Inside NYP: Dr. Mackenzie P. Lerario

The medical director of NewYork-Presbyterian's Mobile Stroke Treatment Unit Program shares her journey of coming out as a transgender woman.

My profession is very important to me. I’ve always wanted to help people, and I get the opportunity to do that on a large scale every day as medical director of NewYork-Presbyterian’s Mobile Stroke Treatment Unit Program and as an assistant professor of clinical neurology at Weill Cornell Medicine. In the past, I’ve kept my private and professional lives separate. Having come out to my family as a transgender woman in May of 2016, I realized I could no longer do that.

When I came out on May 19, 2016, my wife and I were celebrating our fourth wedding anniversary. I realized that not even my closest companion in the world knew who I was. My wife is extremely important to me. To not have her know was something that was weighing on me. She was aware that something was different, that I sometimes wore women’s clothes or jewelry, but we didn’t have a word for it yet because I wasn’t ready to admit to myself that I was transgender.

There wasn’t one single thing that made me decide that I was trans in 2016. It was many little things accumulating over many years. I always knew that I was different, and, in retrospect from my earliest memories, I realize I always wanted to be a girl, to have friends who were girls, to play with girly things. I wanted to wear a dress. Unfortunately, I didn’t have the knowledge or the strength to say that I was not a boy. And society as a whole wasn’t as aware of transgender people, who are now entering politics and entertainment and all these other industries.

“The moment you make that decision — I am now a woman, call me she/her or hers — your whole world changes.”

— Dr. Mackenzie P. Lerario

On our anniversary, I got the urge to start putting my feelings down on paper. I realized that I was a person who was lovable, somebody to be respected, and that this person can be shared with the world. So I started writing a poem and by the end of it, I realized that I was transgender.

At the time, all I could feel was an intense anxiety, about being exposed, being rejected, about not being accepted for what I thought was just natural and normal. I was afraid my wife would divorce me because she did not marry a woman. And I would not have faulted her, but she didn’t, because she loves me. She has been and still is my biggest supporter, staying with me in this marriage, knowing that this was not the person she married. But in many ways, I am that same person. That’s what she tells me, and that’s the person she loves and wants to be married to.

It was very difficult to come out to my parents. They’re the people required to give you unconditional love. They’re the ones who brought you into this world, so rejection from them would have, I think, been an existential crisis. I think they were right to be afraid that their child was going to be exposed to discrimination and harassment. It took me a while to explain that this is not a choice. It’s who I am, how I was born, and it was a change I needed to make in order to live my life. I think everybody had a point of shock and surprise and adjustment. Now my mom takes me shopping. It’s been fantastic, but I feel for those trans people who do not experience a success story like this.

After coming out to my immediate family in 2016, I spent three years planning my transition. I worked very carefully with a gender therapist to decide how and when to come out publicly, to set the framework mentally and emotionally to be able to handle the change, because the moment you make that decision — I am now a woman, call me she/her or hers — your whole world changes.

Had I not spent three years planning, things might not have gone as well. One of my biggest fears was that I would lose the years of training, my position within the hospital, my position as a director of this program, but none of those things happened.

The first person at work I told was my boss, Dr. Matthew Fink, who is the chair of neurology here at Weill Cornell, and he was immediately supportive and accepting and said, “I have your back.” And he did. And the hospital also had my back. And very quickly, I noticed that there was a wave of support for me and that there were more and more people I wanted to share this with. The Mobile Stroke Treatment Unit is a multicenter program within NewYork-Presbyterian involving two medical schools, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons, and four hospitals. There were many people I needed to come out to.

The actual experience of speaking publicly for the first time as a transgender woman was rather transformational. It was at a recent Dialogues in Diversity at the hospital. As I spoke, I realized the commitment of respect from the audience and the support from the institution, and I was no longer nervous. I felt happy being the person I was, and for being able to share that person. It was an outpouring of respect, loyalty, and support.

Every human being deserves to be treated with respect. The healthcare setting shouldn’t be any different, and in fact, we should hold ourselves to the highest standard, to respect everybody who works in this institution, as well as the patients we treat. In this instance, respect means calling people by the name they identify as, by the gender they identify as, and treating them as they choose to express themselves.

Dr. Lerario describes the challenges people who are transgender face.

My name means the world to me. Before I came out, I asked my mom, “Why did you name me Michael?” She said, “I love that name. It’s such a masculine name.” Everybody thought I was masculine. I was not. It was all an act. Mackenzie feels like who I am. I see a lot of good in Michael too. It just isn’t who I am. I asked my family to help pick my new name. As soon as I heard it, it felt right. I’ve always felt like I was this person on the inside, and now I get to express it. There’s no better feeling.

I’m very lucky that I really can’t think of a single instance of discrimination at work. That says a lot about the institution. But outside of NewYork-Presbyterian, just being myself is a challenge. I’ve worked harder in the last month, since coming out publicly, than I have in my entire life: leaving the house, my commute into work, if I’m taking the subway or traveling by airplane for work, being exposed in a way where I’m presenting who I am.

A lot of the strength that I gained as a child with Tourette’s syndrome has helped me to be my true self today. Having Tourette’s is not something I have shared with many people. I was diagnosed with severe Tourette’s and obsessive compulsive disorder at around age 5. I would go to a lot of meetings of the Tourette’s Syndrome Association, and I’d meet musicians and athletes and others with Tourette’s. I remember thinking that if these people can be successful and do what they’re passionate about, so can I.

This made me want to help others with neurological diseases. Now that I’m transgender, I feel that I can be an example for somebody who is struggling. I would love to be able to help by sharing my story so that others can express their authentic identity. I want to make sure that people know there are other transgender people out there living normal, successful, happy lives with families, with jobs, and contributing to society.

So many extraordinarily brave people have paved the way before me and gone through much worse conditions than I have, and have made it easier for me to do what I did. With that being said, what I did was no small feat. I earned the name Mackenzie.

World Pride 2019 is occurring all month in New York City. The level of excitement for the future has never been higher. We’re 50 years from Stonewall, when it was illegal to be the person I am, so there’s a lot to celebrate, and this will be the first time I am celebrating it as I truly am: a transgender woman. I’m thankful that I had the strength to let the world see my true self, because they’re embracing it. Coming out as a transgender woman and living my authentic life have been my greatest accomplishments.

Listen to Dr. Lerario recite her poem, “S(he).”

Mackenzie P. Lerario, M.D., is a vascular neurologist specializing in pre-hospital stroke treatment, academic telehealth networks, acute stroke therapies, and stroke systems of care. Dr. Lerario is the medical director of the NewYork-Presbyterian Mobile Stroke Treatment Unit Program. She is an attending physician in the NewYork-Presbyterian LEAD Academy, assistant professor of clinical neurology at Weill Cornell Medicine, and attending physician at NewYork-Presbyterian Queens. Dr. Lerario has numerous publications in the field of clinical stroke research and frequently presents her research at major international stroke conferences.