WASHINGTON, D.C. - Dr. Rachel Levine answered questions during her Senate confirmation hearing for U.S. assistant health secretary Thursday on Capitol Hill.

First up, Republican Sen. Richard Burr of North Carolina, who criticized Levine for her handling of the COVID crisis as Pennsylvania health secretary.

"How can you assure that the same challenges that Pennsylvania experienced in testing, nursing home care, and now vaccination will not occur when given the opportunity to serve in the public health policy area?" said Burr.

Levine testified Pennsylvania used a scientific-based COVID response and that like many states, it struggled with testing, equipment, and contact tracing.

"I think that the nation's response has improved significantly under President Biden's leadership and when his strategic plan and task force is confirmed I look forward to my role in the nation's response," said Levine.

The questioning moved on to equity in vaccine distribution and the opioid crisis.

But things got tense when Republican Senator Rand Paul of Kentucky used the term "genital mutilation" while asking if minors should be allowed to make independent decisions about gender re-assignment surgery.

"Senator, transgender medicine is a very complex and nuanced field and if confirmed to the position of assistant secretary of health I will certainly be pleased to come to your office and talk with you and your staff about the standards of care and the complexity of this field," Levine said.

Paul said he was not satisfied with Levine's answer.

"What I am alarmed at is that you're not willing to say absolutely minors shouldn't be making decisions to amputate their breasts or to amputate their genitalia," said Paul.

Several Democrats admonished Paul for his comments afterward, speaking directly to Levine.

"I appreciated your thoughtful and medically informed response to Senator Paul's questions earlier in the hearing," said Sen. Patty Murray of Washington.

"It is really critical to me that our nominees be treated with respect and that our questions focus on their qualifications and the work ahead of us rather than our ideological and harmful misrepresentations like those we heard from Senator Paul earlier."

Lehigh Valley LGBT leaders applauded Levine's testimony.

"Dr. Levine demonstrated that she is well prepared to go to work on behalf of the public health of the American people," said Adrian Shanker, Founder and Executive Director of the Bradbury-Sullivan LGBT Community Center in Allentown.

"She answered questions based on science and evidence and reiterated her support for health equity and a medically-appropriate response to the COVID-19 pandemic."

A vote on Levine's confirmation hasn't been scheduled.

If confirmed, she will become the first transgender Cabinet member in U.S. history.

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