Monika: Today it is my pleasure and honour to interview Carys Massarella, doctor of emergency medicine at McMaster University and lead Physician of the Transcare Program at Quest Community Health Centre in St. Catharine’s, Canada. Hello Carys!
In that I mean by being transgendered there is no measurable biological effect in a negative way. The documented poor outcomes for trans identified individuals are a product of issues related to the social determinants of health which effect all such marginalized populations such as poverty, homelessness, access to health care and violence. These are corrected at the political level with advocacy from health care providers and transgender activists as key players.
So for me there is no diagnosis essentially to make. I allow transgender people to claim there identity and then provide safe and medically appropriate access to cross gender hormone therapy and surgery plus support through transition. That is the essence of what I do.
Monika: Is there any reason why so many doctors may regard transgenderism as a mental disorder which requires a psychiatric evaluation?
This leads to a paucity of understanding around transgender healthcare and even changes to how transgender healthcare is being practiced.
So first we need to have the diagnosis removed from the DSM which has been partially addressed in the DSM V with the condition now called gender Dysphoria which implies at least there is not an inherent disorder that needs to be "cured" but rather an experience that needs to be managed in an appropriate way.
Secondly we need to have better training in Medical schools and post graduate residency training programs.
Also if the experts pathologize that's what we end up with. So we in essence, through advocacy, and changing practice need different providers to provide expert opinion. Thus changing the narrative so to speak. We are seeing this to some extent with the new diagnosis of gender Dysphoria but I still think we have further to go where it becomes essentially a treatable medical condition. I see the way forward as medical/surgical transition being a treatable condition and then that's really all that needs to be done and the person moves on with their life. I think we will get there in the next ten years.
Hopefully over time this message will get out there and we will see a shift in attitude. Certainly where I work we are already witnessing this change but then again I live in a liberal progressive country. Not all folks are that fortunate.
|Carys and her bestie Mel.|
We have many conditions that have a defined treatment period and then just maintenance therapy or follow up so there is no reason that we couldn't manage transgender people in the same way.
In most large clinics in North America this is already the case. I would hope to see most surgeries also being covered by either private or public health a insurance plans. This is happening again to a large extent in Canada and the United States but is by no means universal. This is where I do a lot of teaching and advocacy work with regards to transgender healthcare.
In fact at my own Medical School the lecture I give on LGBTQ health is one of the most popular lectures year in and year out. There are the occasional awkward questions but for the most part the response is respectful if not quite enthusiastic. I often hear that people are genuinely interested and willing to change the way they manage transgender patients.
But I do see an improvement particularly with actresses like Laverne Cox and media personalities like Janet Mock. So progress for sure but transgender characters are still portrayed as oddities or opportunities for humour. One series which I think is the best portrayal of a transgender character was the British series "Hit and Miss" which I really enjoyed but unfortunately only had one season of 6 episodes
I work at a Catholic teaching hospital and have gone on to be President of the Medical Staff as a transgender woman and also been awarded the highest award for a physician at our hospital. So my fears in that regard were definitely not realized.
Monika: What do you think about the present situation of transgender women in the Canadian society?
There are always one off success stories like mine but it is not universal. But I do foresee a time where this will change and I believe it will happen in my lifetime. I see a big change in young people in particular. They are much more wiling to accept transgender identity as part of the diversity of society rather than as an anomaly or illness.
Of course, the same is not true everywhere and we are seeing push back in certain countries. I think that when most people are presented with the facts about transgender lives they are generally shocked by the degree of marginalization and lack of rights afforded transgender people and will usually support increased and equal rights for trans folks. So I would say that transgender rights are considered a cause worth fighting for by many cisgendered people not just those who are allies. Certainly in Canada we are moving towards full legal and civil rights for Transgender people.
Also I am a board member of the Canadian Professional Association for Transgender Health so participate in supporting better access to health care. As you said before I speak publicly on transgender issues and have now done two TEDx talks around transgender issues. I have been politically active in my party and I do have access to senior politicians. I am quite proud that all three Conservative politicians in my Federal region (Halton) voted in favour of transgender rights in parliament. I might have helped there. So yes I suppose I am active to some extent.
Monika: Do you like fashion? What kind of outfits do you usually wear? Any special fashion designs, colours or trends?
The nicest compliment I received about my clothes recently was when I went to pick up some dry cleaning the woman at the desk told me they think I have the most beautiful clothes that they dry clean and they love to do it! So that was nice. Also the female paramedics like to come to my hospital just to see what I'm wearing when I work. So yes I have a reputation as a clothes horse.
The answer lies not in "curing" yourself but learning to live with yourself and making the best decision for you whatever that might be. There is no right or wrong answer here. I hope you can find access to compassionate and competent healthcare and transition, if you choose, and lead a meaningful life. That is what I am striving to achieve for all my transgender sisters.