Rachel Levine stood tall in the doorway, offered a polite handshake, and took a seat at the L-shaped desk in her drab, blank slate of an office.

The room, with its empty bookshelves, dual computer screens, and not much else, seemed appropriately open to possibility as the headquarters for a woman about to chart new territory.

Levine, who has just been named Pennsylvania's physician general, spent most of her 57 years - at least outwardly - as a man. If the state Senate confirms her appointment, the doctor, who until a few years ago was known as Richard Levine, will become one of the nation's very few, openly transgender people in public office.

When Gov. Wolf announced her on Jan. 17 as his choice for the cabinet post, he cited her expertise in pediatrics, psychiatry, and behavioral health.

"She has been a leading voice in efforts to treat teens with medical and psychological problems, as well as adults and children with eating disorders," his statement read.

Frankly, Levine said, she would like to be discussing her experience in those fields and her vision for how to improve the health of Pennsylvanians. But she is realistic about why a parade of reporters has come knocking.

"I was not appointed because I was a transgender woman, I was appointed because of my expertise," she said. "But Gov. Wolf didn't shy away from me because I was in the LGBT community, and I think that's amazing."

The governor's decision to appoint her was particularly bold given that in Pennsylvania it is still legal to fire employees for their sexual orientation or gender identity, she said, adding that she is heartened by Wolf's support for House Bill 300 that will protect the LBGT community from this kind of discrimination.

She was dressed conservatively in a tailored gray jacket and matching skirt, accented by rings, bracelets, and an amber necklace.

Before accepting the job, she said, she had to carefully consider how she would balance her public exposure with her wish for privacy. She is willing to discuss her transsexuality in the interest of shedding light on a much-misunderstood community. But she is fiercely protective of her family and friends and puts strict limits on the questions she is willing to answer.

Like most people who struggle with gender identity, she said her awareness that something was different began in childhood and became more intense as she went through adolescence.

She grew up in Wakefield, Mass., a suburb north of Boston, in a family of lawyers. "My mother, father, uncle, sister, cousin, and niece are all lawyers," she said.

She attended the all-boys college-prep Belmont Hill School.

"So that was interesting," she said with a hint of the dry humor she is known for among colleagues.

Among the 63 boys in the class of 1975, many of whom went on to influential careers, Levine stood out as intellectually gifted, graduating magna cum laude, said Joe Henley, a fellow classmate.

"Rich was incredibly bright and hardworking," Henley recalled. "He was a great guy, funny and motivated."

They both played football for the school, he said. As a lineman, Levine was not exactly a star. "But it was not a distinguished team," Henley said. "We lost six and won one."

Looking back over their high school yearbook, Henley was reminded that Levine distinguished himself as president of the drama club and goalie on the junior varsity hockey team. He also sang for the glee club and was a fan of Star Trek and the Moody Blues.

No one was surprised when Levine got into Harvard, Henley said, or went on to become a doctor.

Prefacing her comments about medical school, Levine, half-joking, noted that proper pronunciation is required. "It's TOO-lane, you know. Not Too-LANE. And the city is Nawlins, not New OrLEANS."

Always interested in biology, Levine had worked in laboratories throughout high school and college, but when she discovered the relatively new field of adolescent medicine, Levine said, she knew she had found her passion.

It was a field representative of her own life, dealing with the intersection of mind and body, the complex, fluid, questioning period of development when people struggle to define themselves.

She hopscotches across the rest of her resumé: internship and residency at Mount Sinai Hospital in New York, a stint as chief resident and on the faculty of the medical school, then two decades at the Penn State Hershey Medical Center and Health System.

There, she started a multidisciplinary program to treat eating disorders, and, in her most recent role, served as vice chair of clinical affairs in the Department of Pediatrics.

Along the way, she was married and fathered two children. Her son is now in college and her daughter in high school, she said, asking that they not be named for this article.

Now divorced, Levine said she began the transition to becoming a woman about 10 years ago.

"At some point, I crossed the line," she said, explaining that the shift was triggered by personal changes as well as societal.

"When I was growing up in the '60s and '70s, there was no context," she said. "Things have changed dramatically. There is much better knowledge, especially over the last three to four years. Over the Internet, there are so many more opportunities for the transgendered to find other people who relate the way they do."

As she transitioned, a few of her patients were upset by the change. Most, however, were supportive and understanding, she said, offering an example.

The father of a patient Levine was treating for anorexia nervosa came to see her. She mentioned that she was becoming a woman. His response, Levine said, was typical.

"What has this got to do with my daughter's care?" the father asked.

"Nothing," Levine replied.

"Ok," the father said, and without skipping a beat began discussing his daughter's issues. "So, this week, she has not been eating well."

With that, she put an end to the discussion of her sexuality, reached for a legal pad, and tapped her freshly polished fingernails on the list of substantive points she wanted to cover.

Her top priorities, she said, will be to help Wolf expand insurance coverage under the Affordable Care Act, improve health screenings for the public, address threats such as Ebola and measles, and encourage agencies to cooperate.

"We need to work together to help individuals with their myriad, complex, medical, and psychological problems," she said. "The mind and the body are connected."

Levine has been active in the LGBT community for years, said Ted S. Martin, executive director of Equality Pennsylvania. Four years ago, she joined the organization's board, Martin said.

"When meetings get heated, she has the ability to lower the temperature," Martin said. "Her style is velvet-glovish."

An estimated 700,000 people in America identify as transgender, according to the Williams Institute at the UCLA School of Law.

"It's not a huge community, but they have been vastly underrepresented in government, just as the entire LGBT community has," said Denis Dison, senior vice president of the Gay & Lesbian Victory Fund, which supports LGBT leaders interested in public service.

The key to achieving equality, he said, is "greater visibility and acceptance."

"An appointment of this kind raises the visibility of the community and helps people understand where folks are coming from."

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