At the time, she said, there were “some attacks” on her, but “they were not that brutal.” But after she was elevated to health secretary and took a front-and-center position responding to the pandemic, the hate escalated.

“She told me she was at a gas station early on in the Covid lockdown and some guy in a pickup truck started driving around her screaming about medical tyranny,” said Mara Keisling, the executive director of the National Center for Transgender Equality.

At first, she tried to ignore it. But she drew the line at the dunk tank episode, and used her daily news conference to push back.

“While these individuals may think that they are only expressing their displeasure with me,” she said, they were hurting “thousands of L.G.B.T.Q. Pennsylvanians.”

As assistant secretary for health, Dr. Levine has a wide portfolio; the job is what you make it, and can be either the “most influential public health voice”…

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