Sen. Rand Paul on Thursday ranted about transgender health care while questioning Rachel Levine, a trans woman and Pennsylvania’s now-former health secretary. Levine is being considered for a post in President Joe Biden’s administration.

The Kentucky Republican grilled Levine, a pediatrician, on her support of transgender health care for youth, comparing gender affirmation surgery to forced “genital mutilation,” a practice that is recognized internationally as a human rights violation.

He told Levine she supports “surgical destruction of a minor’s genitalia” — a mischaracterization of her views — and said he’s concerned gender affirmation therapy “can permanently alter and prevent secondary sexual characteristics.”

Models for transgender health care and gender affirmation therapy have been recommended by major medical associations, including the American Medical Association. Transgender health-care providers generally don’t prescribe hormone therapy to prepubescent transgender minors or perform genital surgery on children.

Paul then asked Levine: “Do you believe that minors are capable of making such a life-changing decision as changing one’s sex?”

Levine responded calmly, thanking Paul for his question. “Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed,” Levine said. She promised to discuss the “particulars” further if confirmed.

He pressed: “Will you make a more firm decision on whether minors should be involved with these decisions?” She responded again that if confirmed, she’d be “pleased” to talk with him and his staff about transgender standards of care.

LGBTQ advocates and health experts slammed Paul’s comments as bigoted. Sen. Patty Murray (D., Wash.), who chairs the Senate Health Committee, called Paul’s comments “ideological and harmful misrepresentations.”

“It is really critical to me that our nominees be treated with respect,” she said, “and that our questions focus on their qualifications and the work ahead of us.”

Biden last month nominated Levine 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.

While health secretary, Levine oversaw Pennsylvania’s response to the coronavirus pandemic and became among the most prominent trans women in the commonwealth. She was frequently targeted by gender-based attacks, including transphobic memes, relentless online commentary about her appearance, and having her face plastered on anti-lockdown billboards.

“LGBTQ people, and specifically transgender people, in public service confront a barrage of attacks simply because of who they are,” Alphonso David, president of the Human Rights Campaign, said when Levine was nominated. “We have to be battle-tested. And she brings this experience into the federal government.”