When Joe Biden took office, he didn't just bring in a new set of policies. He brought in a whole new look for the federal government. You've probably heard the buzzwords—"most diverse administration in history"—but what does that actually look like on the ground? For the transgender community, it looked like a seat at the table that had never existed before.
Specifically, the conversation usually starts and ends with Admiral Rachel Levine.
People call her a "cabinet member," but let's be technically accurate: she is the Assistant Secretary for Health. While not a "big-C" Cabinet Secretary like Pete Buttigieg, her role is massive. She was the first openly transgender person ever confirmed by the U.S. Senate. That is a huge deal.
Honestly, the sheer amount of firsts she’s racked up is kind of exhausting to list. She isn't just a political appointee; she’s a four-star admiral in the U.S. Public Health Service Commissioned Corps.
Why Rachel Levine Matters More Than You Think
Before she ever stepped foot in D.C., Levine was already in the trenches. She was the Secretary of Health for Pennsylvania. If you lived in Philly or Pittsburgh during the early days of COVID-19, hers was the face you saw every single day on the news.
She’s a pediatrician by trade.
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Her confirmation was a nail-biter. On March 24, 2021, the Senate voted 52-48. Only two Republicans, Susan Collins and Lisa Murkowski, crossed the aisle to vote for her. Since then, she’s been the point person for everything from the opioid crisis to long COVID. But it hasn't been an easy ride. She has faced a relentless stream of personal attacks that most government officials never have to deal with.
The Infrastructure of Inclusion
Beyond Levine, there’s a whole network of trans and non-binary people tucked away in agencies you’ve probably never thought about. The Biden-Harris administration brought in over 200 LGBTQ+ appointees.
It’s not just about the "firsts." It’s about the "seconds" and "thirds" who are doing the boring, essential work of running a country.
- The Department of Energy: This is where things got a bit more controversial in the headlines. Sam Brinton, who is non-binary, served as the Deputy Assistant Secretary for Spent Fuel and Waste Disposition. Their time in the administration ended following legal issues, which the media jumped on immediately.
- The Department of Defense: While not a "cabinet member" in the traditional sense, the administration’s reversal of the trans military ban changed the lives of thousands of active-duty service members.
- White House Staff: There are trans folks working in the Presidential Personnel Office and the White House Counsel's office. They aren't celebrities. They’re just... working.
The "Cabinet" Confusion
Let’s clear something up. People often use the word "cabinet" as a catch-all for anyone high up in the government.
Technically, the Cabinet is the Vice President and the heads of 15 executive departments. Think State, Treasury, and Defense. As of early 2026, there has yet to be a transgender person serving as a full Cabinet Secretary.
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Rachel Levine reports to the Secretary of Health and Human Services (HHS). In the hierarchy, she’s a "sub-cabinet" official. But in terms of impact? She’s the one overseeing the Office of the Surgeon General and the U.S. Public Health Service.
Basically, she runs the engine room.
Reality Check: The Blowback
You can't talk about these appointments without talking about the friction. Since 2021, there has been a massive surge in state-level legislation targeting trans healthcare.
It’s a weird paradox.
On one hand, you have a trans woman in a four-star uniform helping lead the nation’s health response. On the other, you have dozens of states passing bans on the very healthcare she specializes in.
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Levine has been vocal about this. She calls it "gender-affirming care," and she views it as life-saving medicine. Critics, like Senator Rand Paul, have used her confirmation and subsequent hearings to grill her on the ethics of medical transitions for minors.
It is a culture war that has landed right on her doorstep.
What This Means for 2026 and Beyond
We are now seeing the long-term results of these appointments. It’s no longer just a "novelty."
The presence of trans officials in the federal government has led to tangible changes in how agencies handle things. The State Department now allows "X" gender markers on passports. The Social Security Administration made it easier to update records. These aren't just "woke" talking points for those affected; they are massive bureaucratic fixes that make life significantly easier.
Actionable Insights for Staying Informed
If you're trying to keep up with how these roles are evolving or who is actually in power, don't just look at the headlines.
- Check the Plum Book: This is the official list of every high-ranking government position. It’s published every four years and tells you exactly who holds what role.
- Follow Agency Press Releases: If you want to know what Rachel Levine is actually doing, look at the HHS "News" section. You’ll see she’s usually talking about maternal mortality or the "988" suicide prevention hotline, not just trans issues.
- Distinguish Between Appointment and Confirmation: Some people are appointed by the President but don't need the Senate to say "yes." Confirmations (like Levine's) are much harder to get and carry more political weight.
The story of Biden's trans appointees isn't just about identity. It’s about whether or not the federal government can actually look like the people it represents. Whether you agree with the politics or not, the glass ceiling was shattered in 2021, and it’s not being glued back together anytime soon.
To dig deeper into the actual policy changes these officials have implemented, you should review the HHS Section 1557 regulations, which specifically outline nondiscrimination protections in healthcare. Understanding the difference between executive orders (which can be flipped by the next president) and agency regulations (which are harder to change) is the best way to see the true legacy of these appointments.