It was mid-May and the pandemic was raging in Pennsylvania. Dr. Rachel Levine, the head of the state Department of Health, was speaking on a call with the media when a radio host repeatedly misgendered her.

Levine, who is the most prominent transgender official in the commonwealth, responded calmly, asking the man to “please” stop, telling him: “It’s really insulting.”

It was just one of the times Levine was forced to address her gender while working to manage a pandemic. She’s shaken off insults since 2015, when she made history becoming the first openly trans person to serve as a cabinet member in Pennsylvania. The scrutiny reached new intensity last year as she became a public face advocating for restrictions to slow the spread of the coronavirus — and as Democratic Gov. Tom Wolf clashed with the Republican-controlled legislature over the state’s response.

On Tuesday, President-elect Joe Biden announced that the spotlight on Levine will intensify. He intends to nominate her to be assistant secretary of health, meaning if she’s confirmed by the Senate, she’ll be the highest-ranking trans person ever to serve in the federal government.

The nomination solidifies Levine’s place in LGBTQ history and serves as a reminder of all she has endured — constant transphobic memes, relentless online commentary about her appearance, having her face plastered on anti-lockdown billboards.

“It’s tiring,” Raffi Freedman-Gurspan, who served in the Obama administration and was the first openly trans person to work in the White House, said of the vitriol still directed at trans officials.

But she said Levine’s appointment marks “a new day for transgender America.”

“It’s such an important message to young people and young trans and non-binary identified children who might be wondering: What can I do when I grow up?” she said. “It’s like, you can be the assistant secretary of health.”

Public health officials became something like celebrities in 2020 as Americans either embraced the likes of Dr. Anthony Fauci or disliked them for advocating tactics like mask-wearing and stay-at-home orders. In Pennsylvania, Levine and Wolf have been slammed by constituents and Republican lawmakers who believe business-closure orders and other restrictions amount to government overreach.

Some say Levine never would have faced such a barrage of attacks if not for her gender identity.

“When the history of this era is written, there will probably be very few people who received as awful and as ferocious daily attacks as Dr. Levine,” said State Rep. Brian Sims (D, Phila.), the first openly gay lawmaker elected to the Pennsylvania legislature. “She’s handled all of it with not just grace and composure, she’s handled it the way she has her entire career: She’s focused on science, medicine, and data.”

» READ MORE: Pennsylvania’s Health Secretary Rachel Levine fights hate, fear, and the coronavirus

Alphonso David, president of the Human Rights Campaign, said Levine’s nomination marks “a radical shift in the recognition and acceptance of a community that has been shunned for a long time.” He said it’s especially notable given the Trump administration’s posture toward the trans community, whether it was banning openly trans individuals from military service or withdrawing Department of Education protections for transgender students.

He also noted that in August, Trump campaign lawyer Jenna Ellis misgendered Levine in a tweet and refused to apologize. A spokesperson for Levine at the time said the health secretary “does not have time for this nonsense.”

David said Levine’s ability to shake off attacks is an asset.

“LGBTQ people, and specifically transgender people, in public service confront a barrage of attacks simply because of who they are,” he said. “We have to be battle-tested. And she brings this experience into the federal government.”

Levine — generally known for sticking on message during appearances related to the pandemic — did publicly denounce the ridicule being directed at her during the summer in a statement saying, “Our children are watching.” Her comments came after a series of personal attacks, including from a Tioga County restaurant that featured a menu item with a transphobic description and a Bloomsburg carnival that called a dress-wearing man in a dunk tank “Dr. Levine.”

A day after Levine’s comments, State Rep. Russ Diamond (R., Lebanon), a vocal opponent of mask mandates, released a statement mimicking her remarks.

Diamond had in May led the charge among a group of two dozen Republican lawmakers who called for Levine to resign or be removed from office after it became public that she assisted her mother in moving out of a Pennsylvania personal care home as the coronavirus spread rapidly in congregate-care facilities.

She did so after advising nursing homes to accept coronavirus patients discharged from the hospital. Levine at the time said her mother made the decision herself.

On Tuesday, the U.S. House GOP campaign arm tried to resuscitate the controversy, demanding to know whether Pennsylvania Democrats supported her appointment. The House doesn’t vote on presidential appointments.

Levine will need to be confirmed by a majority of the U.S. Senate, which is split 50-50. Vice President-elect Kamala Harris will have the tie-breaking vote. Sen. Bob Casey (D, Pa.) praised her nomination in a statement.

Sen. Pat Toomey (R., Pa.) said he would give Levine’s nomination “full and fair consideration should it reach the Senate floor.”

“I appreciate Secretary Levine’s hard work as Pennsylvania’s Secretary of Health and her responsiveness to me and my staff throughout the COVID-19 pandemic,” Toomey said in a statement. “However, her role in the Wolf administration’s failure to protect nursing home residents from COVID-19, and the state’s prolonged, arbitrary lockdown, deserves further scrutiny.”

Ruben J. Gonzales, executive director of LGBTQ Victory Institute, said the group is part of a coalition of 32 organizations that recruits and advocates for LGBTQ federal appointees, and is ”ready to fight like hell to defend Dr. Levine and ensure she is judged on her qualifications and nothing else.”

“Anyone who chooses to make an issue of her gender identity is going to look bad now and look bad in the eyes of history,” he said.

Celena Morrison, director of Philadelphia’s Office of LGBT Affairs and the first openly trans person to lead a city office, said it was incumbent on her and other Levine supporters to focus public attention on Levine’s qualifications.

“For Dr. Levine, the LGBT voices have been so loud in support of her that they drown out that negative,” she said. “You see the tons of support and people that are countering that negativity with love and understanding.”