader public health brush.

Then I had the opportunity later to become the secretary of health of Pennsylvania, and then this amazing opportunity to become the assistant secretary for health and an admiral in the Public Health Service Commissioned Corps. So, it is not what I expected in terms of my career, but it has been a unique journey to help people and of service.

Faust: For people who don't know, you also are the head of the U.S. Public Health Service, one of eight uniform services. You have the military branches and you also have NOAA [National Oceanic and Atmospheric Administration]. What does that service do?

Levine: Sure. Thank you for allowing me to talk about that.

As you said, we are one of the eight uniform services. We report to the secretary of Health and Human Services. We're a uniform service, but not an armed service; we're not military. We have about 5,600 medical and public health professionals, from physicians, nurses, pharmacists, public health masters and PhD's, and more that serve throughout our country. They serve at the divisions at HHS, including the CDC, FDA, NIH, my office HRSA [Health Resources and Services Administration], CMS, and more.

But they also serve at the Indian Health Service. We have about 1,600 officers that provide medical care in the Indian Health Service. They serve in the Federal Bureau of Prisons. They serve and provide medical care for the Coast Guard, and many other opportunities in the states as well as overseas.

So, I would encourage people to learn more about the United States Public Health Service and opportunities with our service. We have been around one way or another since 1798, and I'm very pleased to lead that service with my friend and colleague, the surgeon general.

Faust: Admiral Levine, thank you so much for joining us here on 番茄社区.

Levine: Thank you very much. I appreciate being here.

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