‘Deadnaming’ Rachel Levine is not a small act. It’s a warning to the medical profession.
We sometimes tell ourselves that culture wars don’t reach the clinic. They do, writes Arthur Lazarus.
When the U.S. Department of Health and Human Services quietly altered the nameplate on Rachel Levine’s official portrait during the recent government shutdown — replacing her legal first name with the one assigned to her at birth — it might have seemed to some like an insignificant gesture.
But symbols matter. Names matter. And, as we are constantly reminded by the pioneering example of Levine — the first openly transgender person confirmed for a government role by the U.S. Senate — identity matters.
And the deliberate act of using a transgender or nonbinary person’s birth name (or a previous name) after they’ve chosen a new one — a demeaning practice known as “deadnaming” — is more than just an insult to one nationally recognized medical leader. It’s a signal about what our health system is becoming.
It tells every transgender clinician, trainee, staff member, and patient: Your identity is provisional here. Your legitimacy is negotiable. Your name can be taken from you. For a profession that depends on psychological safety, this is no small thing.
Altering it is an attempt to rewrite not only identity but legacy.
Imagine training as a transgender medical resident and watching the federal government manipulate the image of one of the country’s most illustrious physicians — someone who helped lead Pennsylvania through the opioid epidemic, someone who oversaw critical COVID-19 responses, and someone so accomplished that they hold the rank of admiral in the U.S. Public Health Service.
Imagine treating transgender youth in a climate where federal agencies publicly invalidate the very concept of gender identity.
Imagine being a transgender patient, already vulnerable, and seeing your government insist that who you are is, at best, a clerical preference and, at worst, a threat to national security.
We sometimes tell ourselves that culture wars don’t reach the clinic. They do.
They show up when patients avoid care because they fear being misgendered or judged.
They show up when medical students stay closeted to avoid being targeted, derailing careers before they begin.
They show up when clinicians feel pressured to hide their families or their own identities in order to survive training environments already marked by burnout, moral injury, and hierarchy.
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They show up in public health, where trust is essential — whether in vaccines, harm-reduction programs, or pandemic response. When government institutions themselves engage in targeted stigmatization, entire communities disengage.
And they show up in professional integrity. A health system that claims to uphold evidence yet endorses policies contradicted by every major medical association — including the treatment of gender dysphoria — erodes its credibility. When science is invoked only when politically convenient, clinicians feel the ground shift under their feet.
Levine showed grace by calling the deadnaming “petty.” In a sense, she’s right: The act is juvenile. But if the rest of us don’t call it out, we risk missing the larger threat.
A physician’s portrait is not just a piece of decor. It is a public acknowledgment of service, expertise, and contribution.
Professional erasure begins with symbolic gestures — the removal of names, the reclassification of identities, the retelling of who someone “really” is. History is rife with examples of how stripping titles, credentials, or names precedes efforts to diminish authority and restrict participation.
A physician’s portrait is not just a piece of decor. It is a public acknowledgment of service, expertise, and contribution. Altering it is an attempt to rewrite not only identity but legacy.
If medicine is to retain its moral center, clinicians must resist the temptation to disengage. This is not “politics” in the partisan sense. It is professional ethics.
We can start by naming the harm clearly. Deadnaming is not a clerical correction; it is a form of psychological violence aimed at delegitimizing identity.
We must also educate our colleagues, many of whom underestimate the downstream effects of identity-based policies on patient trust, engagement, and health outcomes.
At the same time, we have an obligation to actively support trainees and colleagues — especially those who are transgender or gender-expansive — who may feel newly unsafe or exposed within training environments and workplaces.
Defending evidence-based care is essential: Transgender medicine is medicine. Period. And we must insist that federal agencies speak truthfully about science.
A selective invocation of “scientific reality” is not reality at all; it is ideology masquerading as evidence. Medicine is facing a pivotal question: Are we willing to let political ideology dictate whose identities are valid within our clinics, hospitals, and public health institutions?
Rachel Levine’s portrait matters because deleting her name is an invitation to delete others. It is an attempt to redefine professional legitimacy by biology rather than biography — by chromosomes rather than contributions.
Yet her life is proof that gender identity neither diminishes competence nor negates service.
When a government tries to rewrite that narrative, the medical profession must ask itself: If we do not stand up for the integrity of our colleagues, who will stand up for the integrity of our patients?
Arthur Lazarus is an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University.