Much is written in the medical press now about transgender individuals and how to assess and treat them. But while "the science behind this, the clinical aspects,…are so important, it's also important to understand more the humanistic side and maybe the more humorous side," one expert told attendees at ENDO 2017: The Endocrine Society Annual Meeting here today.

And that physician, Rachel L Levine, MD, knows more than most what she is talking about.

"Fear leads to anger. Anger leads to hate," Dr Levine told the ENDO audience, quoting a "great" transgender woman, Jenny Boylan, a professor of English at Barnard College in New York City. "What she says is that, 'It's almost impossible to hate anyone whose story you know.' So I'd like to tell you a little bit about my story."

Having graduated from Harvard and then trained in pediatrics and adolescent medicine at the Mount Sinai Hospital Medical Center in New York before moving to Penn State Hershey Medical Center, it was in Pennsylvania that Dr Levine transitioned from being a man to a woman, although she had been "out" as transgender for some time.

"I still maintain that when I moved from Manhattan to central Pennsylvania in 1993 that that was actually the biggest transition in my life," she joked, to much laughter from the audience.

Joking aside, she explained that she found Penn State Hershey Medical Center to be "wonderful. Not just tolerant, not just accepting, but really celebratory for diversity in all of its forms" during her transition.

At the time, they had a nondiscrimination policy that included sexual orientation but did not include gender identity and expression. "So they developed that policy and it was affectionately known as the Levine Policy."

And Now to Politics: "The Transgender Physician General"

                                                               

Dr Rachel Levine

                       

So there she found herself, as Rachel Levine, ensconced in academic medicine and adolescent medicine, "and treating patients with eating disorders and fulfilling all of my missions with clinical care, education, research, and administration." At the same time she was also on the board of Equality Pennsylvania, a statewide lesbian, gay, bisexual, and transgender (LGBT) advocacy group.

It was this that brought her to the attention of the new governor of Pennsylvania, and after first cochairing his Transitions Committee, she was asked to consider the position of Physician General for Pennsylvania.

"Things happened quickly after that," Dr Levine explained. "Governor Wolf offered me the position on Friday and I accepted the position on Saturday and it was announced to the public, which was interesting.

"On Monday I saw patients, and on Tuesday it was the inauguration, and on Wednesday, I left academic medicine and walked into the department of health into my new political role."

But what then became apparent was that she now had to be confirmed by the overwhelmingly conservative state senate of Pennsylvania.

"That was a very interesting process….I got to meet all 50 state senators — who are overwhelmingly very, very conservative. And they got to meet me.

"They had an openly transgender woman who they had to accept in their chambers, shake my hand, and sit down and talk about public health, which was a unique experience.

"One of the things that I am most proud of is that I was unanimously confirmed by the Penn state senate in June 2015, so they were able to look solely at my professional qualifications, which is exactly how it should be."

At this point, there was much applause from the audience.

"I did end up getting a lot of press," she continued. "I have been 'out' [for a long time], but this was a different way of being 'out.' There were lots of interviews, and they kept talking about 'The Transgender Physician General.'  "

"Now I'm Just the Physician General…"

Dr Levine went on to explain how, over time, she's had the opportunity to work on many public-health issues.

"My signature issue has been the opioid epidemic, with prescription drug abuse and heroin and overdoses, which is a public-health crisis in Pennsylvania, as it is in much of the nation.

"And what was very interesting and very rewarding was when the articles started to come out and said: 'Physician General Advocates for Better Opioid Stewardship' or 'Physician General Writes a Standing Order Prescription for the Entire State of Pennsylvania for Naloxone.' "

"And so, no longer was I the 'Transgender Physician General,' I was just the 'Physician General,' and that was very rewarding."

Dr Levine has also during this time had the opportunity to work on LGBT issues under the governor's leadership, of which she is very proud and notes: "The governor is firmly supportive of our community."

However, there is still much work to do, she asserted.

"History Has Its Eyes on Us"

"In most places in the country — including where we sit in Florida  — there is no nondiscrimination legislation that includes LGBT individuals, so this is a very challenging time in the US for LGBT individuals. We made a lot of progress in the previous administration, but there are many challenges ahead."

There has been the withdrawal of the previous administration's Title IX protection for transgender students, "which has made it much more difficult for an already-vulnerable population," she noted.

However, "I think it's very important that we don't get discouraged and that we don't get cynical and that we keep fighting," she asserted.

"I'm a very positive and optimistic person, and I think that we will continue to make progress. I'd like to quote my absolute favorite musical and say that 'We can't throw away our shot at this time. History has its eyes on us.' If you don't know, it's Hamilton, and if you haven't seen it, I would strongly recommend that you see it," she noted as an aside.

"I think history is on our side. Fairness, justice, and equality are on our side. We have to stay strong and united together. I appreciate all the support of the Endocrine Society and you, who support our community."

Dr Levine is on Twitter: @physgenlevine.

Dr Levine has no relevant financial relationships.

Follow Lisa Nainggolan on Twitter: @lisanainggolan1 . For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

ENDO 2017. April 2, 2017. Orlando, Florida. Session PL3.

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