Matthew Kacsmaryk, a federal district court nominee who implied that transgender people are delusional, could be confirmed as early as Wednesday.

He cleared a procedural hurdle in the Republican-led Senate on Tuesday, which voted 52 to 44 to end debate and set up final consideration of his nomination to the U.S. District Court for the Northern District of Texas, which includes Dallas.

Kacsmaryk is “among the most” anti-LGBT judicial nominees put forward by President Donald Trump, Sarah Warbelow of the Human Rights Campaign, a progressive LGBT rights group, said.

Trump is making good on a campaign promise to reshape the judiciary with conservative appointments. Most have been white and male, and more than a few have been criticized by Democrats as outside of the conservative mainstream on hot-button issues like abortion, gender, and voting rights.

But Kacsmaryk is facing some of the most widespread opposition from LGBT rights groups that any nominee has seen under Trump, Sasha Buchert of Lambda Legal, a progressive LGBT rights organization, said.

Seventy-five LGBT rights and allied groups including Lambda Legal signed on to a letter to the Senate Judiciary Committee last week, describing him as an “anti-LGBT activist.”

Sen. Susan Collins of Maine, the only Republican voting no on advancing the nomination, outlined her position in a statement e-mailed to Bloomberg Law.

“A number of Mr. Kacsmaryk’s writings and interviews indicate an alarming bias against the rights of” LGBT Americans and disregard for U.S. Supreme Court precedents, Collins said.

Collins criticized Kacsmaryk for describing abortion rights advocates as “sexual revolutionaries” and for saying the effort to give same-sex couples the right to marry was “typified by lawlessness.”