Sen. Rand Paul, R-Ky., asked whether minors should be allowed to permanently change their genders Thursday, and Senate Health, Education Labor and Pensions Committee Chair Patty Murray, D-Wash., accused him of making "ideological and harmful misrepresentations."

Paul likened gender transformation procedures on minors to "genital mutilation" and asked whether President Biden’s nominee for assistant health secretary is in favor of allowing underage children to decide to undergo such treatments.

"According to the [World Health Organization], genital mutilation is recognized internationally as a violation of human rights," Paul said. "Genital mutilation is considered particularly egregious, because as the WHO knows, it is nearly always carried out on minors and is a violation of the rights of children. Most genital mutilation is not typically performed by force, but as WHO notes, by social convention."

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Paul asked Dr. Rachel Levine, who is on track to become the first openly transgender nominee to be confirmed by the Senate, whether she believed minors should be allowed to decide for themselves to undergo permanent life-altering surgeries or hormone therapies.

"American culture is now normalizing the idea that minors can be given hormones to prevent their biological development of their secondary sexual characteristics," Paul said. "Dr. Levine, do you believe that minors are capable of making such a life-changing decision as changing one’s sex?"

"Senator, thank you for your interest in this question," replied Levine, who has been nominated to be assistant secretary of health. "Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed," Levine said. "If I am fortunate enough to be confirmed as the assistant secretary of health, I will look forward to working with you and your office and coming to your office and discussing the particulars of the standards of care for transgender medicine."

From left to right: Sen. Rand Paul, R-Ky., Sen. Patty Murray, D-Wash., and Dr. Rachel Levine (CSPAN)

Paul accused her of evading the question and asked again.

"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," he said. "I am alarmed that you won’t say, with certainty, that minors should not have the ability to make the decision to take hormones that will affect them for the rest of their life. Will you make a more firm decision on whether or not minors should be involved in these decisions?"

Levine replied to Rand’s follow-up with a nearly identical response as to his first question.

Later in the hearing, Murray took issue with Paul’s line of inquiry.

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"I appreciated your thoughtful and medically informed response to Sen. Paul's questions earlier in the hearing," she said. "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 on ideological and harmful misrepresentations like those we heard from Sen. Paul earlier, and I will focus on that as chair of this committee."

Levine served as Pennslyvania's secretary of health from 2017 until last month.