A senior state official has become the first openly transgender person to be confirmed by the US Senate.
Rachel Levine, the former Pennsylvania Health Secretary, has been approved as the Biden administration’s assistant secretary of health.
The vote on Wednesday went 52-48 in her favour, as two Republican senators, Lisa Murkowski of Alaska and Susan Collins of Maine, joined all Democrat members in supporting her nomination.
As Pennsylvania’s top health official, a role she had held since 2017, she had become the public face of the state’s response to the coronavirus pandemic.
In her new role, she is expected to oversee the Health and Human Services offices and programmes nationwide.
President Biden pointed to Ms Levine’s experience when he nominated her in January.
She will bring “the steady leadership and essential expertise we need to get people through this pandemic – no matter their zip code, race, religion, sexual orientation, gender identity or disability”, Mr Biden said.
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The appointment was welcomed by transgender-rights activists, who have called it a historic breakthrough.
Few trans people have ever held high-level offices at the federal or state level.
It comes at a time when legislatures across the US, primarily those under Republican control, are considering an unprecedented wave of bills targeting trans young people.
One type of bill, introduced in at least 25 states, seeks to ban trans girls and young women from participating in female educational sports.
One such measure already has been signed into law by Mississippi governor Tate Reeves, and similar measures have been sent to the governors in Tennessee, Arkansas and South Dakota.
Another variety of bill, introduced in at least 17 states, seeks to outlaw or restrict certain types of medical care for transgender youths.
None of these measures has yet won final approval.