Rachel Levine was sworn in on Tuesday as an admiral in the U.S. Public Health Service Commissioned Corps, becoming the country’s first transgender four-star officer in its uniformed services, which include the coast guard and the military.

She had already made history earlier this year as the first openly transgender person confirmed in a top government job by the U.S. Senate, winning approval for her appointment as assistant health secretary in Joe Biden’s administration.

A professor of paediatrics and psychiatry at Penn State College of Medicine, Levine, 63, previously led Pennsylvania’s response to coronavirus pandemic as the state’s top health official.

Around the world, trans politicians have gained greater prominence in recent years – with Pauline Ngarmpring becoming Thailand’s first trans candidate for prime minister in 2019.

Here are some other trans people who serve in high-level politics and government globally:

– Tamara Adrian, alternate deputy in Venezuela’s National Assembly

Adrian, 67, a member of the small Popular Will party, became in 2015 the second trans woman to be elected to a national legislature in the Western Hemisphere.

A year before her election, she filed an appeal for recognition of her gender identity to the Supreme Court, but despite garnering more than 4,000 signatures, the case did not receive a response from the court.

As a result, Adrian was forced to campaign under the name on her birth certificate.

– Petra De Sutter, Belgium’s deputy prime minister

De Sutter, 58, an activist for progressive legislation regarding trans issues and medically assisted reproduction, was named in 2020 as one of seven deputy prime ministers in Belgium’s new coalition government.

Elected as a member of the European Parliament (MEP) in 2019, De Sutter has chaired the European Parliament Intergroup on LGBTQ+ rights and co-chaired the MEPs Against Cancer Group.

The appointment of De Sutter, who is also minister for public service and public enterprises, was welcomed by LGBTQ+ rights groups as an important step forward for trans politicians in Europe.

– Audrey Tang, Taiwan’s digital minister

Tang, 40, became digital minister in 2016 and is the youngest person to hold a ministerial post in Taiwan.

Tang has said transitioning gender informed her politics by giving her a greater understanding of what it is to be vulnerable.

As a minister, she has pledged to give preferential access to government contracts to social enterprises.

– Diane Marie Rodriguez Zambrano, alternate member of Ecuador’s National Assembly

Zambrano, 39, was the second-ever LGBTQ+ person to run for office in Ecuador. In 1998, protection from discrimination for gay men and lesbians was written into the constitution, but not extended to trans people.

Zambrano, who was also an activist for more than two decades, has said she still receives death threats for her work.

In the National Assembly, she helped set a legal precedent for how trans people are represented in the media, winning a discrimination case against the makers of a programme that mocked trans people as “perverts”.

“I’ve kept on fighting for LGBTQ+ rights because even if I don’t get to benefit from those rights, other generations can live without discrimination or violence,” she wrote on human rights website Frontline Defenders in 2015.

– Caitlyn Jenner, former Republican candidate for California governor

Former Olympic champion and reality TV star Jenner ran for governor of California in September in an unsuccessful bid to unseat Democratic incumbent Gavin Newsom and become the country’s most senior trans elected official.

Jenner, 71, a Republican who denounced former President Donald Trump’s “anti-transgender policies” in a 2018 Washington Post article, received 1% of the vote on the portion of the ballot asking who should replace Newsom if he were recalled.

Reporting by Rachel Savage; Editing by Helen Popper and Katy Migiro.

GAY TIMES and Openly/Thomson Reuters Foundation are working together to deliver leading LGBTQ+ news to a global audience.